Experience in Ethiopia in conducting best practices measles campaign

Integrated Measles Best Practice SIA 2010/2011 Experience from Ethioipia Global Measles and Rubella Meeting, 15-17 March 2011, Geneva

Outline • • • • • •

Background Measles coverage and epidemiological situation Ethiopia SIA Experience SIA implementation/achievement SIA evaluation Opportunities and challenges

Ethiopia: Background • Projected population 2010 (census 2007): 79 million – – – –

Growth Rate: Under-1: Under-5: Under-15:

2.6% 3.2% (1.9m) 14.6% (11.4m) 45% (35m)

Federal Ministry of Health

Regional Health Bureaux (9 Regions + 2 City Administrations)

Zonal Health adminstration (98 Zones)

• Rural: 83% 819 Woreda Health Offices

• Infant Mortality Rate: 75/1000 live-births

15,000 Kebeles 1 health post per 5,000 population) :- The key for the success of the SIA

Reported Measles Cases and Measles Coverage- 1990-2009, Ethiopia 8000

Follow Up 2005 - 2009

90

Administrative Coverage (%)

7000

80

6000

70 60

5000

50

4000

40

3000

30

Cases

Measles Coverage

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

0

1994

10 1993

1000 1992

20

1991

2000

1990

Number of Measles Cases

Best practice 2010

Catch Up 2002 -2004

0

Measles Outbreaks - 2010 Vaccination status of confirmed measles cases. January – Dec 2010 1600 1400 1200 1000 800 600 400 200 0 Under 9 MOs

09mon 4 years

UNVACCINATED

05 to 09 years

10 to 14 years

Vaccinated

15 Years & above UNknown

Confirmed Measles cases January - Dec 2010

Measles SIAs: 2010-2011 • Target: 8.5 million children aged 9 – 47months

– 90.8% of target population in 2010

• Dates:

– 22 - 25 October 2010 – 18-21 February 2011

• Objectives of SIA:

– Give 2nd dose of measles vaccine – Identify ,implement and evaluate best practice SIA

• Integrated interventions: – – – –

OPV (0-59 months) Vitamin A (6-59 months) De-worming (24-59 months) Nutritional Screening (6-59 months and pregnant and lactating women)

2010 2011

Pre-Identified SIA Best Practices Coordination

Micro planning and Training

• National and sub national Task Force with subcommittee's led by government health bureau • Weekly updates from each level for management and monitoring of SIA

• Emphasis on Kebele level planning with identification of hard to reach and difficult populations • Participatory approach in training .

Logistics

Advocacy and Social Mobilization

• Required logistics available pre SIA with initiation of distribution 3-4 weeks before implementation • Flexibility in distribution mechanisms including transport fleet for emergency distribution

• • • •

High level political engagement Advocacy visit to regional presidents Evidence-based messages (KAP) Diverse channels of communication • radio, tv, town criers, house to house canvassing, schools, banners, IEC, mobile vans

Pre – Identified SIA Best Practices Monitoring and Evaluation • Pre campaign assessments (3-4 weeks and 1 week prior to SIA) and feedback given to address gaps • Different methods utilized to monitor performance: – Daily review meetings, with daily coverage reporting using SMS ( second phase)

• Administrative, rapid convenience monitoring, independent monitoring

Resource Mobilization • Significant Government contributions :- .017 cost per child • High level cooperation between EPI partners • Engagement of partners at all levels: o Human resources, transport, social mobilization, logistics

Implementation of Best Practice Integrated Measles SIA

Funding for 2010/11 Measles SIAs Funding from the Measles Initiative

Item

Total Budget (USD)

Vaccine and injection materials

5,371,901

Operational costs

6,464,204

746,219

1,502,205

Grand Total

11,836,105

746,219

1,502,205

Target population (< 5)

12,859,245

Cost per child (USD)

0.92

FMOH

Nutrition Partners (EOS)

UNICEF

Global Polio Initiative

3,345,097

2,026,804

2,101,540

1,364,240

750,000

2,101,540

4,658,097

2,776,804

WHO

Coordination activities:- weekly meeting A National task force led by the DG of Health Promotion and Disease Prevention Directorate, FMoH taking care of the coordination of preparation

Regional level task force led by RHB-PHEM head

Launching Activities

Implementation

SIA Administrative Coverage, Ethiopia, 2010-11 OPV Coverage

Measles Coverage >=95% 90-94%

80-89%

National coverage 106%

National coverage 97%

Independent Monitoring Assessment of Woreda Performance, Ethiopia 2010 Proportion of Children missed during the SIA

Number of woredas for measles vaccination

Number of woreda for Polio Vaccination

>10%

106

107

5-10%

67

79