REVOLUTIONARY GOVERNMENT OF ZANZIBAR. COMPREHENSIVE MULT YEAR PLAN - ZANZIBAR 2010 – 2014 EPI/MOHSW ZANZIBAR July 2009. TABLE OF CONTENTS Acronyms And Abbreviations 3 Executive Summary 4 1.0 Background 4 1.1. Introduction .........................................................................................................................................4 1.2. Location And Surface Area............................................................................................................5 1.3 Administrative Structure ...............................................................................................................5 1.4 Climate....................................................................................................................................................5 1.5 Population Projection 2008..........................................................................................................5 1.6 Economy.................................................................................................................................................6 1.7 Socio-Economic Status .................................................. Error! Bookmark not defined. 1.8 Health Service Delivery...................................................................................................................7 1.9 Linkage Of Epi To Moh ...................................................................................................................8 1.10 Number Of Health Facilities By Districts................................................................................8 1.11 Number Of Health Facilities Offering Immunization Services ....................................8 1.12 Users’ Fees And Immunization....................................................................................................8 2.0 Epi In The Context Of Global And National Priorities 9 2.1 Global Priorities..................................................................................................................................9 2.2 Who African Regional Strategic Plan For Epi.......................................................................9 2.3 Epi In The Context Of Global Priorities ...................................................................................9 3.1 Routine Immunization .................................................................................................................11 3.2 Cold Chain And Other Epi Logistics .......................................................................................12 3.3 Advocacy, Communication And Social Mobilization......................................................13 3.4 Capacity Building ............................................................................................................................13 3.5 Targeted Disease Initiative And Disease Surveillance..................................................14 3.5.1 Polio Eradication........................................................................................................................14 4.0 New Vaccine 20 ii ACRONYMS AND ABBREVIATIONS 1. AD--------------------------- Auto –disable (syringe) 2. ADB ------------------------- African Development Bank 3. AEFI------------------------- Adverse Event Following Immunization 4. AFP-------------------------- Acute Flaccid Paralysis 5. BCG ------------------------- Bacillus Calmette Guerin 6. CMS ------------------------- Central Medical Stores 7. CFC-------------------------- Cloro –fluoro- carbon 8. DHMT ---------------------- District Health Management Team 9. DHO------------------------- District Health Officer 10. DMO ------------------------ District Medical Officer 11. DTP – HB ------------------ Diphtheria, Pertussis, Tetanus and Hepatitis B 12. DQS- ------------------------ Data quality self-audit. 13. EPI -------------------------- Expanded Programme on Immunization 14. FSP -------------------------- Financial Sustainability Plan 15. GAVI------------------------ Global Alliance for vaccines and immunizations 16. GDP------------------------- Gross Domestic Product 17. Hib---------------------------Haemophilus influenzae type b 18. HMIS------------------------ Health Management Information System. 19. LP gas ---------------------- Liquid Propane gas 20. MCH------------------------- Maternal and Child Health 21. MDVP----------------------- Multi dose Vial Policy 22. MLM------------------------ Mid Level Management 23. MNT------------------------ Maternal and Neonatal Tetanus 24. MNTE---------------------- Maternal and Neonatal Tetanus Evaluation 25. MOHSW -------------------- Ministry of Health and Social Welfare 26. NIDs ------------------------ National Immunization Days 27. NT --------------------------- Neonatal Tetanus 28. OPD ------------------------- Out Patient Department 29. OPV ------------------------- Oral Polio Vaccine 30. PIU -------------------------- Program Implementation Unit 31. PHCU ----------------------- Primary Health Care Unit 32. SIAs ------------------------- Supplemental Immunization Activities. 33. SNIDs ----------------------- Sub National Immunization Days 34. TBA----------------------- -- Traditional Birth Attendant 35. TT------------------------- -- Tetanus Toxoid 36. UNICEF--------------------- United Nations Children’s Fund 37. UNFPA-------------------- - United Nations Population Fund 38. VVM------------------------- Vaccine Vial Monitor 39. WHA ------------------------ World Health Assembly 40. WHO---------------------- World Health Organization 41. ZFDB--------------------- Zanzibar Food and Drug Board 42. ZMO---------------------- Zonal Medical officer 3 EXECUTIVE SUMMARY The immunization programme in Zanzibar has it’s the goal of reducing morbidity and mortality due to vaccine preventable diseases. The programme broad areas of activity include service delivery, disease surveillance and supplementary immunization activities. The comprehensive Multi-Year Plan 2010-2014 identified several reasons for poor immunization performance in different levels. The plan will focus on empowering and supporting districts and utilizing the opportunity of integrated health services including introduction of new vaccines such as Pneumococcal in 2010 and rotavirus in 2011. Although immunization services are among the highly accepted services by the community in Zanzibar, advocacy and social mobilization remains an essential to maintain it. Vaccination against EPI targeted diseases is provided in government and private Reproductive and Child Health (RCH) clinics and the coverage exceeded 80% in 80% of the districts. The immunization program for Zanzibar aims to achieve and sustain coverage rate of above 90% for all antigens in 80% of the districts by the end of 2014. However, vaccine preventable diseases, particularly measles outbreaks, are major challenge for the implementation of EPI program. Social mobilization strategies were outlined and will be used to improve access and utilization of immunization services in the coming five years. The program will also strengthen its advocacy role in order to put immunization issues as an agenda for political decision-makers and promote strengthening of routine immunization coverage at all levels. The main issues that need to be addressed includes:- • Increasing immunization coverage in low performing districts • Introduction of new and under-utilized vaccines such as Pneumococcal in 2010 and Rotavirus in 2011 • Conducting supplemental immunization activities especially for measles in 2011 and 2014. • Strengthening integrated disease surveillance. • MNT Validation • Measles pre elimination • Polio eradication and implementation of Polio importation preparedness plan. Injection Safety will continue to be among the priority areas in 2010– 2014. Non-Polio AFP rate in 2008 reached above 1/100,000. The 2010 – 2014 Comprehensive Multi-Year Plan, will address more issues in integrated disease surveillance activities by conducting training of clinicians, community sensitization and advocacy to key stakeholders. Emphasis will be placed on those silent districts as far as AFP, Measles and MNT reporting are concerned. Immunization infrastructures in Zanzibar are among the areas earmarked for improvements in the coming five years. New Freezer room will be procured and installed and cold chain replacement plan will be implemented in all vaccine stores. This will also include the expansion of the storage capacity at Zonal vaccine store. The Ministry of Health through EPI with the support of GAVI, WHO, UNICEF and other partners have prepared this cMYP with full section on costing, financing and Financial Sustainability of the programme covering the period of 2010-2014. The Multi year plan has incorporated the activities earmarked in the previous Financial Sustainability Plan (FSP). This includes programme costing, financing and future resource requirements activities as well as advocacy, mobilization of resources from central and local government. 1.0 BACKGROUND 1.1. Introduction Zanzibar is one of the political entities constituting the United Republic of Tanzania. It consists of two large Islands, Unguja and Pemba and few sparsely populated islands such as Tumbatu and Uzi in Unguja, Kojani, Fundo, Shamiani and Makoongwe in Pemba. Zanzibar has considerable autonomy in her domestic affairs administered through the Revolutionary Council and the House of Representatives. Although the Health care portfolio for Zanzibar is not a Union Government matter, there is considerable