Working together an integration resource guide for immunization services throughout the life course Section X: Lorem Ipsum Working together an integration resource guide for immunization services throughout the life course Working together: an integration resource guide for immunization services throughout the life course ISBN 978-92-4-151473-6 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Designed by büro svenja Printed in Switzerland Contents Acknowledgements V Abbreviations and acronyms VII About this resource guide VIII Executive summary XI 1. Introduction 1 What do we mean by integration? 2 How is integration reflected in global policies and strategies? 3 Why is integration growing in importance for immunization programmes? 6 The life course approach to integration 10 National integrated health policies 18 2. Types of integration 19 Health systems integration 20 What do we know about integration in health systems in general? 22 Integrated health service delivery 32 Integrated settings 41 Comprehensive approaches to disease control 43 Intersectoral collaboration 47 3. Health services that could provide immunization services or referrals 51 Integrated Management of Neonatal and Childhood Illness (IMNCI) 52 Integrated community case management (iCCM) 53 Antenatal care 54 Postnatal care (Hepatitis B birth dose, postpartum screening) 55 4. Planning for integrated immunization programmes 59 Context 62 Compatibility 63 Feasibility 64 Acceptability 67 Accountability 69 Equity 69 Integrated service checklist 71 III Working together 5. Benefits and risks of integrated immunization programmes 73 6. Monitoring and evaluation of integrated immunization programmes 77 Planning for monitoring and evaluation (M&E) 81 Monitoring changes in integrated service delivery and coverage 82 Monitoring changes in the quality of care 86 Evaluating integrated services 86 Strengthening the evidence base for integration 88 7. Useful references 89 Appendix: additional health services that can be provided with immunization 93 Nutrition 95 Growth monitoring and nutritional counselling, including breastfeeding 95 Vitamin A supplementation 99 Malaria 104 Distribution of long-lasting insecticidal nets (LLINs) 104 Intermittent preventive treatment in infancy (IPTi) of malaria 108 Seasonal malaria chemoprevention (SMC) 112 Neglected tropical diseases 114 Deworming 114 Reproductive and maternal health services 117 Family planning 117 HIV 123 HIV services 123 Male circumcision for HIV prevention 128 Water, sanitation and hygiene interventions 132 Hygiene kit distribution 132 Other health interventions 135 Hearing screening 135 IV an integration resource guide for immunization services throughout the life course Acknowledgements This document was developed by the Expanded Programme on Immunization (EPI) Department of Immunization, Vaccines and Biologicals (IVB) of the World Health Organization (WHO) and written by Emily Wootton (WHO), Laura Nic Lochlainn (WHO) and Margaret Watkins (CDC). The following individuals have contributed to the production of the guide and their inputs are acknowledged with sincere gratitude. WHO Centers for Disease Control Tracey Goodman and Prevention (CDC) Paul Bloem Aaron Wallace Ikechukwu Ogbuanu Marta Gacic-Dobo Burnet institute Jan Grevendonk Chris Morgan Laure Dumolard Christoph Steffen UNICEF David Schellenberg Imran Mirza Jan Kolaczinski Valentina Buj Andrea Bosman Martina Penazzato John Snow, Inc Julie Samuelson Craig Burgess Antonio Montresor Robert Steinglass Margie Montgomery Rebecca Fields Messeret E Shibeshi Teshome Desta Woldehanna WaterAid UK Bernadette Daelmans Om Prasad Samira Aboubaker Megan Wilson-Jones Rita Kabra Maurice Bucagu Özge Tunçalp Lina Mahy Lisa Rogers Tom O’Connell Nuria Toro Polanco Edward Kelley V Working together © UNICEF/UN065045/Ose VI an integration resource guide for immunization services throughout the life course Abbreviations and acronyms AEFI Adverse events following LLINs Long lasting insecticide treated immunization nets ANC Antenatal care LMIS Logistics management CHWs Community Health Workers information systems cMYP Comprehensive Multi-Year M&E Monitoring and evaluation Planning for Immunization MNT Maternal and neonatal tetanus DHS Demographic and Health Surveys MOV Missed opportunities DTP Diphtheria-Tetanus-Pertussis for vaccination EID Early infant diagnosis of HIV NCD Non-communicable disease EPI Expanded Programme ORS Oral rehydration salts on Immunization PIRI Periodic intensification GAPPD Global Action Plan for the of routine immunization Prevention and Control of PMTCT Prevention of mother to child Pneumonia and Diarrhoea transmission of HIV GRISP Global Routine Immunization PPH Postpartum haemorrhage Strategies and Practices SDGs Sustainable Development Goals GVAP Global Vaccine Action Plan STH Soil-transmitted helminths HBR Home-based record TTCV Tetanus toxoid containing vaccine HEAT Health Equity Assessment Toolkit UHC Universal Health Coverage HEI HIV HIV exposed infants UNICEF United Nations Children’s Fund HepB-BD Hepatitis B birth dose USAID United States Agency for HIV Human immunodeficiency virus International Development HPV Human Papillomavirus VAS Vitamin A supplementation iCCM Integrated community case VMMC Voluntary medical management male circumcision IMNCI Integrated management of WHO World Health Organization neonatal and childhood illnesses WRA Women of reproductive age IPTi Intermittent preventive treatment in infants IYCF Infant and Young Child Feeding VII Working together About this resource guide Who is this resource guide for? This resource guide is intended for use by national managers from immunization, reproductive, maternal child and adolescent health and other related programmes. It may also be useful for global, regional and country level policy-makers and partners responsible for the design, implementation, monitoring and evaluation of integrated services, policies or health systems strengthening. What are the objectives of the resource guide? The guide aims to bring together a range of relevant resources, summarize current knowledge and provide guidance on the integration of immunization with other health interventions, health policies or activities to strengthen health systems. The specific objectives of this guide are: • to encourage all programme managers to consider opportunities for the integration of immunization with other