Community participation for progressive and sustainable immunization improvements

The Reach Every Child in Every District (RED) strategy is a community-based approach used to identify non-immunized children for immunization services. Zambia adopted the RED strategy in 2004 to improve the quality and performance of routine immunization services. Activities were initiated in twelve low performing districts and have been scaled up to the rest of the country.

USAID/Health Services and Systems Program (HSSP) and UNICEF provided technical assistance to introduce and scale-up the program, while WHO/GAVI provided financial support. HSSP supported community involvement in planning, establishment of community/household registers, implementation, and feedback meetings for the RED strategy scale-up. Monitoring was conducted after intervention and control sites were identified and structured questionnaires and focus group discussions were used for technical supervision.

Results include sustained improvements in immunization coverage rates (from 21% to 80% in target districts). Improved defaulter tracing practices has also resulted in reduced drop-out rates. Challenges include long-term sustenance of voluntarism, and ensuring basic resources such as provision of transport needed for defaulter tracing.

Active community participation through the RED strategy in Zambia has promoted integration of childhood interventions, resulting in improved access to health services with progressive and sustained immunization coverage. Key findings include: a) Improved community participation improves health outcomes; b) Strong District Health Management support systems are essential to program success; and c) Community leadership support is critical for sustained results. This program should be considered as part of a comprehensive district health plan as a way of including communities to improve service delivery.