Progress in routine immunization in the

African Region

Annual Measles Partnership meeting

Feb 2007Washington DC

2Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Immunization coverage in AFR. 2001 - 2006

3Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

0

10

20

30

40

50

60

70

80

2001 2002 2003 2004 2005 2006

% c

over

age

Angola DR Congo Ethiopia Nigeria

Measles vaccination coverage in the big 4. AFR. 2001 - 2006

4Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

• Low quality of service

• Inadequate training and supervision

• little or no outreach services,

• links with the community not systematic

• Inadequate monitoring system

• district disparities not reflected in national coverage data

• Lack of district micro-planning

Key barriers to achieving high coverage

5Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Reaching Every District Strategy:operational components

• Re-establishment of outreach services

• Supportive supervision

• Community links with service delivery

• Monitoring and use of data for action

• Planning and management of resources

6Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa6

Support to scale–up RED implementation

• 90% districts in AFR implementing all components

of RED in 2006

Country Total Districts # RED Districts

2005 2006

Angola 164 60 82

DRC 505 339 503

Ethiopia 85 57 65

Nigeria 774 0 475

RED in the Big 4

7Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Immunization financing

• Increasing immunization self- financing

– More countries have line item in the national

budget for vaccine purchase

• More partner support and better utilisation of

funding

– Important funding gaps still remain

8Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Financing Profile for Routine EPI support. AFR. 2006

9Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

MP support for Routine EPI

• Measles Partnership support for routine EPI amounting

to 10% of operational costs coming through the WHO

• Supporting the implementation of RED strategy

– Micro-planning process

– Re-establishment/ scaling up of outreach activities

– Training of health workers

– Monitoring (monthly/ quarterly meetings)

10Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa10

2005: 73%

DPT3 Coverage. AFR. 2005 – Nov 2006

2006* : 75%

*Source: 2006 EPI Monthly report

NDND

<50%

50 - 79%

>= 80%

EMRO

>= 90%

25%

71%

63%

11Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa11

District EPI performance by block. AFR. Jan - Nov 2006

Block

% of districts achieving DPT-3 coverage

>=80% 50%-79% <50%

Western 61% 26% 13%

South/ Eastern

66% 26% 8%

Central 53% 26% 21%

12Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa12

Reported district level DPT3 coverage Jan-Nov 2005 vs 2006,

Big Four Countries

13Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

ND

Measles coverage. AFR. 2005 – Nov 2006

2005: 68%

50 - 79%

EMRO

<50%

>=80%

ND: No data

2006*: 74%

ND

* Source: 2006 EPI Monthly report

14Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Changes in measles coverage between 2000 – 2006. AFR

• Increase in coverage; 33 countries

• Increase by > 25% of 2000 figures: 25 countries

• Decline in coverage; 8 countries

• (Eq G, Angola, Tanzania, Zambia, Zimbabwe..)

15Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

5 country RED evaluation (2005)Key findings

• In 4 of 5 countries, RED was initiated using available data to

prioritize districts

• In 4 countries, immunization coverage increased by >/= 10%

points

• In MAD, a decline in national coverage. However, RED had a

protective effect in the target districts

• Successful introduction of RED; contingent on availability of

funds for training,micro-planning…

16Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Challenges

• Resource limitations• Funding, health workers, vehicles, …

17Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa17

Way forward

• Continue to focus on the Big 4 (particularly Nigeria and

Angola), and the central block

• Support member states to scale up the implementation

of all 5 components of the RED in all districts

• Support countries to improve the quality of routine

immunization data through the DQS

• Continue to encourage governments to invest in EPI

18Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Issues for discussion

• Recognizing the role of the routine immunization (“keep-up”) in sustaining the gains in measles mortality reduction:

– Can MP help bring in more donor support for routine EPI?

– How can countries be supported to focus activities in high risk districts?

19Bureau Régional de l’OMS pour l’Afrique / WHO Regional Office for Africa

Thank you