AddressingAddressingAddressingAddressing

Missed

Opportunities for

Vaccinationto Reduce Coverage Gaps;

Experience in AFRO

3

Is MOV a

problem?

4

What is the

proportion of

MOV?

Background

on MOV

Four main points to touch on today

MOV

partnership

MOV

assessment

findings

Country

Example:

DRC

Main components of the MOV strategy

Coordination among partners and countries to scale up

and maximize impact

8

The 10The 10The 10The 10----step process of the MOV strategystep process of the MOV strategystep process of the MOV strategystep process of the MOV strategy

Reducing Missed Opportunities for

Vaccination12

Chad Burkina FasoMalawi Kenya

DRC Nigeria Mozambique Zimbabwe

Angola MadagascarMauritania South Sudan

37%

51%

88%

76%

61%

93%

72%

48%

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Chad Malawi Burkina Faso Kenya DRC

(Kinshasa)

DRC

(Mbuji Mayi)

Mozambique Nigeria

(Delta)

Nigeria

(Sokoto)

Proportion of children with 1+ MOV*

17

*Among children not up-to-date before visit

Proportion of children with 1+ MOV* at a vaccination visit

18*Among children not up-to-date before visit

Chad Malawi Burkina Faso Kenya Kinshasa Mbuji Mayi

DRC

28% 31%

56%

30%

55%77%

Delta Sokoto

Nigeria

Mozambique

90% 17%

n=43 n=21

19%

n=55n=30n=92 n=14

n=33 n=186

25% 25%

n=10

80%21%

n=7

14%

n=26

MOV* by reason for visit

19*Among children not up-to-date before visit

Medical consultation

100%

89% Kinshasa, DRC

Burkina Faso

Kenya

87%

Accompanying a

caregiver

100%

Malawi

Kenya

Kinshasa, DRC

Healthy child visit

100%

89%Malawi

Kinshasa, DRC

Mbuji Mayi,

DRC

Summary of reasons for MOV

Health care

workers• Failure to screen

• False contra-indications

• Vaccine wastage• Delayed schedules

• Over-aged children

Health

services

• Limited hours

• Shortage and stock-outs

• Lack of integration• Poorly-designed

records

• Other adverse policies

• Vaccination card availability

Caregivers

• Vaccine hesitancy

• Lack of knowledge of vaccines and schedules

• Vaccination card to clinic

21

Interventions

to reduce MOV

Main strategy to reduce MOV Main strategy to reduce MOV Main strategy to reduce MOV Main strategy to reduce MOV

Screen and vaccinate!!!

OR

Screen and refer to vaccination area!!!!

Reducing Missed Opportunities for Vaccination 22

Policy Health workers

Service delivery Relocate vaccination

rooms to be more visible

Establish screening

desks in health facilities

Ensure adequate stocks of

vaccines and supplies

Stock management

Health worker trainings to

include staff outside of EPI

Centralised procurement

Update EPI manuals, policies

and SOPs to address MOV

Increase supportive supervision

Dashboard for vaccine stock

checks and requests

MOV job aids

Advocate for integration of

services

Community engagement

Capacity building

Successful MOV Successful MOV Successful MOV Successful MOV aaaassessment modelsssessment modelsssessment modelsssessment models

• Chad, Malawi, Kenya, Kinshasa (DRC),

Nigeria

Full on-site

support by WHO

Full on-site

support by WHO

• Burkina Faso, AMP…no formal WHO training

• Mozambique, VillageReach

Remote support

of assessment

coordinator

Remote support

of assessment

coordinator

•Mbuji Mayi (DRC), WHO staff …with remote

support from WHO

•Zimbabwe, WHO staff, MoH and JSI

Use of trained

assessment

coordinator

Use of trained

assessment

coordinator

25

DRCDRCDRCDRCMOV implementation and

results achieved so far

MOV* by reason for visit, DRCMOV* by reason for visit, DRCMOV* by reason for visit, DRCMOV* by reason for visit, DRC

27

89%

55%

89%

100%

61%

95%

77%

100% 99%

93%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Medical

consultation

Vaccination Healthy child visit Accompanying All Reasons

Kinshasa Mbuji Mayi*Among children not up-to-date before visit

Nine activities to reduce MOV…

1. Trained 3 staff members from 19 health zones and 678 health workers

(including non-EPI staff) on routine EPI activities to reduce MOV

STATUS

2. Provide continuous training through formative supervision including

MOV activities

3. Promote national EPI guidelines for children aged 0-24 months

4. Support the implementation of guidelines to reduce MOV for all

children

5. Intensify communication with parents about vaccination

6. Provide solar refrigerators for all health facilities

7. Transport vaccines in all health areas

8. Ensure free health cards are available in all health facilities

9. Ensure motivation of providers (financial or non-financial)

…including use of “tokens” for screening children visiting a health facility

-

2,000

4,000

6,000

8,000

10,000

12,000

Jan Feb Mar Apr

2016 2017 2018

MOV training in KinshasaMOV training in KinshasaMOV training in KinshasaMOV training in Kinshasa----West West West West ledledledled totototoin the in the in the in the numbernumbernumbernumber of DTP3 doses of DTP3 doses of DTP3 doses of DTP3 doses

5,089 additional doses in 2018

MOV in an urban health zone

31

Thank you

WHO

20, Avenue Appia1211 Geneva

Switzerland

Thank you and spread the word

For more information visit:

http://www.who.int/immunization

/programmes_systems/policies_strategies/MOV/en/