UNICEF Ethiopia/2013/Sewunet
The LastThe Kilometers Ten (L10K) S U E C
and (SNNP) Peoples’ regions. Southern Nations, Nationalities Amhara, andTigray, Oromia, populated Ethiopia: regions of partners, in most four the with works 12local L10K Training Inc. Institute implemented by JSI & Research UNICEF, and and USAID, Melinda Foundation, Gates isL10K funded by Bill the & healthinterventions. maternal, and newborn child highof impact reproductive, demand, access utilization and improveincrease quality and delivery structure. works to It Ethiopia’s basicservice health and Primary Health Unit, Care bridgehouseholds between aims strengthenL10K to the I R UCCESS DITORIAL MPROVEMENT OVER PDATES services qualityimmunization for skills Building OUTINE What it takes to improve improve to takes it What health outcomes in rural rural in outcomes health L10K project evaluation project L10K appreciated outcomes health Improved
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MMUNIZATION STORY
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and decreased with with decreased and areas many in stagnated immunization on program expanded of coverage administrative national the forthree years, 2010, since Nonetheless, 2006. and 2002 districts between 29 to fromdistricts 9 increased also 80% has more than of coverage DPT3 with of districts number The 2006. 81% in to 63% 2003 in from increased coverage DPT1 coverage: immunization routine in improvement gradual and madesteady has Ethiopian 2003 in approach (RED) district every reaching the and program extension health ofthe expansion and introduction the With regions. eleven of the out ten targets in tetanus elimination neonatal and maternal achieved has it and countries, neighboring polio wild maintain to able been has country vaccine against birth cohort annual million 3 of its nearly proportion a large protecting successfully is 1980, it in immunization on program expanded an launched Since Ethiopia vaccine a dies from someone seconds ten every As result, a services. immunization basic to have access not stilldo children of millions improving, is globally coverage immunization Though declined. significantly have diseases vaccine preventable of other morbidity and mortality and eradication is to close polio eradicated, been has pox small immunization, Through citizens. their of health the to immense difference an making already are they children, their vaccines to provide successfully can countries When - free status in spite of its circulation in in circulation spite of its in free status R OUTINE
- preventable diseases. The The diseases. preventable - preventable disease. preventable
I MMUNIZATION UNICEF Sverige
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I MPROVEMENT Pneumococcal Vaccine (2013); survey on on survey (2013); Vaccine Pneumococcal Post (2012); Survey Coverage Immunization National ofthe results the consideration takesinto plan The improvement 2013. in plan improvement immunization an prepared from its partners support with (FMoH) Health of Ministry Federal Ethiopian the of fact this Cognizant Tigray). and Ababa Addis to lowascompared persistently are Gambella and Afar, areas of Somali, (pastoral disparities regional significant other partners working in immunization. immunization. in working partners other and offices, health woreda departments, health zonal bureaus, health regional the FMoH, with collaboration is in working L10K Thus, initiative. such support can who partner one as identify been has strategy community strong its of L10K because and plan improvement this is supporting FMoH of the partners the of one USAID as systems. delivery variousimmunization the in experienced problems major reflect These studies (2011). Report Chain Cold and Logistics Management, Vaccine (2012); and Ethiopia in Performance System Immunization Routine of ofthe Drivers Evaluation JSI/ARISE (2012); Utilization Service Immunization of Services Determinants Socio - Introduction Evaluation of Evaluation Introduction - economic, Behavioral and Health Health and Behavioral economic, MARCH 2015 MARCH
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MARCH 2015, Vol. 3, Issue 4 2 News from the Last Ten Kilometers
ROUTINE IMMUNIZATION... (Cont. from page 1) EDITORIAL Immunization is a high impact child survival intervention that saves USAID/L10K’s expanded program on immunization (EPI) aims to contribute to the millions of lives each year. Its results has been the single greatest public reduction of incidences of vaccine health achievement of all times. The benefits of vaccination extend preventable diseases in targeted woredas. It is beyond reduction of mortality and morbidity and prevention of specific implemented with the objective of increasing diseases in individuals; it averts cancer, extends life expectancy, and access, demand, and utilization of empowers women to opt for fewer children (as the need to have many immunization service and providing potent children reduces with favorable child health care) which in turn reduces vaccines to children in targeted zones. The maternal mortality. specific activities of the intervention are categorized into the following objectives: Since the initiation of expanded program of immunization (EPI) in
