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/