strengthening routine as a motor for other interventions a report from côte d’ivoire partners for...
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Strengthening Strengthening Routine as a Routine as a Motor for other Motor for other InterventionsInterventions
A report from A report from CCôôte d’Ivoirete d’Ivoire
Partners for Measles Advocacy 8Partners for Measles Advocacy 8thth Annual Meeting Annual Meeting Washington DC, 23 – 24 September 2008Washington DC, 23 – 24 September 2008
Maya van den Ent, PharmD, MPH, UNICEFMaya van den Ent, PharmD, MPH, UNICEF Alphonse Toko, MD, UNICEFAlphonse Toko, MD, UNICEFEdward Hoekstra, MD, MSc, UNICEFEdward Hoekstra, MD, MSc, UNICEF Paul Basikila, MD, UNICEFPaul Basikila, MD, UNICEFRownak Khan, MD MPH, UNICEFRownak Khan, MD MPH, UNICEF Epa Kouakou, MD, UNICEFEpa Kouakou, MD, UNICEF
UNICEF
Outline
Country situation of Cote d’Ivoire
Measles campaign micro-planning
Routine immunization
Integration of High Impact Interventions with RI
Can measles campaign strengthen Can measles campaign strengthen
routine immunization & health systems?routine immunization & health systems?
UNICEF
Cote d’Ivoire
Zones under control of impartial forces
ABIDJAN
TIASSALEAGBOVILLE
BANGOLO
BEOUMIBIANKOUMA
BOUAFLE
BOUAKE
BOUNA
BOUNDIALI
DABAKALA
DALOA
DANANEDIMBOKRO
DIVO
DUEKOUE
FERKESSEDOUGOU
GAGNOA
GUIGLOISSIA
KATIOLA
KORHOGO
LAKOTA
M'BAHIAKRO
MAN
MANKONO
ODIENNE
OUME
SAKASSOU
SAN PEDRO
SASSANDRA
SEGUELA
SINFRA
SOUBRE
TABOU
TIEBISSOU
TOUBA
TOUMODI
VAVOUA ZUENOULA
TOULEPLEU
BONDOUKOU
ADZOPE
ABOISSO
TANDA
BONGOUANOU
ALEPE
ADIAKE
ABENGOUROU
BOCANDA
AGNIBILEKROU
TENGRELA
YAMOUSSOUKRO
GRAND-LAHOUZones under control of FAFN
Zones under control of the government
DPT3 coverage: 16%
Zone affected by war
National DTP3 coverage 50% in 2004
UNICEF Focal point (TA)
UNICEF
Health facilities offering services
579
302
395
447
497513
0
100
200
300
400
500
600
Nu
mb
er
of
he
alt
h f
ac
ilit
ies
before crisis Aug 04 Dec 04 Mar 05 Jun 05 Oct 05
Number of health facilities, offering health services in the zone affected by the crisis
Measles catch-up campaign
Aug 05
UNICEF
Capacity building through measles catch-up campaign
Micro-planning
Training Health Workers on vaccination, injection safety
Training of Community Health Workers
Cold chain• National and 2 regional freezer rooms• 224 Refrigerators and freezers for HC • Reparation & maintenance of cold chain
equipment
Building of 4 incinerators
UNICEF
Measles micro-plan
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
>15km
5-15km
<5km
Map outMap outWhere, Where,
How many How many Children Children
livelive
UNICEF
Diarrhea
Malaria
MeaslesPneumonia
Neonatal
Others
Diarrhea Malaria Measles Pneumonia Neonatal Others
Why do Ivorian children die?
UNICEF
Coverage of 7 interventions
4%
10%
0%
0%
0%
16%
16%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AnteNatalCare3
TT2+
ITN use
De-worming
Vitamin A
DPT3
Measles 1
missed opportunities
Rationale for integration of other interventions (2004 crisis affected districts) *)
Source : DC-PEV, RH Cote d’Ivoire (administrative data)
UNICEF
Coverage of 7 high impact interventions
6%
0%
28%
76%
82%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
ITN use *)
Vitamin A §)
DPT3 *)
Measles 1 *)
missed opportunities
missed opportunities
missed opportunities
Rationale for integration of other interventions (2006)
Source: (1) MICS 2006 & (§) DC Nutrition Reporting data (routine program)
UNICEF
Possible reduction in child mortalitycoverage % CMR increase
reduction
• Measles 16 – 82% 2.8%
• Vitamin A supplementation 0 – 82% 3.3%
• ITN use 10 – 60% 9%
• Source: MBB
UNICEF
Micro – planning EPI+ & Focused ANCWHERE & HOW MANY?
