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Tools for SIAs and RI Social Mobilization 12 th Annual Measles & Rubella Initiative Tools for SIAs and RI Social Mobilization 12 th Annual Measles & Rubella Initiative Meeting 10 th-11 th September, 2013 WB Mbabazi, RJ Davis, M Charles, A Patel 1

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Global Immunization Aspirations 1. Global Measles goals § By 2015 § Vaccination coverage: § Global Immunization Aspirations 1. Global Measles goals § By 2015 § Vaccination coverage: § § § Reported incidence: Mortality reduction: <5 cases of measles per million 95% (compared to 2000 Nos) By 2020 § § 2. Routine: >90% national level and >80% in every district SIAs: > 95% in M, MR or MMR in every district. Sustain 2015 goals > 95% coverage with both the first and second routine doses of MCV (or measles- rubella-containing vaccine as appropriate) in each district and nationally. GVAP mission

Major Challenges for Measles Elimination Have a communication Angle to the solutions 1) Weak Major Challenges for Measles Elimination Have a communication Angle to the solutions 1) Weak immunization systems 2) Large outbreaks and changing age distribution 3) Funding http: //www. thelancet. com/journals/laninf/article/ PIIS 1473 -3099(13)70133 -6/fulltext BBC Caption (6 th May 2013)

AMCROSS CONCEPTUAL APPROACH AND TOOLS For SIAs & RI promotion 5 AMCROSS CONCEPTUAL APPROACH AND TOOLS For SIAs & RI promotion 5

Sustainable measles elimination programming Polio Eradication Measles control MNT Elimination Meningitis control YF control Sustainable measles elimination programming Polio Eradication Measles control MNT Elimination Meningitis control YF control Influenza control Adapted from IMMUNIZATIONbasics Project

House-to-House Strategy: Leveraging SIAs experience into Routine Immunization q In SIAs, ARC has learnt House-to-House Strategy: Leveraging SIAs experience into Routine Immunization q In SIAs, ARC has learnt that: Ø Ø Ø q H 2 H canvassing reaches populations that are missed by traditional mass media, even in urban areas. Data from 13 African countries (Bob 2012) showed that higher coverage are reached wherever H 2 H strategy was used Cost per beneficiary averages $0. 32 but can vary, being about $0. 16 in cities compared to $0. 57 in rural areas Testing H 2 H Strategy in immunization defaulters: Ø Ø Prevention: Baby tracking in Kilindi district of Tanzania Correction: Defaulters tracing in Dar es Salaam & 3 selected cities in Uganda 7

Using H 2 H strategy to look for 20 M infants who missed their Using H 2 H strategy to look for 20 M infants who missed their MCV 1 70% of them are from 10 Countries, using 2009 -2011 JRF reported immunizations (in millions)

Top 10 Countries with DTP un & underimmunized children in 2012, AFRO Nigeria 2853024 Top 10 Countries with DTP un & underimmunized children in 2012, AFRO Nigeria 2853024 Ethiopia 892012 Kenya 453129 Uganda 317994 DRC 286156 Zambia 229925 Tanzania 199826 Cameroun 142215 Madagascar 117857 Angola 86306 0 500000 1000000 1500000 2000000 2500000 Data Driven Selection of targeted countries and Districts

Where do the under- or un-immunized children live? In Uganda § § Arua Lira Where do the under- or un-immunized children live? In Uganda § § Arua Lira § § Greater Kampala (K’la & Wakiso) 80% of immunization defaulters live in 36 districts URCS targeted 4 of 36 § Urbanized § Highest numbers Testing the House-to. House canvassing strategy in defaulters tracing 1 st defaulters tracing week took place in first week of July, and was integrated with the UNICEF supported “Family Health Days”.

Where do the under- or un-immunized children live? In Tanzania § 80% of immunization Where do the under- or un-immunized children live? In Tanzania § 80% of immunization defaulters lived in 51 districts in 2009 and 70 districts in 2011 § National plan for correction of missed immunizations as part of RI coverage improvement plan implemented since 2009 § Progressively more districts attained 80% DTP-3 coverage but the Greater Dar es Salaam did not change § TRCS supported to use the House-to-House strategy in turning fortunes in Dar

Improving DTP-3 trends but poor performance localized 2010 2009 2011 Below 80% to 89% Improving DTP-3 trends but poor performance localized 2010 2009 2011 Below 80% to 89% 90% + Greater Dar (3 Districts) remained underperforming x 3 yrs

Interventions description Defaulters Tracing § Campaign Approach § Volunteers conduct Quarterly H 2 H Interventions description Defaulters Tracing § Campaign Approach § Volunteers conduct Quarterly H 2 H visits to all H/Holds § § § Screening for RI defaulters Remind defaulters Nudge defaulters to correct missed doses Baby Tracking § Community-based volunteers § Identify and register all newborn babies § Conduct House-visits to all families with infants § § Remind them of the next scheduled RI dose Information on the next planned EPI sessions 13

Delays in Project Start denies complete outputs of H 2 H strategy in RI Delays in Project Start denies complete outputs of H 2 H strategy in RI q In Uganda AMCROSS Ø Ø Was drawn into the vaccine supply chain crisis for more than 6 months. Testing our advocacy and networking credentials First H 2 H tracing for defaulters took place in July, 2013 v Reached 50% of Households in selected 4 districts v Found 79, 316 children < 5 yrs who have incomplete immunization and supported 70% of them to update their immunizations q In Tanzania: Ø Translation of project proposals into implementation plans delayed (Alignment with RED scale up plans, procuring buy in from the 3 -layers of government and development of M&E tools) Ø First H 2 H tracing of EPI defaulters planned for 15 th to 21 st Sep 14

Immunization program needs, priorities SIA tools (Including Social Mob) can be used to strengthen Immunization program needs, priorities SIA tools (Including Social Mob) can be used to strengthen Routine Immunization SIA input RI Follow-up Improved RI micro-plans implemented Revised population estimates Health worker training Cold chain equipment Fuel to operate it for RI Defaulters tracing & was Social Where H 2 H educative/ reminder system Social mapping immunization policy makers and defaulters ooooops, Reinforced through supervision, etc. Sustainable Elimination Improved reach of RI Improved quality of services RI improved availability & reliability Sustained Community Mobilization? Demand

Conclusions § § § There exists monitoring infrastructure to tell us where unimmunized children Conclusions § § § There exists monitoring infrastructure to tell us where unimmunized children are or live MRI partners can advocate for routine MCV coverage improvements, in selected high-priority countries Each individual MRI partner can do small routine MCV promotional interventions in the high-priority countries contributing the most un and under-immunizations Too early to tell, BUT H 2 H canvassing can find defaulters and provide them reminders, incentives and structures for correction of missed RI doses Advocacy and social Mob stream of interventions developed and used in SIAs that strengthen RI needed 16

Thank You Anne Ray Charitable Trust Thank You Anne Ray Charitable Trust