1. Kenya Pediatric Association Conference,
Immunization in Kenya Strengthening Vaccine Coverage and Utilization and Introducing New Antigens in the Setting of Devolution
Dr. Collins Tabu
Kenya Pediatric Association Conference,
Mombasa, 12th April 2019

2. Immunization Performance, Kenya- Key Principles
To be able to interrupt transmission of disease, a critical number/ Proportion of children must be vaccinated
National Immunization targets for every vaccine is 90% Nationally and at least 80% in every County, through:
Increasing access to Immunization- More Health Facilities equipped and vaccinating daily
Mobilization of Communities to utilize immunization services
Provision of immunization outreach services
The vaccine quality needs to be maintained to ensure effectiveness in preventing disease
Ensuring vaccines are stored in recommended cold chain equipment
Ensuring effective vaccine monitoring

4. Performance of the Immunization program, Kenya
Reported Immunization Coverage Trends ( )
Unimmunized Children & Penta 3 Coverage
Number of unimmunized children is lowest since devolution.; general improvement leading to better coverage numbers.

6. Select Vaccines Impact- Rotavirus
Following Rotavirus Vaccine Introduction:
Proportion of children aged <5 years hospitalized for rotavirus declined by 30% in the first year and 64% in the second year of vaccine introduction
Hospitalizations for all-cause acute gastroenteritis in children <5 years of age decreased by 31% in the first year and 58% in the second year of vaccine introduction
Seasonal peaks were reduced substantially
The cost effectiveness ratio for PCV versus status quo was
US$ 38 per DALY averted
From the Government perspective, introduction of Rotavirus is cost saving

7. Polio Eradication: Significant decline in number of persons paralyzed by wild polioviruses, *
Last case of
type 2 polio

8. Distribution of measles and Rubella Cases in Kenya, 2012- 2016
2013
2014
2015
2016

9. Childhood mortality trends

10. Unimmunized Children in ESAR (2017)
Country
Imm. Coverage (%)
# Un-immunized
Ethiopia 73
853,470
Angola 52
557,280
South Africa 66
385,560
Somalia 42
343,360
South Sudan 26
308,580
Kenya 82
266,940
Uganda 85
253,650
Mozambique 80
214,600
Madagascar 74
212,680
Malawi 88
76,680
Tanzania 97
62,490
Zimbabwe 89
56,210
Burundi 91
38,070
Zambia 94
37,080
Namibia
8,400
Eritrea 95
7,750
Rwanda 98
7,160
Lesotho 93
4,060
Eswatini 90
3,700
Botswana
2,600
Comoros
2,250
ESAR
3,702,570
92% of the total burden
in 9 countries
Nothing interesting?
Source: WHO-UNICEF 2018

11. Key Drivers of Non Performance
Interruptions in Service Delivery
Health Worker Strikes
Interruptions in Vaccine Supply
Scheduling of immunization Services- Vaccination services offered on specific days
Health Worker & Facility capacity
Health worker capacity to offer immunization services- Lack of vaccine storage equipment, Lack of knowledge & Skills
Missed Opportunities for Vaccination
Health Worker Practices and Attitudes towards Immunization Clients

12. Key Drivers of Non Performance
Community Engagement issues
Rumors, Myths and Real or Perceived Vaccine Reactions
Weak community engagement and or participation
Economic Barriers to Immunization
Communities not prioritizing immunization- No visibility to vaccine preventable diseases
Lack of IEC materials on Immunization

13. National responsibilities in immunization
Overall policy
Procure traditional vaccines
Maintaining and operating national and regional stores
GAVI co-funding demands
Resource mobilization and partnerships
Update immunization needs forecast
Forecast informs budget allocation
Develop procurement and workplan based on budget
Implement plans and ensure that immunization remains a priority during budget implementation

14. County responsibilities in immunization
Counties receive vaccines from central government.
Counties are responsible for the following procurements and operational costs:
Injection devices
Cold chain equipment and maintenance
Collection and distribution of vaccines and related supplies
HR for immunization
Outreach activities & Demand creation (mobilization)
Immunization data tools production and data management
Other operating costs (electricity, rent, building maintenance)

15. What do we need to do?
Ensure un-interrupted supply of vaccines in all Health Facilities
Ensure every health facility reports
Ensure ALL Vaccines are offered on a daily basis in ALL Health Facilities
Ensure ALL Government vaccines are offered free of charge
Implement outreach services at least twice a month for all Health Facilities
Facilitate community engagement and participation in immunization
Invest in community health systems and train health workers
Strengthen immunization program management and oversight
Strengthen link between planning for immunization and budgeting persists

16. Costing Immunization services in Kenya(Per Child)
Total cost per child is estimated to be 3,324 per child per annum.
The cost of vaccines, syringes is the main cost driver.
Immunization unique cost are only 192 shillings per child while the rest are shared cost with services.
COUNTY IMMUNIZATION SPECIFIC COST

17. …..who is for us?

18. Political Commitment for Immunization
Presidential Declaration on Immunization:
All children to be vaccinated before joining school
All Counties to ensure all unvaccinated children are reached
Country continues to fully procures all traditional and emergency strategic vaccines and honors its co-financing obligations to Gavi
Country has a dedicated line item for immunization in the Printed estimates
Country has put in place the necessary Governance structures for Immunization:- NITAG, NICC, NVSAC, TWG
Devolution of Health and Immunization, increasing resource allocation, accountability, community ownership and participation

23. New Vaccines Plans, 2019 HPV Vaccine Yellow Fever vaccine expansion
Meningococcal Vaccine
Malaria Vaccine
Change in Vaccine Formulations:
Pneumococcal Vaccine Two dose to Four dose formulation
Tetanus Toxoid to Tetanus Diptheria
Vaccines for the Future:
Typhoid Vaccine

24. Thank You