What is “Reaching Every District” (RED) in Immunization? A brief overview Information from the global immunization partnership presented by Lora Shimp

Background n GAVI goal for 2005: reach 80% coverage with DPT3 in 100% of districts in 80% of countries n Too many children are left out, never reached by primary (routine) vaccination n High drop-outs, impossible to reduce without improved service delivery and communications n In the same country, high national coverage can hide big differences between districts n Equity in services, sustainability

Immunization Challenges Increase routine coverage and quality with existing vaccines Reduce mortality due to all vaccine-preventable diseases and eradicate polio Mobilize sustained national financing Assure immunization works in reformed context of integration, decentralization, and privatization Use immunization as vehicle for other population- based interventions and reaching the unreached

Five operational components needed to “Reach Every District” 1) Re-establishment of outreach services regular outreach for communities with poor access 2) Supportive supervision on site training by supervisors 3) Community links with service delivery regular meetings between community and health staff 4) Monitoring and use of data for action chart doses, map population in each health facility 5) Planning and management of resources better management of human and financial resources

Resume outreach vaccination activities means… n Regular outreach (usually monthly) - planned and communicated with communities n Appropriate logistical support (transportation, cold chain) n Trained and motivated staff n Flexibility to adjust to specific communities

Supportive supervision Different from “tourist visits” Appropriate and user-friendly supervision tools Clear supervision goals to help health staff solve problems Combine with on-site training Opportunity to integrate other health interventions (Nutrition, IMCI, Malaria…)

Linkages with communities involve… n Identifying and developing partnerships with community structures and groups n Strengthening capacity of the EPI, health workers and vaccination teams to plan and communicate immunization services effectively and actively with clients and the community n Enhancing community ownership and involvement in planning and utilization of immunization services n Advocacy with community leaders to support services and staff and inform communities

Monitoring for action means… Proper use of EPI monitoring tools Indicators include: coverage, completeness, timeliness, quality of data Use of data to improve planning and management Use of tools and feedback for continuous self monitoring at health facility level (wall charts, mapping populations served)

Planning and management of resources needed at district level Details of human and financial resources needed (micro planning) Material resources needed (logistics plans) Sustainability aspects Current situation Future funding prospects Partners commitment (ICC) Community awareness and social mobilization

Suggested Partner Actions: working at district level n Disseminate and utilize tools and processes with partners (e.g. actively participate in ICCs and communication sub-committees involving NGOs and partners at district levels) n Consider mechanisms like MOUs and “social contracts” with MOHs to become more involved in service delivery (advocacy and mobilization) n Use health sector reform/decentralization as opportunity for greater NGO and district-level involvement n Better monitoring to support immunization improvement and demonstrate contribution at district level (monitoring drop-outs, capacity building, self- monitoring)