Bringing Immunization Services Closer to Communities

"Barriers such as inadequate understanding of immunization and insufficient demand for immunization services by families and communities; limited access to immunization services for communities located in hard-to-reach areas; and inadequate numbers of health staff to provide services to very large and scattered communities have hampered the delivery of services to many target populations."

To address these problems, the World Health Organization (WHO) adopted the Reaching Every District (RED) approach as an extension of routine immunisation (RI) services in Ghana in 2003. This publication attempts to document and share some of the experiences from the initial implementation of the RED approach in Ghana, also suggesting that RED can provide a framework for improving other priority interventions (e.g., those being undertaken by Roll Back Malaria (RBM), Integrated Management of Childhood Illnesses (IMCI), Expanded Programme on Immunization (EPI), Integrated Disease Surveillance and Response (IDSR), and Soil Transmitted Helminthiasis) in a more coordinated and integrated manner.

As outlined here, the 5 operational components for RED include:

1. Re-establishing outreach vaccination: regular outreach for communities that are underserved
2. Supportive supervision: on-site training by supervisors
3. Links between community and service: regular meetings between community and health staff
4. Monitoring for action: chart doses and map populations for each health facility
5. Planning and management of resources.

A variety of communication strategies are outlined, such as the involvement of religious leaders in promoting community participation in immunisation services so as to enhance demand for service and ownership. For example: "More than 300 representatives from various religious groups, including Muslims, attended workshops in the districts....Participants at the meeting expressed their willingness to join hands to champion the cause of immunization in their communities and in religious services. They made the following suggestions:

• "Health authorities should send information early so they can also relate messages to their congregations in time. They complained that information from the health authorities often reached them very late.
• Church groups will from time to time monitor the immunization status of children in their congregation and inform health authorities for the appropriate action.
• Health authorities should organize outreach sessions on adolescent programmes in the communities just as they do for immunization programmes."

"Feedback from the orientation workshops for leaders of religious groups on their roles and tasks in communicating EPI [Expanded Programme on Immunisation] show that the leaders can educate their members and mobilize them for immunization if they are adequately oriented and involved in the programme."

Another strategy explored is social mobilisation. Experience from previous polio National Immunization Days (NIDs) shows that many children miss the opportunity to get vaccinated because they are taken to the market by their mothers. It is against this background that Eastern region was given support to organise immunisation sessions on market days on a trial basis in June and July of 2004. The funds were used for social mobilisation and motivation of the field staff. Table 3 shows that market day immunisations contributed 2 percent of Penta 3 and oral polio vaccine (OPV) 3 to the total number of children covered in the region. "These children would have been missed if the market operation had been ignored."

Click here to download the 17-page report in PDF format.