Measles SIA Readiness Assessment-Uganda Experience Dr. Henry Luzze Presented at a workshop for accelerating progress towards measles and rubella control and elimination in Geneva: June 2016

Outline Background Measles SIA performance Objectives Methods Results Challenges Conclusion

Background Uganda is on course with the pre-elimination target Has conducted a total of four SIAs since 2003 Latest nationwide follow up SIA was conducted from 03 to 05 October 2015 targeting about 7 million children aged 6–59 months

Measles SIA performance (2003-2015) Year National Coverage Number of districts with coverage   <50% 50-79% 80-89% 90-94% >95% 2003 2006 96% 3 14 64 2009 104% 2 27 23 8 52 2012 100% 21 12 50 2015 95% 5 63

The SIA Readiness Assessment Tool A Measles SIA readiness assessment tool was developed by WHO: to monitor SIA preparation at the national and district levels To improve the quality of SIA preparation To monitor readiness to conduct a high quality SIA IST introduced the tool in quality SIAs peer review workshop (2014 Dec ), EPI managers meeting

Objectives At the national level assessment was to ensure whether the national level has put in place the fundamental elements necessary to support successful SIA preparation and implementation at the sub national level. At the district level assessment was to provide greater insight in the status of readiness to conduct high quality measles SIA at the implementation level and whose results can be quantified and aggregated to assess overall readiness at higher administrative levels.

SIA Readiness Assessment Tool Format 4 categories to be assessed at national and district levels: Planning, coordination, financing Monitoring and supervision Vaccine, cold chain and logistics Advocacy, social mobilization and communication National level tool Administered by ICC and/or National Steering Committee Frequency: periodically beginning >1 year before SIA District level tool Administered by supervisors and monitors Frequency: visits at 8, 4, 2 and 1 week before the SIA Data must be entered in the Excel spreadsheet (YES/NO) Tool must be adapted to country context/practices

Methods Findings from district visits were entered on a computerized excel ( graphically displays summary statistics, by or district). Summary statistics reviewed at each time point prior to the planned SIA start date. Actions to be taken by whom, when that was monitored prior to next assessment for progress Findings shared with Operational level managers, NCC members, UNEPI program managers & partners. All data were submitted to the WHO office by e-mail.

National Level Readiness assessed at 6m, 4m, 3m, 2m, 1m, 2w and 1w prior to the SIA administered by WHO yellow highlights indicate the optimal time for completion of activity Tool enabled early identification of problems and addressing them significant delays in transfer of funds to districts led to postponement of SIA. % readiness at national level increased over time N N This slide shows the outcome of the national level assessment of readiness in Uganda for the measles follow up SIA that was planned for the 26 September 2015. The table shows the critical activities by area (e.g planning and coordination, monitoring and supervision, etc). The yellow highlights indicate the optimal time for completion of activity. Yes or No are indicated for each activity. The red oval highlights shows the % of components assessed as “ready” at each time point.

District Level Readiness District level readiness was assessed 4 times at 8, 4, 2 & 1 week prior to the SIA. 29 (26%), 50 (45%), 48 (43%) and 46 (41%) of districts were assessed at 8,4,2 &1 weeks, respectively. The readiness was conducted by 6 Int’l & 34 national STOP members, 11 WHO regional field officers & telephone interviews with district health officers (DHO) & EPI focal persons trained on the tool & deployed to the field. All data were submitted to the WHO office by e-mail.

District Level Readiness Planning and Coordination 8W 4W 2W 1W This slide shows the 7 components that are assessed at the district level to evaluate the planning and coordination readiness. The blue bars are the percentage of districts which have indicated that the critical activity has been completed at 8, 4, 2 and 1 week before the SIA. The tool shows steady progress with increasing readiness at the district level. However, late disbursement of funds to districts led to delay in activities and the health workers were not trained 1 week before the SIA. The SIA was then delayed by one week to ensure that this important activities takes place before the SIA. Uganda Finally achieved national coverage of 95.3%, with 56% of the districts achieving more than 95% coverage. According to country feedback, The SIA readiness assessment tool was instrumental in ensuring quality SIA.

District level readiness- Planning and Coordination Example Actions Taken After the findings of the eight week assessment, feedback communications were made with DHOs and WHO focal persons. Districts also started calling UNEPI and WHO seeking guidance and resources. Designated responsible person for the district SIA, Identified target population from previous polio and SIA and child health day data, Most districts activated the coordination teams, Secured local political commitments by involving authorities in the committees. This includes promises to use district vehicles for campaign activities

District Level Readiness- Monitoring and Supervision 8W 4W 2W 1W This slide shows the 3 components that are assessed at the district level to evaluate the supervision and monitoring readiness. The blue bars are the percentage of districts which have indicated that the critical activity has been completed at 8, 4, 2 and 1 week before the SIA. The tool shows steady progress with increasing readiness at the district level. (please note change in scale of y axis) Uganda Finally achieved national coverage of 95.3%, with 56% of the districts achieving more than 95% coverage. According to country feedback, The SIA readiness assessment tool was instrumental in ensuring quality SIA.

District level readiness- Supervision and Monitoring Example Actions Taken Following feedback and follow up from the readiness assessment, a few districts began to show a better level of readiness at the four week before SIA readiness. By the two weeks assessment, districts identified supervisors by name and location. Districts designated specific person for data collection and aggregation (biostatisticians) With frequent communications and technical support (central supervisors) from the center, the district level readiness showed significant improvement during the two weeks and one week assessments.

Challenges Encountered with the use of the Tool Lack of timely submission of the tool from the districts to national level especially in the first months Competing activities by respondents meant not receiving from all districts Being a new tool, it took time for people to become familiar

Advantages of the Tool It addresses all SIA preparation and monitoring issues necessary both at the national and district level. Is an effective means of identifying current status and limitations of the preparedness at the earliest possible time. It provides a simple-to-use quantitative assessment of preparedness to conduct a high quality SIA at the national and sub-national levels. It identifies specific strengths and weaknesses related to SIA preparations over time, and identifies needed actions at the local level to address gaps. It also facilitates reporting of preparedness data to higher level authorities for timely interventions.

CONCLUSION Measles SIA Readiness Assessment Tool was found instrumental in improving quality of SIA preparation and monitor readiness for a high quality campaign. Improvement noted from 8 weeks to 1 week prior to SIAs Was adapted for polio HTH SIAs for 2015

Thank you

Tool addresses preparedness in the following ways: It provides a simple-to-use quantitative assessment of preparedness to conduct a high quality SIA at the national and sub-national levels; It identifies specific strengths and weakness related to SIA preparations over time, and identifies needed actions at the local level to address gaps; It facilitates reporting of preparedness data to higher level authorities for timely interventions, including potential decisions to postpone or partially postpone the SIA until adequate readiness is achieved

Components of the tool Planning, Coordination & Financing Vaccine, Cold Chain & Logistics, by Activity Percent of expected preparatory activities completed by district / national level Social Mobilization and M & Supervision

SIA Readiness Assessment Tool A concise (not exhaustive) simple-to-use instrument that takes a snapshot of readiness at different points in time and in different areas. Attempts to address a number of limitations of existing pre SIA monitoring tools Facilitates better supervision of the most important SIA preparation activities Identifies needed actions and responsible persons to fill gaps Tracks the progress of SIA preparations through a quantified, aggregated data analysis to higher levels (e.g. of district data at the provincial level)

Results

8 Weeks prior to SIAs the activities to be assessed at district level are xx for interpretation of this result

Suggesting to remove as 8 weeks this is not assessed

Please interpret result those that are below 80% for the time are lagging behind