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APHA Scientific Session and Event Listing

Recorded presentation

Dr. Rose Macauley, MD, MPH¹, Patricia A. Taylor, MPH², Lora A. Shimp, MPH², and Dr. Deo Nshimirimana, MD, MPH¹. (1) Prevention and Control of Communicable Diseases, WHO Africa Regional Office, P.O. Box BE 773, Harare, Zimbabwe, 47 241 38039, macauleyr@afro.who.int, (2) IMMUNIZATIONbasics Project, JSI Research and Training Institute, Inc., 1616 N. Fort Myer Drive, Suite 1100, Arlington, VA 22209

Background: In 2002, WHO, UNICEF and their partners in the Africa region devised the Reaching Every District (RED) approach to improving immunization coverage in low-performing countries. RED focuses attention at district level on five key elements of successful immunization programs: 1) planning and management of resources, 2) sustainable outreach, 3) supportive supervision, 4) linkages between communities and health services, and 5) active monitoring. WHO's Africa Regional Office (AFRO) worked with 16 African countries before the end of 2003 to introduce the RED approach. Purpose: In June 2005, AFRO commissioned a study to document the results and lessons learned with RED in five early implementation countries--Ethiopia, Madagascar, Kenya, Democratic Republic of Congo and Zimbabwe. Methods: A standard framework was used to collect information about RED implementation in each country. Site visits were conducted, and coverage data were analyzed for all districts prior to and after RED introduction. Results: All countries identified their low performing districts as a first step, but each implemented the RED approach differently. District planning and active monitoring were the strongest elements across the five countries, while linkages between communities and health services and supportive supervision were the weakest. Nonetheless, immunization coverage increased in four of the five countries studied, and in the fifth, RED appeared to have had a protective effect when coverage fell precipitously in other districts. Across the five countries studied, the number of districts with DTP3 coverage >80% more than doubled after the introduction of RED (2002-2004). Likewise, the number of districts with DTP3 coverage <50% declined from 377 in 2002 to 222 in 2004. AFRO estimates that the number of children completing the DTP series by their first birthday in the five countries increased by 1.2 million children between 2002 and 2004. Policy implications: Results from the five studies helped the countries involved to identify their own programmatic strengths and weaknesses. AFRO also compiled results from the five early implementation countries and used them to identify strengths and weaknesses overall. Based on the study's positive findings, AFRO is currently working with other countries in the region to expand the RED approach.

Learning Objectives: By the end of the session, participants will know

• the five elements of the Reaching Every District (RED) approach;
• early implementation results and lessons learned in five countries--Ethiopia, Madagascar, Democratic Republic of Congo (DRC), Kenya and Zimbabwe; and,
• the three most important findings and actions being taken to strengthen and expand RED in these and other African countries.

Keywords: Maternal and Child Health, Immunizations

Related Web page: www. who.afro.int

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation