USAID’s Maternal and Child Survival Program (MCSP) Uganda – Routine Immunization (RI) Quarterly Report January 1 to March 31, 2018 MCSP/Ambrose Watanda USAID/Uganda Quarterly Progress Report (Program Year 4) Project Name: USAID’s Maternal and Child Survival Program (MCSP) Routine Immunization (RI) Program Reporting Period: January 1 to March 31, 2018 Obligation Funding Amount: $891,939 (Field Support) Project Duration: July 2014 – December 2018 Program Year 4 (PY4): October 1, 2017 to September 30, 2018 Person Responsible for this Report: Dr. Ssekitto Kalule Gerald – Chief of Party, MCSP Project Objectives: 1. Strengthen the Uganda National Expanded Programme on Immunization’s (UNEPI) institutional/technical capacity to plan, coordinate, manage, and implement immunization activities at national level. 2. Improve district capacity to manage and coordinate the immunization program as guided by UNEPI leadership. MCSP Uganda RI PY4 Q2 Report 2 Acronym List AD auto-disable ART antiretroviral therapy CAO Chief Administrative Officers CCT Cold Chain Technician CDC Communicable Disease Control DHIS2 District Health Information System Version 2 DHMT District Health Management Team DHO District Health Officer EPI Expanded Program on Immunization HC Health Centre HF health facility HSD health sub-district IP Implementing Partners JSI John Snow Inc. LC1 Local Council 1 LMA Leadership, management and accountability MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program MCSP Maternal and Child Survival Program MCV2 measles-containing vaccine second dose MEL Monitoring, Evaluation, and Learning MOH Ministry of Health PDSA Plan-Do-Study-Act cycles PHC primary health care PY Program Year QI Quality Improvement Q2 second quarter QRM Quarterly Review Meetings REC Reaching Every Community/Child REC-QI Reaching Every Community/Child using Quality Improvement techniques RED Reach Every District RHITES Regional Health Integration to Enhance Services in Eastern Uganda RI Routine Immunization RMNCAH Reproductive Maternal Newborn Child and Adolescent Health SAS Senior Assistant Secretary/Sub-county Chief SS supportive supervision SS4RI Stronger Systems for Routine Immunization SW South West Td tetanus diphtheria TT tetanus toxoid TWG Technical Working Group TWC Technical Working Committee UNEPI Uganda National Expanded Programme on Immunization UNICEF United Nations Children’s Fund USAID United States Agency for International Development USG United States Government VHT Village Health Team WHO World Health Organization MCSP Uganda RI PY4 Q2 Report 3 I. Introduction The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 25 priority countries with the ultimate goal of preventing child and maternal deaths. MCSP’s partnership with USAID/Uganda started with the 2012 initiation of technical assistance to strengthen routine immunization (RI) through MCSP’s predecessor, the Maternal and Child Health Integrated Program (MCHIP). With USAID’s support, MCHIP worked to strengthen UNEPI and operationalize Uganda’s national Reaching Every Community/Child (REC) strategy by adding elements of Quality Improvement (QI) to create the REC-QI approach, which introduces the Plan-Do-Study-Act (PDSA) cycles. From 2012-2014, MCHIP developed the REC-QI approach and implemented its performance improvement cycle approach in five districts. Using REC-QI, MCHIP was able to improve facility-level planning and delivery of immunization services, introduce simplified tools for using data for action, involve communities to better map and reach all who needed services, and put mechanisms into place for feedback and problem solving with health personnel and non-traditional stakeholders such as community and other leaders. In 2014, USAID/Uganda requested MCSP to continue MCHIP’s work by expanding to 10 additional districts and maintaining technical support to UNEPI at the national level. Following the July 2017 splitting of one of the 10 districts supported by MCSP into two (Pallisa split into Butebo and Pallisa), MCSP expanded from 10 to 11 districts. In the now 11 MCSP-supported districts, MCSP is working with district health teams to improve capacity to manage RI, improve health service delivery and eventually increase vaccination coverage in a sustainable way. At national level, MCSP is supporting the Ministry of Health/Uganda National Expanded Programme on Immunisation (MOH/UNEPI) staff to enhance policies, standards and leadership toward a stronger RI system. MCSP is also being implemented alongside the “Stronger Systems for Routine Immunization” (SS4RI) project which was awarded to John Snow, Inc. (JSI) in 2014 by the Bill & Melinda Gates Foundation, and which uses the same REC-QI