Mapping of population & un - reached children per localityWHEN?
Planning of outreach sessions, with community membersWHAT?
– Bundled vaccines– Vitamin A– De-worming tablets– ITNs– SP for IPTp– Iron tablets
HOW? Fuel and per diem
UNICEF
Guidelines for micro-planning
CANEVAS DE MICROPLANIFICATION DES ACTIVITES PREVENTIVES DE L’AIRE DE SANTE A . ANALYSE DE LA SITUATION I . INFORMATIONS GENERALES SUR L’AIRE DE SANTE
JJ MM AAAA Date _______/______/_______
1.1. Nom de l'Aire de Santé : 1.2. Type de l’ESPC* : Urbaine /____/ Rurale /_____/
1.3. Nom du district sanitaire : 1.4. Nom de la région sanitaire :
1.5. Nom du Responsable Centre de Santé :
1.6. Distance entre le village le plus éloigné et le Centre de Santé (Km) 1.7. Distance entre le village le plus proche et le Centre de Santé (km) * Etablissement Sanitaire de Premier Contact 1.8 Population de l’aire de santé
a) Population totale
c) Pop. d’enfants de 0-11 mois (2,95% de pop. totale)
d) Pop. d’enfants de 12-23 mois (2,56% de pop. totale)
e) Pop. d’enfants de 0-59 mois (17,39 % de pop. totale)
f) Pop. d’enfants de 6-11 mois (1.5 % pop. totale)
g) Pop. d’enfants de 12-59 mois (14.44% de pop. totale)
h) Pop. des femmes 15-49 ans (23,26 % pop. totale)
i) Population des femmes enceintes (5% de pop. totale)
j) Population de naissance attendu (4,7% de pop. totale)
k) Pop. d’enfants de 6 mois 14 ans (43,58 % pop. totale)
l) Source d’information des données démographiques
Situation analysis ofDemographics,
Human Resources,Performance &
Development of micro-plan
At Health Facility level
UNICEF
Objectives of the micro - plan
Results based planning with
coverage of intervention as outcome
At Health Facility level
UNICEF
Outreach plan MBengue (1)Centre de sante: CSU M'Bengué
1 M'Bengue 7687 227 19 384 32 0 150Souhouo 334 10 1 17 1Souhoua 147 4 0 7 1
Total strategie fixe 8167 241 20 408 34 5 0 150 8 0circuit 1 582 17 1 29 2 0.5 20 0.5 1,500
Fondo I 145 4 0 7 1 20Fondo II 0 0 0 0 0 14
1 Sindjougou 437 13 1 22 2 20circuit 2 269 8 1 13 1 0.5 30 0.75 1,500 1 Tietougou 269 8 1 13 1 30
Total S. Avancee 851 25 2 43 4 1 50 - 1.3 3,000 circuit 3 1,840 54 5 92 8 1 48 2 3,000
Gara I 0 0 0 0 0 40Gara II 0 0 0 0 0 48Loukpoho 0 0 0 0 0 48Sandrigue 1840 54 5 92 8 34
circuit 4 1368 40 3 68 6 1 38 1.9 3,000 Kassalgue 417 12 1 21 2 38Sanhara 388 11 1 19 2 34Soleyaha 563 17 1 28 2 32
Autre 176 5 0 9 1 0 34Korloho 0 0 0 0 0 28Wiriguevogo 0 0 0 0 0 28Woklo 0 0 0 0 0 26Yenifori 0 0 0 0 0 26N'Golokaha 176 5 0 9 1 34
Total S. Mobile 3,385 100 8 169 14 2 48 - 4.3 3,000 Total aire de santé 12,403 366 30 620 52 8 98 150 13 6,000
% réel PC affecté à SF 66%% réel PC affecté à SA 7%% réel PC affecté à SM 27%
Carburant mensuelPop cible 0-
11 mois mensuel
Pop cible Femmes enceintes
annuel
Pop cible Femmes enceintes mensuel
Distance CS-Village A/R
ou circuit(km)
Distance CS-DS A/R
Population totale 2006N°
Quartiers /villages
Pop cible 0-11 mois annuel
CollationNo seances ou sortie par
mois (arrondi)
WHERE&
HOW MANY
UNICEF
Outreach plan MBengue (2)
S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S4S1S2S3S41 M'Bengue Dispensaire
