Situation analysis Puntland State of Somalia Garowe 28th May 2001

Agreements MOSA 2 International NGOs 1 National Society (SRCS)

MCH/OPD Facilities Bossaso Gardo Bender Beila Iskushuban Bargal Garowe Sinjiif Kalabyr Burtinle Dangorayo Eil town Qarhis Godobjiran Hasbahale Galkaio Harfo Baadweyn Goldogob Jirriban Balibusle

Districts where EPI services are functional??????

BARI NUGAAL MUDUG Bossaso Garowe Galkayo Alula Iksuhsuban Kanda la Bender/Be yla Gardo Eyl Giriban Goldogob Dankoroyo Burtinle Cold Chain Cold chain situation Bargaal Hasbahale Harfo 50 % is working Bacad Weyne

SUMMARY OF UNICEF EPI COVERAGE SURVEY Very low coverage during baseline survey. Drop out rate (DPT1 DPT 3.) 30 % drop out Drop out rate (DPT1 DPT 3.) 30 % drop out Very low coverage in Puntland. 2% of women were provided second dose of TT immunization in Only 21 % of all children immunized

48% BCG scar shows very low coverage in Baidoa. 6% of BCG immunization have not developed BCG scar. Drop out rate (BCG/ DPT3) of 57% in child immunization. 36% measles immunization resulted to conduct measles campaigns in Baidoa District. The results depicted very low coverage. However 78% out 20.4% of children were fully immunized before one year of age. 25% of women were provided second dose of TT immunization. SUMMARY OF EPI COVERAGE SURVEY RESULTS CONDUCTED BY UNICEF & PARTNERS IN BAIDOA TOWN

Very low coverage during baseline survey. Drop out rate (BCG/ DPT3) of 67% in Bay and 77% in Bakool. 9% of women were provided second dose of TT immunization. No data in Bay IMC survey Very low coverage in Bay and Bakool regions. SUMMARY OF IMC EPI COVERAGE SURVEY RESULTS IN BAY AND BAKOOL REGIONS

Very good coverage but needs to be sustained. Drop out rate of 69% in 2000 and 38% in % of women were provided second dose of TT immunization in No data in Good coverage of but needs to be increased. SUMMARY OF WORLD VISION EPI COVERAGE SURVEY RESULTS IN BUALE 2000 & 2001

Cold chain not functioning in certain areas Inadequate supervision Shortage of qualified Human resources Few implementing partners Existing MCH structures are not providing EPI services on a daily bases. Request for supply come in late

TOR MCH staff not well defined. (Staffing pattern) Information lacking concerning immunization schedule for mothers/ caregivers Lack of confidence in MCH staff Attitude of MCH staff towards parents, patients etc….

Missed opportunities Availability/ use of IEC materials for MCH centres and parents/ caregivers HIS system not completely understood Reporting not regular Quality/ reliability of data ? Motivation of staff?

Definition of catchment areas? target population? Social mobilization (responsibilities) Co-ordination between partners

Strengthen the MCH structure Question of Catchment population Need for more implementing (EPI) partners Need for transportation - resource allocation Appropriateness of cold chain eg gas/solar panels/electric as opposed to kerosene refrigerators

Need for separate budget line for EPI implementation Training and follow up of EPI activities Monitoring and evaluation of EPI activities Feedback of EPI surveys Quality of vaccines (for purpose of monitoring) Cold chain management training

Further development of MCH standards Need for common EPI policy eg incentives, motorcycles, office equipment etc Appropriateness of social mobilisation strategies - Puntland version best Inadequate participation of international staff in EPI (acceleration) activities Need for regional cold chain

No clear roles and responsibilities of EPI stakeholders Need for clear action points and prioritisation Lack of EPI maintenance/replace old equipment Service providers - no screening, high drop- out rates, no supervision tools

Mothers not aware of vaccination schedules Need to increase capacity of MCH staff related to EPI activities Contraindication not clearly known to health staff Missed opportunities Low community participation

Inadequate cold chain Social mobilisation messages insufficient Inadequate distribution of MCH facilities (eg in Bossaso) Enlarge scope of EPI partners - private, local NGOs, MOSA Lack of motivation of MCH staff