support demand creation for Ethiopia in the 1980s, the coverage improved progressively, however immunization service at community its benefits were not fully utilized. The 2012 national immunization level in low-performing woredas coverage survey showed a lower than reported coverage with wide thorough integrated refresher training regional variation and with problems of drop outs. Recently, the and use of media; administrative vaccine coverage stagnated and this led the Federal support to reduce bottlenecks that Ministry of Health of Ethiopia to analyze the reasons in detail and to prevent access to quality immunization come up with an improvement plan - routine immunization services; and improvement plan (RIIP) in November 2013 – requesting the support of support the health system to enhance partners. One such partner is USAID, which in turn selected JSI/L10K as immunization services. its implementing partner. As of September 2014, L10K has supported implementation of routine immunization plan L10K’s aim of improving high impact maternal, neonatal, and child by deploying immunization officers to zonal health care practices and its community based experiences are its health departments in Southern Zone of Afar, competitive advantage that will help in increasing access, demand, and North West Tigray, Awi, East Wellega, Gedio, utilization of immunization service. Demand creation and linking health Bench-Maji, and Yem special woreda. Within services with the community is one of the current areas that L10K is these implementing zones, USAID/L10K works working in. Additionally, its community based data for decision making in 64 woredas. A baseline survey has been (CBDDM) is an excellent mapping tool utilized in its current operational carried out and the results have been used to areas. L10K has also taken lessons from JSI’s UI-FHS project of prioritize woredas and health facilities. The implementing reach every district (RED) approach. field team is supported by the central office of
L10K by updating, developing, and elaborating The already existing platform of L10K will help in identifying children to tools and guidelines which complement those be vaccinated to make sure that they are protected from vaccine of the Ministry. preventable diseases. L10K’s EPI intervention which is implemented in Some of the activities carried out so far 7 zones, 64 woredas, 229 health centers and 1036 health posts, will include: contribute to eradication, elimination, and accelerated control of data interpretation of the baseline targeted disease and ultimately achieving and sustaining MDG 4 and 5 survey, (Reduce child mortality and Improve maternal health respectively). advocacy and awareness creation meeting, In general, JSI has many years of experience in supporting RED approach training and micro- immunization program and ensuring data quality, data generation and planning, (immunization in practice compilation, timely reporting and above all, use of data for action. In training for 90% of the woredas and 225 health facility heads and focal persons Ethiopia there are four different JSI projects working on immunization will be organized), and service (L10K, IFHP, UI-FHS, and DELIVER vaccine supply chain). These participation in quarterly immunization projects will create a forum to share their experiences in program review meetings. management, community linkage, implementation of reach every community (REC) approach, and logistics management from which L10K has also supported the FMoH’s two L10K will further its benefit. rounds of polio and one round of meningitis vaccination campaign.
News from the Last Ten Kilometers 3 MARCH 2015, Vol. 3, Issue 4
learnings from this period, L10K extended for two more years – up to 2015. UPDATES With plans of initiating a new phase but before moving into this
phase, L10K requested the Federal Ministry of Health to Improved health outcomes appreciated evaluate its Project and field trips were made to the four L10K On February 19 and 20, 2015 staff from the Bill and Melinda operational regions where two zones were selected per region Gates Foundation (BMGF) visited health projects in Tigray. and the following health facilities and communities were Senior Program Officer, Rebecca Ferguson (who makes visited. frequent visits) and Dr. France Donnay, Senior Program Officer for Maternal Health visited the health post of Kewanit Region Zone Woreda Health Health Kebele, Wukro Maria health center Axum Hospital in Tahtay Center Post Maychew woreda (district) as well as non L10K sites: North La’ilay Adidaro Mai Western Adiyabo Anbesa Betehannis health center and Adwa hospital . TIGRAY South Samre Gujit Hinsa Briefing was given on the Government’s health extension Eastern program and community strategies applied by L10K to compliment the government’s program. West Denbecha Denbecha Gudber Gojam AMHARA The general functions of the hospitals and health centers was North Shoa Debresina Debresina Sina explained and more specifically the L10K supported referral system from health post to health center and hospital was Bench Maji Sheko Sheko Gayzega SNNP highlighted. The visitors appreciated the positive change due Sheka Yeki Kubito Ermich to the improved referral work which has enhanced number of deliveries taking place at the facilities. Jimma Shebe Shebe Yanga Sombo Dogoma OROMIA Moving into the community the visitors dropped by the West Nedjo Amuma Kilto health post and talked to health extension workers, health Wollega Yabel Mako development army members, and women and husbands who Areas visited by the Ministry of Health’s team had come in search of health services. The visiting team, discussed with a lactating mother who had delivered her In each of these woredas the evaluating team discussed with baby just a week ago. zonal and woreda staff, health workers at the different levels, L10K grantees, 1 to 5 health development team leaders, and mothers in the community.
