TANZANIA EXPERIENCE ON IMMUNIZATION COVERAGE Monitoring and Using Data

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TANZANIA EXPERIENCE ON IMMUNIZATION
COVERAGEMonitoring and Using Data

• Presenter
• William Msirikale

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BACKGROUND 

• EPI was introduced in Tanzania since 1975.
• The primary aim is to protect children from
  Vaccine Preventable Diseases.
• The overall goal is to contribute in the
  reduction of infant and childhood mortality
  rates.
• This is expected through the achievement of a
  high and effective vaccination coverage for all
  antigens, using quality vaccines.

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BACKGROUND

• - EPI has been running as an integral part of MCH
  services.
• MCH services is now under the Reproductive and
  Child Health Section.
• From her Introduction to 1984 the routine
  immunization coverage national-wide was less than
  50

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 UNIVERSAL CHILD IMMUNIZATION 

• From 1985 to 1989 there was Universal Child
  Immunization campaign in Tanzania.
• This raise the immunization coverage of children
  under one year of age from less than 50 to more
  than 80.

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UCI Conted

• During UCI there was a multi-sectoral approach to
  booster Immunization.
• There was commitment from higher political,
  religious and other community leaders.
• This resulted in increased public awareness and
  reception of immunization services offered.
• This was a greater boost for awareness.

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 EPI AS A VERTICAL PROGRAM

• From 1980 to 1996 EPI was a vertical programme.
• DANIDA supported EPI as a project to strengthen
  its managerial and financial capacity.
• Other partners were UNICEF, RI, JICA, WHO and
  others.
• External support for EPI was stable for number of
  years.

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These condition creates stability of EPI antigens
coverage. Being a project we were able to
monitor the programme activities in monthly basis
. The monitoring was done for .
Distribution of vaccines, kerosene and supplies
at all levels. -         . Immunization coverage
at all levels. . Cold chain performance
at all level -   
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TOOLS USED TO MONITOR THE PROGRAMME

• 1. At health facility level
•  
• - Tally sheets.
• MCH 3 form as the reporting form.
• - Performance monitoring form (chart).
• - Under five register used to detect defaulters
•  

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 2. District level

• Performance monitoring forms used to compile
  the district reports, data from MCH 3 forms the
  reports from health facilities.(monthly report)
• Distribution report form used to compile
  vaccines and kerosene (monthly report)
• Performance monitoring form (chart) to assist
  health worker to monitor progress.

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3. Regional level

• Performance monitoring forms used to compile
  the regional reports, data from all district
  reports. .(monthly report)
• -Distribution report form used to compile
  vaccines and kerosene which were distributed
  from regional level to districts and dates
  distribution made. .(monthly report)
• -Performance monitoring form (chart) to assist
  health worker to monitor progress.

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4. National level

• All performance report forms and distribution
  report forms, from all districts and regions were
  received at national level monthly and compile a
  national performance report and distribution
  report.
• This helped Monthly Monitoring and Feedback,
  therefore it was easy to detect and rectify
  problems.
• In 1995 Completeness and Timeliness of districts
  reports was 80 and 70 respectively.

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EPI UNDER HEALTH SECTOR REFORM

• The Ministry of Health is implementing the Health
  Sector Reform.
• Under this new arrangement, EPI ceased to be a
  project from 1st July, 1996.
• Generic functions are integrated as follows- 
• 1.       Procurement, storage and distribution
  taken by Medical Stores Department(MSD)
• 2.     Regional and district transport taken by
  Central Transport Unit
• 3.     Monitoring and Evaluation Function of
  the Management Information System(HMIS)

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EPI national level has the following
responsibilities-

•  
• 1.       Policy and guidelines formulation
• 2.     Specific EPI functions of cold chain
• 3.     Specific training and supervision to
  ensure services are of quality.
• 4.     Monitoring
• 5.     Disease control activities eg Polio
  eradication, Measles campaign, and MNT
• 6. Program management

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AFP Cases 1995 2002United Republic of Tanzania
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Neonatal Tetanus cases 2000United Republic of
Tanzania
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CURRENT SITUATION 

• Tanzania health system administratively is
  divided into National, Regional, District and
  health facility levels.
• The immunization reporting is through the
  integrated HMIS utilizing quarterly reports from
  health facilities to districts and districts to
  regions.
• The Regional reports are sent to the central
  level electronically (on diskettes). 
• Primary data recording is through the child
  health cards, Immunization tally sheets, client
  registers and vaccine ledgers.
• These are summarised quarterly and annually at
  all levels. 

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Vertical reporting and monitoring by EPI are -

• -         AFP surveillance for Polio eradication
• -         Measles case based surveillance
• -         Get annual reports from regions during
  EPI annual evaluation meeting.
•  

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Current

• In 2001, The Completeness of district routine
  reports was 100 annually were as the timeliness
  of these reports could not be measured.
• EPI Central office fail to gather any routine
  district reports from HMIS Central level.
• EPI used to collect the routine reports through
  EPI annual evaluation meetings.

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DQA

• In August 2002, the DQA found the verification
  factor of 90 for immunization data.
• Most problems earmarked by the DQA team are
  related with HMIS National level.
• The DQA revealed that HMIS is working from H/F to
  regional level

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DPT3 COVERAGE 2001United Republic of Tanzania
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DPT 1 / DPT3 Drop out rates by Districts Year
2001United Republic of Tanzania
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Timeliness of districts reports in Tanzania 2000
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2001
2000
1998
1997
1996
1995
1999
1992
1991
1993
1994
1989
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2001
97
96
93
95
98
99
2000
81
1994
82
83
85
84
86
87
88
91
90
92
2001
2001
2001
2001
2001
2001
2001
2001
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New vaccines Technologies

• EPI Tanzania mainland introduced the DPT-Hep B in
  the January 16th, 2002.
• The introduction of this vaccine was going hand
  with hand with the introduction of AD-Syringes
  for all antigens except BCG.
• BCG vaccine was continued provided using the
  disposable syringes until December,2002 when
  Ad-syringes were for all vaccines.

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CONSTRAINTS 

• 1. HMIS national level is not providing data to
  EPI central level.
• The EPI Programme has developed an annual
  immunization data collection exercise directly
  from districts.
• 2. Shortage of HMIS tools in some of the
  health facilities hampered effort to accurately
  Monitor performance.

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CONSTRAINTS Conted

• 3. Competing priorities is also a problem at
  district level.
• The transport for monthly distribution of
  supplies such as kerosene, vaccines, and cold
  chain spare parts is a problem in some of the
  districts because of competition with other
  programmes like
• Malaria and family planning.

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CONSTRAINTS Conted

• At the moment the responsibility is under the
  district to include it in their plans.
• 4. The big distances between the districts and
  health facilities affects the collection of Data.
•   5. Inaccessibility has been another problem.
  (Due to bad roads, rivers, islands and Nomadic
  population)

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CONSTRAINTS Conted

• 6.   District dropout rate not available at
  national level as in HMIS system DPT-HB 1 data
  are not available at national level.
• 7.     In some districts District MCH
  coordinators and District Cold Chain Officers are
  not regularly included in supervision plan which
  lead to the limitation of supervise and promote
  immunization services within the districts.

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THANK YOU!