SouhouoSouhoua
Total strategie fixecircuit 1
Fondo I Chef de villageFondo II Chef de village
1 Sindjougou Chef de villagecircuit 21 Tietougou Chef de village
Total S. Avanceecircuit 3
Gara I Chef de villageGara II Chef de villageLoukpoho Chef de villageSandrigue
circuit 4Kassalgue Chef de villageSanhara Chef de villageSoleyaha Chef de village
AutreKorlohoWiriguevogoWokloYeniforiN'Golokaha
Total S. Mobile
2x
N°Quartiers /villages
Dates de passage des équipes
decjan fev juillet aoutLocalisation site de vaccination
novoctsepmars avril mai juin
WHEN
UNICEF
Input needsStratégie Opérationelle: SYNTHESE DE L'AIRE
Doses Nb Bte/Flacon Nb Bte/Flacon arrondi
BCG 0-11 mois 293 24 flacon de 20 dose 61 3.0 8DTC 0-11 mois 293 24 flacon de 10 doses 122 12.2 25POLIO 0-11 mois 293 24 flacon de 10 doses 122 12.2 23VAR 0-11 mois 293 24 flacon de 10 doses 41 4.1 10FJ 0-11 mois 293 24 flacon de 10 doses 41 4.1 10VAT FE 434 36 flacon de 20 dose 120 12.0 13Seringues BCG 0-11 mois (BCG) 293 24 boite de 100 34 0.3 3Seringues Autobloquante0-11 mois / FE (DTC_HepB, VAR, FJ, VAT) boite de 100 270 2.7 9Seringues a dilution 0-11 mois / FE (VAR, FJ) unite 11 11.2 37Boites de securite 0-11 mois / FE (BCG, DTC_HepB, VAR, FJ, VAT) unite 3 2.7 9
VIT A 100.000 UI 6-11 mois 293 24 34 0.1 3Vit A 200.000 UI 12-59 mois 1,433 119 1 fois tous les 6 mois 328 0.7VIT A 200.000 UI Femme en Post-partum Immediate 408 34 2 doses en 24 heures 85 0.2
Fer/Folate FE 434 36 boite de 1000 comp 4,070 4.1 9SulfoPyri FE 434 36 boite de 100 comp 271 2.7 4Mebendazole 500 mg 0-11 mois et FE 727 61 boite de 100 comp 76 0.8 4MII 0-11 mois et FE 690 58 unite 72 71.9 105
Nb litre Cout FCFA14 8,795
Nb de sortie Cout FCFA3.0 6,000
TOTAL 14,795
3
Cible par mois
ObservationAntigènes Besoins
Carburant
Collation
Groupe cibleCible
par an
WHAT &
HOW
UNICEF
Results – Districts affected by crisis & Abobo (Abidjan) & San Pedro
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
# o
f c
hild
ren
va
cc
ina
ted
BCG DTPHepB Measles Yellow Fever
2004 2005 2006
6,431 more children vaccinated6,431 more children vaccinated 26,554 more children vaccinated26,554 more children vaccinated
Objective 60% for 2006Objective 60% for 2006
UNICEF
In summaryIn summary
• Measles campaign micro – planning can Measles campaign micro – planning can be applied to routine activitiesbe applied to routine activities– Tailor outreach activities by health facilityTailor outreach activities by health facility
• Use data for choosing type interventions Use data for choosing type interventions and set targetsand set targets
• Measles vaccinations (campaign and Measles vaccinations (campaign and routine) are optimal moments to deliver routine) are optimal moments to deliver other life saving interventionsother life saving interventions– Reduce child mortality even moreReduce child mortality even more
UNICEF
Measles InitiativeMeasles Initiative Working Together to Save Lives Working Together to Save Lives
JapaneseGovernment
Ministère de la Santé – Cote d’Ivoire