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Ways And Methods Of Strengthening An Immunization Program In Sheema District

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I can strengthen an Immunization program in Sheema district through the following ways.

Planning and management of resources

If Micro-plans are made available in Sheema district and health facility levels, this would lead to strengthened immunization. The method showed success for example in Kenya, Ethiopia and DRC, micro-plans were introduced through national-level training, and both district and health facility micro-plans were developed at the district level. In Ethiopia, micro-plans were developed at the district level, with input and support from local administrative authorities and community leaders. In Madagascar, health staff reported that community involvement in development of micro-plans strengthened the process.

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Supportive supervision

Routine Immunization supervisory visits to health facilities planned at the district level and incorporated into annual work plans can strengthen immunization strategy in Sheema district. In Ethiopia for example, partners organizations were actively involved in conducting RI supervision visits. In other countries, RI supervision was integrated with acute flaccid paralysis and measles surveillance. Some supervisors reported conducting <50% of planned visits due to lack of resources such as staff, transportation and fuel. To reduce the number of supervisory visits canceled due to lack of transportation, RI and other health programs shared resources such as transport.

Immunization policy and strategies

Successful national immunization programmes depend on up-to-date policies and effective strategies in order to achieve and sustain their goals. Some of the strategies include the RED strategy which aims to fully immunize every infant with all vaccines included in the national immunization schedule of countries. In order to achieve this goal, the strategy focuses on building national capacity from district level upward to maximize access to all vaccines, old and new.

Re-establishing outreach services

In many countries a large proportion of the population only have access to immunization though outreach sessions. Outreach is any delivery strategy that requires health facility staff to leave their facility to deliver immunization. Ideally a minimum of four contacts per year are required to fully immunize an infant. For some communities, access can only be provided irregularly, and may require mobile teams to provide outreach, which will involve resources beyond the health facility and district level. Outreach sessions, especially mobile teams, present opportunities to provide other interventions along with immunization.

Linking services with communities

Involving the community with the planning and delivery of the service will encourage community ownership and improve attendance. Identifying community volunteers for example Village Health Teams in Sheema district (Kyangyenyi sub county) providing them with a role, such as follow up of defaulters, and holding regular meetings is an important step towards building a link with the community. The efforts to work with community leaders focuses on promoting immunizations, supporting assisting in newborn and defaulter tracking and developing district and health facility level micro-plans forexample In Ethiopia, district managers included zonal councils in annual planning meetings and shared outreach schedules with village leaders. Additionally, health workers were assigned to specific villages for immunization outreach. In Zimbabwe, mobilization of resources (e. g. fuel) was coordinated with communities, local organizations and the private sector. In Kenya, district staff held meetings with stakeholders and established partnerships with religious and charitable organizations. In addition, communities participated in resource mobilization for immunizations through contributions to community development funds Community volunteers can be trained to track children that have dropped out, generate demand, and mobilize community resources are used extensively to link services to the community. Through RED, community volunteers are provided refresher training and registers to track dropouts. For their services, volunteers expect compensation, and the absence of incentives results in high turnover rates or limited participation so motivation through incentives is a good step towards strengthening immunisation in the district.

Linking with other interventions

Integration is one of the six guiding principles of the Global Vaccine Action Plan 2011-2020 (GVAP) which recognizes that that the achievement of immunization goals depends on strong immunization programmes that are closely coordinated and work in synergy with other primary health care delivery programmes.

Strategic Objectiveof Global Vaccine Action Plan further expands on the opportunity for immunization to serve as a delivery platform for other priority public health interventions. Effective integration between programmes can also contribute to increasing vaccination coverage by reducing Missed Opportunities of Vaccination (MOV). A MOV is defined as any visit to a health facility by a child (or adult) who is eligible for vaccination (unvaccinated, partially vaccinated or, not up-to-date, and free of contraindications to vaccination), which does not result in the person receiving all the vaccine doses for which he or she is eligible. Linking HIV testing with EPI services provides opportunities for early infant diagnosis of infected babies and to ensure that testing coincides with immunization.

Another example is combining the administration of vitamin A supplements with immunization services as an important part of the effort to eliminate vitamin A deficiency and save lives. Millions of children have received vitamin A through National Immunization Days (NIDs) to eradicate poliomyelitis. Vitamin A supplementation has been successfully linked with vaccination campaigns and routine immunization services in many countries. Providing high-dose supplementation to mothers at immunization contacts soon after delivery provides a further benefit to young infants through enriched breast milk.

Monitoring and use of data for action

Monitoring and use of data for action implies not only the timely collection of data at district level, but the use of the data to solve problems. Some simple tools, including wall charts that display access and utilization need little training, but are very useful to take action according to monthly progress. Not only do districts collect coverage data, but also a large amount of other information, including logistics, supply, surveillance, all of which should be used to improve the immunization system. Some qualitative data may not be available in regular reports and may need to be collected though supervisory visits District level review meetings to discuss immunization program status among health facilities within the catchment are recommended quarterly. In DRC, the national RI program analyzed monthly immunization coverage data and shared the results with division directors and the technical subcommittee of the Inter-Agency Coordinating Committee, where corrective measures were proposed for low-performing areas. Partners reported that this regular review of information at the national and sub-national levels was beneficial for improving RI coverage.

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