1. Supporting Routine AND Supplementary Immunization Activities in STOP

2.  2009 external evaluation of major barriers to interrupting poliovirus transmission (WHO)  RI is weak across re-infected countries leading to inability to quickly control importation  Recommendations to WHO D.G.  Systematic attention by the polio eradication programme to strengthening RI systems  Appropriate balance needed between SIAs and RI services across endemic countries  Coordination must be improved between partners to ensure both RI and SIA are conducted optimally  Capacity in social mobilization, planning, management and monitoring should be strengthened

3. Note: routine strengthening assumes 2.5% annual improvement in routine immunization coverage until 95% Constant routine Strengthen routine only Annual measles deaths Strengthen routine + “catch-up” + “second opportunity” “Catch-up” + Constant routine Year

4.  Social mobilization activities  Planning  Target population identification  Cold chain  Surveillance  Human resources  Vaccine safety  Waste management  Management teams

5.  What you can do  Have campaign materials emphasize ▪ Routine services protect against other VPDs ▪ Location of RI sessions ▪ Routine vaccine schedule  When you can do it  Training materials development  Health worker training  Campaign monitoring  Meetings with community social mobilization committees

6. Don’t forget to come back next month for your routine immunization!

7.  What you can do  Plan campaigns with minimal interruption to routine program  Ensure RI supervision checklists exist  Check that microplans exist for SIA and RI  Develop systems that benefit RI: update maps, …  When you can do it  National level planning meetings  Facility/district staff meetings  Facility visits

8.  Define targets  Areas of low coverage  High risk areas/pops  Areas of continued disease transmission  Refer high risk/zero dose areas to RI for follow up Look at this map with the high risk areas in blue! Target population identification

9.  What you can do  Check vaccination cards  Check if health worker has given messages on RI ▪ Location of vaccination post ▪ Reminder about next vaccine ▪ Reminder about any missed vaccinations  When you can do it  Campaign monitoring

10. I’ll take this opportunity to promote routine and supplemental immunizations!

11.  What you can do  Check functioning of each freezer & refrigerator  Check that regular monitoring is occurring  Verify ice pack conditioning  Report back to management team  When you can do it  Campaign monitoring visits  Health facility visits during planning, training and surveillance visits I’m taking note of your broken cold chain equipment. Let’s work with the district to get this fixed!

12.  What you can do  Check vaccine stock records  Check condition of all vaccines ▪ VVM stage ▪ Ensure HW knows how to interpret  Discuss numbers & stock with HW  Report stockouts to district  When you can do it  Health facility visits

13. Let’s talk about ways to improve stock management to reduce vaccine wastage.

14.  What you can do  Check awareness of health workers on ▪ How to handle suspected cases ▪ What is reportable? Measles, AFP, …  Availability of case investigation forms/manuals  Functionality feedback loop from labs to facilities  When you can do it  Health facility visits  National lab visits  Meetings with district officials

15.  Many RI health workers work in campaigns  What you can do  Provide motivation in your interactions  Train, supervise & discuss RI issues Great work!

16.  What you can do  Check awareness of health workers on ▪ Proper vaccination techniques ▪ Handling of AEFI  Availability of AEFI plans for all vaccines  Availability and proper use of incinerators / pits  Check proper syringe disposal techniques  When you can do it  Health facility visit  Immunization sessions

17. What a brave boy you were! I need to put this used needle in the safety box.

18.  In many locations  District health management teams manage SIA as well as RI  Convey messages  High routine coverage lengthens the period between campaigns  Updates on weak areas which affect both activities ▪ cold chain ▪ target populations ▪ surveillance

19. The maps do not include the slum areas along the river. We must update them!

20.  Social mobilization planning  Emphasize routine messages  District level campaign planning  Emphasize sharing of maps and action plans  Campaign training  Offer training in other aspects of EPI  Surveillance system interactions  Lend support to surveillance of other diseases

21.  National/District decision-maker meetings  Report on problem areas  Ensure emphasis on RI messages  Health facility visits  Cold chain  Vaccine management  Health worker knowledge  Monitoring / Community visits  Vaccination cards  Awareness of RI

22.  Ideally, EPI programmes include both RI and SIA activities  However, different partners may own different activities  Evaluate the country situation  Be in line with the in-country structure

23.  STOP folder – 9 Opportunities to Enhance Synergy between Supplemental Immunization Activities and Routine Immunization Services  Local EPI Director & WHO office  http://www.who.int/health_topics/immunization/en http://www.who.int/health_topics/immunization/en  Immunization Essentials: a Practical Field Guide  STOP point of contact

24. 1. Identify those of you with EPI experience in balancing RI & Polio/Measles 2. Quickly Match with 1 or 2 persons in the room with less/no experience 3. Spend 10 minutes discussing in group what you can do in polio/measles assignments to strengthen RI 4. We will review ideas as a group