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Strengthening Routine Immunization and Surveillance

Strengthening Routine Immunization and Surveillance to Prevent Disease at a Lower Cost

In collaboration with UNICEF and the Capacity Project, Health Systems 20/20 has worked to expand routine immunization outreach, data collection, and analysis. Strong routine immunization and surveillance programs reduce morbidity and mortality by ensuring that vaccine coverage is high, reducing vaccine wastage and stockouts, identifying outbreaks earlier, and reducing the need to rely on resource-intensive special vaccination campaigns.

In April 2007, WHO's Regional Office for the Eastern Mediterranean (EMRO) and the Ministry of Public Health and Population (MOPHP) conducted a quick assessment of the immunization management information system (IMIS) being piloted in the Amran governorate. The MIS was developed and initially piloted in Amran through the PHRplus project, and Health Systems 20/20 supported expansion of its implementation from Amran into the Marib Governorate.

The team visited the governorate National Expanded Programme on Immunization office, EPI store, and the Jabal Iyal Yazid District because of low Pentavalent-3 coverage for 2006 (less than 75%) and found that the MIS provided an excellent way to determine the catchment area for immunization activities. The MIS revealed that about 20% of children from the Al Jabal Iyal Yazid District were vaccinated in the neighboring Amran District, which means that the coverage is not as low as reported. The MIS also improved stock management to prevent stockouts, excess supply, and expiration wastage.

The effectiveness of IMIS technology led to an IMIS expansion strategy, which included training for hundreds of immunization workers and several statisticians in Taiz and Amran. An MIS Data Quality self-assessment tool used to train immunization workers indicated 95% accuracy in the data recorded in Amran and 91% in Taiz. After completing a workshop, district supervisors are now able to accurately monitor and evaluate immunization performance at each post within their district. . As a result of MIS expansion, EPI officials are able to review accurate vaccination data from each district and have a clear understanding of cold chain issues, immunization worker absenteeism, and coverage and vaccine management issues. Analysis of the data has led to a meaningful expansion of immunization coverage.

Developments resulting from this work in Amran:

• Opening of 11 new immunization posts
• Procurement of 15 new cold chain refrigerators from the MoPHP
• Centralized communication: Using the updated EPI/IMIS guidelines, the EPI was able to return 26,000 doses of ruined Penta vaccine to the central EPI office in Sana’a
• Timely identification and response to local epidemics such as a recent measles outbreak among internally displaced persons from Harf Sufran district and the Governorate of Saada