Research #3 - Non-Government Organization
- Ang Yong Xiang Adwin
- Oct 23, 2018
- 5 min read
After looking at Government policies, I will have to look at this challenge from another perspective which is the Non-Government Organization.
RED Strategy (Reaching Every District) - WHO
RED strategy is created a with a goal of 80% immunization coverage in all districts and 90% nationally in WHO member states.
The strategy focuses on building national capacity from district level upward to maximize access to all vaccines, old and new.
The strategy addresses common obstacles to increasing immunization coverage such as poor quality district planning, low quality and unreliable service, inadequate monitoring and supervision of health workers.
There are Five RED operational components
1. Re-establishing outreach services
According to WHO, a large proportion of the populace in many countries only have access to immunization through outreach sessions. Outreach is any delivery strategy that requires health facility staff to leave their facility to deliver immunization.
Ideally a minimum of four contacts per year are required to fully immunize an infant. However, in certain communities, such contacts are provided irregularly and may require mobile teams to provide outreach, which will involve resources beyond the health facility and district level.
2. Supportive supervision
Supportive supervision implies providing on site training to health workers at the time of a supervisory visit, or at regular district meetings. To be supportive, supervisors should make regular schedules for visits, help to solve problems locally and follow up regularly with supply and resource issues. Supervisors will themselves need training to adapt their own approaches to supervision.
3. Linking services with communities
Involving the community with the planning and delivery of the service will encourage community ownership and improve attendance. Identifying community volunteers providing them with a role, such as follow up of defaulters, and holding regular meetings is an important step towards building a link with the community.
4. Monitoring and use of data for action
Monitoring and use of data for action implies not only the timely collection of data at district level, but the use of the data to solve problems. Some simple tools, including wall charts that display access and utilization need little training, but are very useful to take action according to monthly progress. Not only do districts collect coverage data, but also a large amount of other information, including logistics, supply, surveillance, all of which should be used to improve the immunization system. Some qualitative data may not be available in regular reports and may need to collected though supervisory visits.
5. Planning and management of resources
The district micro-plan is the key to the RED strategy. The micro-plan should be based upon a local situation analysis which involves every health facility and through them the community that they serve. At the national level, there is a responsibility to ensure the needed financial and human resources are available to the district, while the district must ensure the resources are efficiently used, through regular monitoring and adjusting the micro plan. Continuing to fund the RED strategy for more than the first year of implementation is vital for sustainability of coverage increase.
My thoughts
There are many potential areas of note in this strategy that WHO has implemented. Such as the maintaining of outreach services and keeping such services more regularly are areas whether it can better managed with technology. Such as tracking of regions where outreach service has been implemented, utilizing data visualization technology for easier management which is similar to the 4th component but with slightly different reason. Having such system in place would also allow easier coordination in all countries as a whole.
There many ways we aid in linking services with communities as well, such providing an app or a website etc. which the communities can use to access services. Which is what the original idea was for.
The monitoring and usage of data for action is something we can consider and explore, as there are many forms of data gathering methods and using those to display in a more effective manner.
Planning and management of resources is an area which was pointed out by the SAP, where tracking of vaccines is also crucial to aiding in a pandemic.
Missed Opportunities for Vaccinations (MOV) Strategy
The MOV strategy aims to reduce missed opportunities and therefore increase immunization coverage by making better use of existing vaccination sites
Missed opportunities for vaccination can occur:
During visits to health facilities/mobile health services for immunization services (“vaccination contact”);
During visits to health facilities/mobile health services for curative services (e g treatment of mild fever, cough, diarrhoea, injuries; “treatment contact”);
During visits to health facilities/mobile health services for other preventive services (e g growth monitoring, nutrition assessments and oral rehydration training sessions, etc ); and
While accompanying a family member to a health facility for any type of service
Principles
1. Focus on implementing actions at the local level, where most of the reasons for missed opportunities for vaccination are identified
The MOV strategy is based on a bottom-up approach that obtains information on the reasons for MOV from service providers and the users of health services, at the health facility level The strategy uses a participatory research approach to obtain the commitment, and leverage the knowledge and experience of the local staff and users to resolve identified issues When health workers and local communities take ownership and responsibility for reducing missed opportunities, the impact on the number of children vaccinated is augmented
2. Emphasis on country leadership
MOV assessments should not be performed as stand-alone research projects by an academic institution Every effort should be made to have the Ministry of Health (MOH)’s Expanded Programme on Immunization (EPI) team incorporate reducing MOV into their programme improvement plans and to use the MOV strategy to optimize health service processes, policies and mechanisms In order to achieve long-term gains, the MOV strategy in each country begins with a country-led assessment of why opportunities for vaccination are missed It then specifically addresses the issues identified using locally- tailored interventions The MOV strategy is designed to be low-cost and action-oriented It is intended to be supported at the national and sub-national levels and implemented and managed by the health facility staff
3. Capitalization on existing platforms and builds synergies
The MOV strategy should be integrated with other ongoing country work plans and activities for increasing routine vaccine coverage and improving vaccination timeliness and coverage equity
Where applicable, the MOV strategy can be built into health systems strengthening activities, to take advantage of synergies with other non-immunization services/programmes The MOV strategy should not be viewed as a stand-alone or discreet project, but rather as complementary to existing microplanning and programme improvement approaches such as RED (‘Reaching Every District’) The focus on health facilities seeks to improve the management, organization and integration of service delivery at the lowest level possible As a result, the coverage of other primary health services can also be improved.
4. Investment in sustainable monitoring and supervision
Reducing MOV requires an investment in regular monitoring of coverage and frequent supportive supervision from the next higher level of the health system It is important to monitor the number of children vaccinated, to compare this from month to month, and to compare similar months from year to year All facilities should track monthly vaccination coverage using standard monitoring charts These monitoring charts should be large enough to be displayed and visible to all users of the health facility as well as for review during community meetings (See MOV Intervention Guidebook for a sample monitoring chart)
My Thoughts
This strategy brings up another interesting area of focus that we can better develop our idea towards. Almost every single individual at some point in time would have interacted with doctors for simple check-up. The key strength of this strategy is to switch up the perspective of the people who implements this strategy, focus on people who visits health facility, rather than getting people to visit the health facility. This strategy is cheap to implement rather than having to spend budget on flyers, social media advertisement etc. etc. which results in higher cost. This is a perspective that I believe is worth exploring more into.
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