Using Measles SIAs to Strengthen Routine Immunization

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Using Measles SIAs to Strengthen Routine
Immunization

• Rebecca Fields, JSI
• 11th Annual Meeting
• The Measles and Rubella Initiative
• September 18, 2012

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Extensive previous and recent work on SIAs and
health/immunization systems
Disease Eradication Friend or Foe to the Health
System
Taylor Commission Effects of PEI on health
systems
Jharkhand study (NPSP/ CDC)
UNF/ Red Cross Meeting
Nepal SIAs WHO/CDC
1994 1996 1998 2000 2002
2004 2006 2008 2010
2012
Checklist to optimize impact of PEI on RI
Impact of measles elimination on health systems
(LSHTM)
Ethiopia Implementing Best Practice SIAs
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Many SIAs in countries with MCV1 lt 80 and
weaker health/immunization systems
SIAs completed and planned, 2010-2013
MCV1 coverage, 2011
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Using Measles Activities to Strengthen
Immunization and Surveillance Objectives

1. Develop guidelines for countries on planning and
   implementing SIAs in ways that deliberately
   strengthen routine immunization and surveillance
2. Propose indicators to monitor and help manage
   such efforts
3. Develop prototype advocacy materials to promote
   measles control as a fundamental part of
   immunization system strengthening

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Field work to inform development of guidance for
countries

• Countries selected based on anticipated SIAs,
  routine immunization coverage, geographic
  variation
• Lao PDR August 2011
• Bihar State, India December 2011
• Approximately 2 weeks of field work
• National level interviews and data review
• Districts visits to 4 districts/country
  high/low RI performance urban/rural
• Facilities gt4 facilities to elicit health worker
  perspectives
• Field work supplemented with interviews and
  reviews of experiences in Ethiopia, Jharkhand,
  Nepal, other countries in Africa

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Subset of large menu of possible activities
Program area Possible activities When? Before/ During/After SIA
Planning Build planning for RI strengthening into all phases of SIA planning (e.g. workshops, tools) Before
Planning Use SIA head counts to revise target population for RI microplans After
Planning Use information on costs of reaching hard to reach during SIAs to revise RI budgets After
Training supervision Conduct needs assessment and include key topics to reinforce routine immunization skills in SIA training Before
Monitoring and evaluation Use findings from SIA supervision checklists to correct deficiencies for RI After
Monitoring and evaluation Apply findings from RCAs on source of information to RI communication strategies After
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Possible activities (continued)
Program Area Possible Activities When? Before/ During/After SIA
Communication/ social mobilization/ advocacy Provide key messages to caregivers on need to return for RI and when (if possible) During
Communication/ social mobilization/ advocacy Foster strong relationship with media for accurate, supportive coverage of RI After
Provide feedback to local community and political leaders on SIAs and RI During/ After
Vaccine supply management Post-SIA, physically inventory and redistribute vaccine stocks After
Cold chain/ Logistics Update inventory, distribute new equipment for SIA and RI needs Before
Cold chain/ Logistics Use data on CCL problems identified during SIA as basis to correct for RI After
Surveillance In SIA training, reinforce skills on measles case detection and reporting Before
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Process outlined in country guidance module

1. Communicate and advocate for RI strengthening as
   an integral component of a Best Practice SIA.
2. Assign clear responsibilities before/during/after
   SIAs
3. Identify challenges to RI that SIAs can help
   address
4. Prioritize certain activities to strengthen RI
   and avert negative impact ? based on feasibility,
   potential contribution, resources needed
5. Plan and budget for RI strengthening activities
   include in SIA guidelines
6. Monitor and evaluate to build accountability for
   this component of SIA

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Features of module for countries

• Checklist to aid planning
• Extensive menu of potential activities
• Scorecard to help prioritize activities
• Support for advocacy
• Illustrative indicators and monitoring approach
• Suggested format for post-SIA review meeting on
  using SIA to strengthen routine immunization and
  surveillance

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Global-level indicators characteristics

• Limited to 1-2 to avoid imposing burden
• Broadly applicable across countries
• Easy to collect and report
• Meaningful show connection between SIAs and RI
• Avoid creating unrealistic expectations about
  what SIAs will do for RI

K. Feldon
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Indicators Combine broad and specific

• Broad to gauge global and regional progress

• Specific to describe country priorities

AND

• At least one indicator describing a program area
  a country selects for using SIAs to strengthen RI
  

• Country plan, prepared and funded using SIA
  resources, to strengthen and monitor routine
  immunization performance. OR
• Structures to coordinate SIAs and RI at national
  and subnational levels are established and
  functional before, during, and after SIAs.

K. Feldon
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What will it take to implement such activities?A
menu of ideas is not enough

• Political will on part of governments and
  partners RI strengthening needs to be deliberate
  part of high-level advocacy and language for
  describing the SIA
• Budget Limited but assured. Needed to secure
  attention and commitment.
• Assignment of responsibilities coordinating
  structures at different levels responsible for
  the SIA/RI interface functional before and after
  the SIA
• Human resources
• Timeframe

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Why use SIAs to strengthen routine immunization?

• Routine immunization is essential to achieving
  high levels of population immunity
• Prominent addition to the Global Measles Rubella
  Strategic Plan
• Guiding Principles
• Milestones
• Performance indicators
• Adding this component incurs marginal costs but
  can lead to specific, lasting improvements in RI,
  thereby helping achieve elimination target
• SIAs may be viewed as more central to other
  efforts and partners NVI, developmental
  bilaterals, etc.

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• Thank you

E. Simons