The team gave its feedback by stating that the L10K Project has overall contributed to improving the health system. L10K’s community strategies such as the Community Based Data for Decision Making (CBDDM) - a
community mapping tool– was also At Kewanit health post, the HEW explains the wall charts commended.
Detail report of the
visiting team shall be L10K project evaluation available shortly.
The L10K Project was initiated in October 2007 to support the health extension program of the Ethiopian government to improve reproductive, maternal, newborn and child health (RMNCH) care behavior and practices. Operating as a five- A Health Development Army Team year project, L10K reached its project time line in 2012. Leader explains how she carries out However, receiving supplemental fund and based on its her daily work SUCCESS STORY Building skills for quality immunization services
the area. Dilnesaw Tadesse is the head of Sheko health centre in Sheko Woreda of Bench Maji zone, SNNP. In January 2015, an immunization training program The health center provides immunization service to was organized by the Bench Maji Zonal Health children and mothers. However, this service has Department together with L10K. Dilnesaw was one been deteriorating from time to time due to various of the trainees among other staff of the facility who interrelated factors. participated. The training equipped health workers with much needed knowledge and skills in Despite the fact that all vaccines are heat-sensitive delivering quality immunization service. By the end and most are freeze-sensitive, vaccines in the of the training, Sheko health center was able to This quarterly health center were not stored in proper have one trained focal person for immunization newsletter is compartments of the refrigerator. Fridge tags have service. produced by the Last recorded six alarms in a month, indicating that vaccines have been dangerously exposed to A month after the training and during a supervision Ten Kilometers temperature variation that resulted in the vaccines visit to Sheko health center, Dilnesaw guided the Project, funded by losing their potency (strength). Shake tests that visitors through the procedure of how their facility the Bill & Melinda help to check whether freeze-sensitive vaccines now manages and monitors the cold chain system. Gates Foundation, have been subjected to freezing temperatures, was The visitors observed fridge temperature was UNICEF and USAID. not carried out properly. Poor transportation monitored twice a day; vaccines were loaded in system further contributed to vaccines losing their proper compartments, and fridge tags showed no potency since transporting the vaccines from the alarm, nor were there any expired vaccines. With a MARCH 2015 forecast plan put in place there were no problems health center store to immunization providing sites, Volume 3, Issue 4 were not carried out in appropriate cold chain of shortage and over storage of vaccines. equipment. Immunization sessions and vaccine In a short period of time Sheko health centre’s The Last Ten forecast plans were never developed by the health Penta 1 coverage of 6 month performance (before center and as a result, there was poor stock Kilometers Project the training) which was (385) 71% improved to management where there would be over or P.O.Box 13898 (561) 78% in its 8 month performance (after the understocked number of vaccines. Addis Ababa, training). In addition, Penta dropout rates which Ethiopia Dilnesaw as the head of the facility understood that was -6% improved to +4% putting the health centre he had serious problems on his hand. The health into a one-step higher category of poor access and http://l10k.jsi.com workers at the facility had skill gaps in cold chain good utilization (category 3) from a category of management and vaccine handling. The number of poor access and poor utilization (category 4). Tel +251 11 662 0066 unvaccinated children in the catchment area of the Fax +251 11 663 With continued support Dilnesaw is confident that facility was high and the small number of Sheko health centre will be able to further improve vaccinated children and mothers had a weak chance demand for and utilization of the service thereby of developing immunity since the vaccines were ensuring quality immunization coverage. Disclaimer: Information, usually impotent. The poor quality of immunization views or opinions service resulted in frequent outbreaks of measles in expressed in this L10K’s expanded program on immunization (EPI) is a USAID funded intervention which is carried out in newsletter do not partnership with the Federal Ministry of Health. The intervention aims to contribute to the reduction of necessarily represent or reflect those of Bill & incidences of vaccine preventable diseases. It works to increase access, demand, and utilization of Melinda Gates immunization service and provide potent vaccines to children. Foundation, UNICEF and USAID.
Inappropriate vaccines handling before training (left) and proper storage in refrigerator after training (right)