Quick Links #11 Improving routine immunisation - lessons from reaching every district, community, child (RED/REC)

Below you'll find a brief list of just some of the polio communication resources related to reaching every district/community/child from The Communication Initiative for Pakistan and Afghanistan.

Hi Everyone

One of the major issues the December 2019 review of Afghanistan’s Immunization Communication Network (ICN) looked at was how best to respond to the bans imposed by anti-government elements (AGE) on house-to-house vaccination campaigns and the likelihood that fixed-site vaccination at health facilities would be a reality for some time to come.  Equally, interrupting Pakistan’s widespread outbreak is linked in part to improving essential immunisation coverage and building stronger ties between the polio programme and health facilities.  Both of these issues mean coming to terms with quite different approaches to vaccination – house-to-house, which ‘pushes’  vaccination out to caregivers, on the one hand, and fixed-site campaigns, which require ‘pulling’ caregivers to where the vaccine is available, on the other.  While there is a lot of overlap, these approaches require different forms of communication, training, and community engagement.  The polio programme has deep knowledge of how to do house-to-house campaigns.  However, approaches based on fixed-site plus outreach for routine immunisation may not be as well understood.

There has been considerable work done on how to maximise essential or routine immunisation coverage and a lot of success using RED (reaching every district) or REC (reaching every community/child), which focus on facility-based immunisation and outreach.  As the programmes in Afghanistan and Pakistan respond to the different challenges they face, having a greater understanding of the thinking and methods employed by RED/REC may provide useful insight and experience towards both adapting polio campaigns to maximise fixed-site coverage and to better integrating with, and providing support to, health facilities and essential immunisation efforts.

This Quick Links focuses on RED/REC with an overview of the strategy, a guide for its implementation, and analysis of its adaptation in different countries.

The RED Strategy

RED is a strategy to achieve the goal of 80% immunisation coverage in all districts and 90% nationally in the World Health Organization (WHO) member states. RED aims to fully immunise every infant with all the vaccines included in countries’ national immunisation schedule. In order to achieve this goal, the strategy focuses on building national capacity from the district level upward to maximise access to all vaccines and to address common obstacles to increasing immunisation coverage, with a focus on planning and monitoring. In brief, the RED approach encourages countries to use coverage data to conduct an analysis of the distribution of unimmunised infants and thereby prioritise districts with poor access and utilisation of immunisation. Districts are encouraged to make microplans to identify local problems and adopt corrective solutions.

Reaching Every District (RED) - A Guide to Increasing Coverage and Equity in All Communities in the African Region 2017 Edition

The purpose of this guide is to support countries to plan and implement the components of the RED approach so as to strengthen immunisation systems to sustainably and equitably increase access to and use of vaccination services (as measured by coverage rates and equity indicators).  It provides a set of tools and planning guides emphasising the following 5 areas (i) reducing inequity in immunisation coverage, (ii) integrating health services, (iii) delivering vaccines beyond infancy using a life course approach, (iv) focusing on urban, economically poor, and marginalised populations, and (v) paying special attention to insecure and conflict areas.

Additionally you may be interested in the following assessments and evaluations of RED/REC across a range of countries:

Exploring the Adaptation of the RED/REC Approach to Other RMNCH Areas in Haiti, Kenya, and Uganda 

This document summarises country experiences applying the RED/REC approach, highlights key enablers and challenges to adaptation, and presents recommendations for countries considering adaptation of the approach in the future.

An Evaluation of Immunization Services, Using the Reaching Every District Criteria, in Two Districts of Gujarat, India 

This report describes a qualitative assessment of clinic-level immunisation service delivery in 10 primary health centres (PHCs) located in 2 districts of Gujarat, India. Assessment criteria were derived from the RED strategy. Interviews with staff from the PHCs revealed several barriers to immunisation service delivery, including: (i) vaccine and supply stockouts; (ii) hard-to-reach communities; (iii) unreliable internet access; (iv) cold chain equipment malfunctions; and (v) inconsistently maintained and utilised immunisation records and registries.  This RED-based evaluation of the vaccine delivery system in Gujarat identified several points where the system was performing sub-optimally and possible solutions to these challenges.

From Reaching Every District to Reaching Every Community: Analysis and Response to the Challenge of Equity in Immunization in Cambodia

Based on a 2012 evaluation of RED in Cambodia, this paper discusses the importance of taking RED below district level to ensure vulnerable communities are not left out.  It recommends a shift in strategic and operational response that includes: (i) a re-focus of planning on facility level to detect disadvantaged communities, (ii) establishment of monitoring systems to provide detailed information on community access and utilisation, (iii) development of communication strategies and health networks that enable providers to adjust service delivery according to the needs of vulnerable populations, and (iv) securing financial, management, and political commitment for “reaching every community”.

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Quick Links archive on the Polio and Immunisation Network

For more information see:

CI Polio Network

GPEI Resources

UNICEFs Rhizome C4D site

Cheers

Chris

A note on Quick Links: 

Quick Links is a small experiment from The Communication Initiative that might help those working for polio eradication in Pakistan and Afghanistan identify useful knowledge on issues the programme is facing.  It is designed to be brief and not add too much to anyone's inbox.  Each email focuses on an area of particular importance to the Pakistan and Afghanistan programmes and presents brief descriptions of three resources that may be of interest or use to those of you working in the country.  The mailing list, by design, is quite small though anyone who's interested can send a request to cmorry@comminit.com and they'll be added to the list.  We also welcome suggestions and requests for specific topics to be covered and/or resources to be identified.