Strengthening Routine as a Motor for other Interventions A report from Côte d’Ivoire Partners for Measles Advocacy 8 th Annual Meeting Washington DC, 23 – 24 September 2008 Maya van den Ent, PharmD, MPH, UNICEFAlphonse Toko, MD, UNICEF Edward Hoekstra, MD, MSc, UNICEFPaul Basikila, MD, UNICEF Rownak Khan, MD MPH, UNICEFEpa Kouakou, MD, UNICEF

UNICEF Outline Country situation of Cote d’Ivoire Measles campaign micro-planning Routine immunization Integration of High Impact Interventions with RI Can measles campaign strengthen routine immunization & health systems?

UNICEF Cote d’Ivoire - Abidjan

UNICEF Cote d’Ivoire DPT3 coverage: 16% Zone affected by war National DTP3 coverage 50% in 2004 UNICEF Focal point (TA)

UNICEF Health facilities offering services Measles catch-up campaign Aug 05

UNICEF Capacity building through measles catch-up campaign Micro-planning Training Health Workers on vaccination, injection safety Training of Community Health Workers Cold chain National and 2 regional freezer rooms 224 Refrigerators and freezers for HC Reparation & maintenance of cold chain equipment Building of 4 incinerators

UNICEF Measles micro-plan Map out Where, How many Childrenlive

UNICEF Why do Ivorian children die?

UNICEF missed opportunities Rationale for integration of other interventions (2004 crisis affected districts) *) Source : DC-PEV, RH Cote d’Ivoire (administrative data)

UNICEF missed opportunities Rationale for integration of other interventions (2006) Source: (1) MICS 2006 & (§) DC Nutrition Reporting data (routine program)

UNICEF Possible reduction in child mortality coverage % CMR increase reduction Measles 16 – 82% 2.8% Vitamin A supplementation 0 – 82%3.3% ITN use 10 – 60%9% Source: MBB

UNICEF At 9 months Measle s Yellow Fever Vitamin A ITN

UNICEF Micro – planning EPI+ & Focused ANC WHERE & HOW MANY? Mapping of population & un - reached children per locality WHEN? Planning of outreach sessions, with community members WHAT? –Bundled vaccines –Vitamin A –De-worming tablets –ITNs –SP for IPTp –Iron tablets HOW? Fuel and per diem

UNICEF Guidelines for micro-planning Situation analysis of Demographics, Human Resources, Performance & Development of micro-plan At Health Facility level

UNICEF Objectives of the micro - plan Results based planning with coverage of intervention as outcome At Health Facility level

UNICEF Outreach plan MBengue (1) WHERE & HOW MANY

UNICEF Outreach plan MBengue (2) WHEN

UNICEF Input needs WHAT & HOW

UNICEF Results – Districts affected by crisis & Abobo (Abidjan) & San Pedro 6,431 more children vaccinated 26,554 more children vaccinated Objective 60% for 2006

UNICEF In summary Measles campaign micro – planning can be applied to routine activitiesMeasles campaign micro – planning can be applied to routine activities –Tailor outreach activities by health facility Use data for choosing type interventions and set targetsUse data for choosing type interventions and set targets Measles vaccinations (campaign and routine) are optimal moments to deliver other life saving interventionsMeasles vaccinations (campaign and routine) are optimal moments to deliver other life saving interventions –Reduce child mortality even more

UNICEF Measles Initiative Working Together to Save Lives Japanese Government Ministère de la Santé – Cote d’Ivoire