UNICEF Ethiopia/2013/Sewunet MARCH 2015 Volume 3, Issue 4 ROUTINE IMMUNIZATION IMPROVEMENT PLAN COVER STORY ROUTINE IMMUNIZATION 1 IMPROVEMENT PLAN When countries can successfully provide significant regional disparities (pastoral vaccines to their children, they are already areas of Somali, Afar, and Gambella are making an immense difference to the persistently low as compared to Addis EDITORIAL 2 health of their citizens. Through Ababa and Tigray). UPDATES 3 immunization, small pox has been eradicated, polio is close to eradication Cognizant of this fact the Ethiopian Federal Ministry of Health (FMoH) with support Improved health and mortality and morbidity of other outcomes appreciated vaccine preventable diseases have from its partners prepared an immunization improvement plan in 2013. significantly declined. The improvement plan takes into L10K project evaluation Though immunization coverage is globally consideration the results of the National improving, millions of children still do not Immunization Coverage Survey (2012); SUCCESS STORY have access to basic immunization services. Post-Introduction Evaluation of As a result, every ten seconds someone Pneumococcal Vaccine (2013); survey on Building skills for dies from a vaccine-preventable disease. Socio-economic, Behavioral and Health 4 quality immunization Services Determinants of Immunization Since Ethiopia launched an expanded services Service Utilization (2012); JSI/ARISE program on immunization in 1980, it is Evaluation of the Drivers of Routine successfully protecting a large proportion Immunization System Performance in of its nearly 3 million annual birth cohort The Last Ten Kilometers (L10K) Ethiopia (2012); and Vaccine Management, against vaccine-preventable diseases. The Logistics and Cold Chain Report (2011). What it takes to improve country has been able to maintain wild health outcomes in rural These studies reflect major problems Ethiopia polio-free status in spite of its circulation in experienced in the various immunization neighboring countries, and it has achieved delivery systems. L10K aims to strengthen the maternal and neonatal tetanus elimination bridge between households targets in ten out of the eleven regions. USAID as one of the partners of the FMoH and Primary Health Care Unit, is supporting this improvement plan and Ethiopia’s basic health service With the introduction and expansion of the L10K because of its strong community delivery structure. It works to health extension program and the reaching strategy has been identify as one partner improve quality and increase every district (RED) approach in 2003-2004, who can support such initiative. Thus, L10K demand, access and utilization Ethiopian has made steady and gradual of high impact reproductive, is working in collaboration with the FMoH, improvement in routine immunization regional health bureaus, zonal health maternal, newborn and child coverage: DPT1 coverage increased from health interventions. departments, woreda health offices, and 63% in 2003 to 81% in 2006. The number other partners working in immunization. L10K is funded by the Bill & of districts with DPT3 Melinda Gates Foundation, coverage of more than UNICEF, and USAID, and 80% has also increased implemented by JSI Research & from 9 districts to 29 Training Institute Inc. districts between 2002 and 2006. L10K works with 12 local partners, in the four most Nonetheless, since 2010, populated regions of Ethiopia: for three years, the Amhara, Tigray, Oromia, and national administrative Southern Nations, Nationalities coverage of expanded and Peoples’ (SNNP) regions. program on immunization stagnated in many areas and decreased with UNICEF Sverige Cont. on page 2 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