methodology as 26 Districts supported to MCSP/Uganda. SS4RI is introducing the REC-QI approach in an additional 10 implement REC-QI by districts, bringing the total number of districts in which REC-QI will have been the end of MCSP & introduced to 26 before MCSP and SS4RI end in 2019. SS4RI in 2019 MCSP RI’s implementation approach focuses on building the capacity of personnel in districts, health sub-districts (HSD) and health facilities to carry out REC-QI practices that strengthen the management, delivery, and utilization of routine immunization services. The key REC-QI practices include: building capacity for data analysis and use, quarterly review meetings involving political, civil and religious leaders (e.g. non-health stakeholders), integrated supportive supervision (SS) visits, mapping of health facility (HF) catchment areas, micro-planning, community engagement, Quality Work Improvement Teams, and testing changes using Plan-Do-Study-Act (PDSA) cycles. This report covers MCSP-RI’s implementation, achievements and lessons learned in the second quarter (Q2) of Program Year Four (PY4), i.e. January 1 to March 31, 2018. II. Summary of PY4 Q2 Achievements MCSP continued to strengthen UNEPI’s technical and institutional capacity to implement immunization activities at the national level and the district capacity to implement the REC-QI approach for RI system strengthening. MCSP facilitated revision of the EPI Standards, adaptation of the EPI Curriculum, and submission of these key documents to MOH for final review and endorsement. The MCSP team MCSP Uganda RI PY4 Q2 Report 4 continued with REC-Q1 implementation in nine districts but began to explore modifications to the REC- QI approach to address the lack of change in reported figures for RI coverage and drop out in some of the MCSP-supported districts. Additionally, MCSP provided technical support for containment of a measles outbreak in Butebo district. Finally, MCSP completed data analysis for the Kaporchwa assessment and drafted the report, which was being internally reviewed as of the end of the quarter. Round one data analysis for the REC-Q1 study was completed and sections of the report were drafted for expansion into a full draft once round two data collection and analysis are completed next quarter. III. Description of Activities for the Quarter Objective 1: Strengthen UNEPI’s institutional/technical capacity to plan, coordinate, manage, and implement immunization activities at national level. MCSP provided technical support to finalize and present the EPI Standards and EPI Prototype Curriculum in the Communicable Disease Control (CDC) Technical Working Group (TWG) of MOH, and provided responses to the feedback received. These two key EPI documents were made ready for presentation in the Senior Management Committee. Also through the CDC TWG and EPI Technical Working Committee (TWC) meetings, MCSP provided technical inputs into the review of the Comprehensive Multi-Year Plan for Uganda and UNEPI’s Annual Work Plan for 2018. MCSP attended the Regional EPI Managers’ Meeting for East and Southern Africa held in Kigali, Rwanda from March 20-22, 2018. During the meeting it was emphasized that the end of funding for Polio is a reality and countries should plan to cover the gaps in funding that will be created in the 2019 country plans (particularly funding to cover the positions of surveillance officers). The elimination of Maternal Neonatal Tetanus and control of measles and rubella were discussed as well and the need for countries to switch from Tetanus Toxoid (TT) to tetanus diphtheria (Td) using a schedule recommended by the World Health Organization (WHO). In addition, the meeting provided updates and strategies for new vaccines introduction such as a second dose of measles-containing vaccine (MCV2), typhoid conjugate vaccines, and oral cholera vaccine but emphasized a need for the National Immunization Technical Advisory Group to guide selection of the new vaccines to be introduced. WHO and individual country delegations shared experiences in EPI and performance trends in the region, including the general trend of stagnation in coverage and it was agreed that there is a need ‘to do things differently’ to achieve better results. Country delegations were challenged to think of innovations that can change the trends and consider integration of maternal, child and adolescent services to increase reach, efficiency, and sustainability of services. Participation in this kind of meeting strengthened MCSP/Uganda’s ability to support UNEPI, by ensuring that global and regional perspectives are captured in MCSP’s work. This is particularly important as UNEPI prepares to take on the expanding