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Lao People's Democratic Republic Technical Assistance Consultant’s Report Project Number: 40004-01-02 December 2007 LAO: Revitalizing Community Demand for Immunization (Financed by the Poverty Reduction Cooperation Fund) Prepared by Ms. Che Katz and Mr. Keophouthone Kittiphanh For Asian Development Bank This consultant’s report does not necessarily reflect the views of ADB or the Government concerned, and ADB and the Government cannot be held liable for its contents. (For project preparatory technical assistance: All the views expressed herein may not be incorporated into the proposed project’s design. Phase V Final Project Report Revitalizing Community Demand for Immunization (TA4787-Lao) Submitted by Che Katz & Keophouthone Kittiphanh December 2007 This report is dedicated to the hard work, creativity and innovation of the Luang Prabang Province immunization team and especially the 4 district health teams of Viengkham, Phonexay, Paxang, and Phoukhoun. The Luang Prabang team is leading the way in Lao PDR to a new way of delivering quality user-friendly health services. In the words of one team member In the past we have learnt a lot from other projects.... but the important thing we learnt in the RCDI project was about social marketing ...... make the villagers interested in our service..... in the past I never thought about selling health like selling Beer Lao – but now I know we have a service and we need to sell it. Acknowledgements This Project owes a great deal too many organizations and individuals. In particular the Asian Development Bank (ADB), UNICEF, Glaxo Smith Kline, Ministry of Health Lao People’s Democratic Republic, and World Health Organisation. Many individuals played an invaluable role particularly Susan Kerr and Vincent de Wit of ADB who provided ongoing technical support for the project; Lisa Studdert (ADB), Susan Mackay (UNICEF) and Deborah E. Myers (GSK), who were instrumental in developing the concept for this project and sourcing funds for it; and the UNICEF country office team including Olivia Yambi, Laila Ismail-Khan, Desiree Jongsma Dominique Robez-Masson, Aboudou Karimou Andele, Ingrid Hilman, Samphanh Khamsingsavath, Malaythip Lasoukan, Ruth Landy, Simon Ingram, and Vilay Phouthalath. In the Ministry of Health the project was strongly supported by: Dr Somchit Department of Health and Nutrition, Dr Kaisone and her team in Maternal and Child Health, Dr Anonh and his team in EPI services especially Chansay Pathammavong, and Dr Armohn and her team in Provincial Luang Prabang particularly Viengsavanh Kaseumsouk the EPI manager. Others who provided valuable support and encouragement to the RCDI project included: Craig Wilson, (WHO), Pricha Petlueng (WHO), and Odile Pham Tan (Lux-Development). TableofContents EXECUTIVE SUMMARY .......................................................................................................................... 1 1.0 INTRODUCTION............................................................................................................................... 4 2.0 THE IMMUNIZATION SITUATION IN LAO PDR...................................................................... 4 3.0 OVERVIEW OF RCDI PROJECT................................................................................................... 4 3.1 BACKGROUND............................................................................................................................. 5 3.2 GEOGRAPHIC COVERAGE........................................................................................................... 5 3.3 RCDI PROJECT STRUCTURE...................................................................................................... 5 3.4 PRINCIPLES AND APPROACH OF RCDI...................................................................................... 7 3.5 PHASES OF RCDI ....................................................................................................................... 8 3.5.1 Phase I.................................................................................................................................... 8 3.5.2 Phase II................................................................................................................................... 8 3.5.3 Phase III ................................................................................................................................. 9 3.5.4 Phase IV.................................................................................................................................. 9 3.5.5 Phase V................................................................................................................................. 10 4.0 PROJECT INTERVENTIONS ....................................................................................................... 10 4.1 OVERVIEW ................................................................................................................................. 10 4.2 BUILDING PARTNERSHIP........................................................................................................... 11 4.3 IMPROVING ACCESS AND QUALITY OF USER FRIENDLY IMMUNIZATION SERVICES................ 12 4.4 MOBILIZING AND EDUCATING THE COMMUNITY ....................................................................... 13 5.0 PARTICIPATORY MONITORING & EVALUATION OF RCDI............................................. 14 5.1 MONITORING AND EVALUATION PROCESS............................................................................... 14 5.2 DATA COLLECTION METHOD .................................................................................................... 16 5.3 FINDINGS OF CENTRAL/PROVINCIAL FIELD REVIEW IN LUANG PRABANG ............................ 16 5.4 FINDINGS OF THE PARTICIPATORY EVALUATION WORKSHOP................................................. 18 5.5 IMPACT OF RCDI ON IMMUNIZATION COVERAGE RATES ........................................................ 19 5.6 OPPORTUNITIES AND CONSTRAINTS OF THE RCDI................................................................. 27 5.7 EVALUATION SUMMARY............................................................................................................ 27 6.0 LIMITATIONS OF THE STUDY................................................................................................... 28 7.0 DISCUSSION ON THE OPERATIONAL RESEARCH QUESTIONS...................................... 28 7.1 CREATING DEMAND FOR IMMUNIZATION IN LOW COVERAGE COMMUNITIES.......................... 28 7.2 FIXED HEALTH FACILITY ........................................................................................................... 30 7.3 PARTNERING AND MOBILIZING OTHER SECTORS. ................................................................... 31 8 LESSONS LEARNT......................................................................................................................... 32 9 SUSTAINABILITY .......................................................................................................................... 33 9.1 SUSTAINABILITY WITHIN THE EXISTING PROJECT SITES......................................................... 33 9.2 EXPANDING RCDI TO OTHER DISTRICTS AND PROVINCES..................................................... 34 9.3 COST-BENEFIT OF THE RCDI INTERVENTION .......................................................................... 35 9.4 ABILITY FOR THE RCDI TO BE REPLICATED ............................................................................ 35 10. RECOMMENDATIONS FOR THE FUTURE.............................................................................. 36 11.0 CONCLUSION............................................................................................................................. 38 ANNEXES Annex 1 Project Schedule Annex 2 Financial overview of Project Annex 3 Summary of Project activities by district Annex 4 Trip report for Team 2 Central/Provincial Evaluation SUPPLEMENT Supplement 1 Creating Demand for Immunization in your District: Tips for Marketing and Communicating about Immunization Supplement 2 Summary Report of the Evaluation Workshop prepared by government (Lao) Supplement 3 RCDI Central Dissemination Presentation of 20 December 2007 ACRONYMS ADB Asian Development Bank BCC Behaviour Change Communication CAECCD Community Action on Early Childhood Care & Development Project CBO Community Based Organisation CIEH Centre for Information and Education for Health EPI Expanded Program for Immunization DCMC District Committee for Mother and Children DFID UK Department of International Development DPT3 Third round of diphtheria-pertussis-tetanus vaccine GSK Glaxo Smith Kline IEC Information, Education and Communication Lao PDR Lao Peoples Democratic Republic LCC Low-Coverage Communities LPB Luang Prabang LWU Lao Women’s Union MCH Maternal and Child Health MDG Millennium Development Goal M&E Monitoring & Evaluation MoH Ministry of Health MOU Memorandum of Understanding NGO Non Government Organisation OR Operational Research ORT Oral Rehydration Treatment PCMC Provincial Committee for Mother and Children PE Peer Education PLA Participatory Learning & Action PRF Poverty Reduction Fund RCDI Revitalizing Community Demand for Immunization SEDP Socio-Economic Development Plan SVK Savannakhet TA Technical Assistance UNICEF United Nations Children Fund UXO Unexploded Ordinance VCMC Village Committee for Mother and Children VDG Village Development Group WHO World Health Organization Phase V Final Project Report Revitalizing Community Demand for Immunization
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