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Transitioning from
Reach Every District (RED) to
Reach Every Community (REC)
Dr. Zenaw Adam
Universal Immunization through...
WHY from District (RED) to Community
(REC)?
• Almost all districts have been reached
with RI
• There are still unreached p...
Concepts in moving from RED to REC
• Customize the approach to suit the context
• Address the “HOW” (facility level analys...
How to operationalize these concepts?
Main examples to be discussed
Ethiopia:
Using Quality Improvement
(QI) methodology t...
Ethiopia: RED to REC supported by health
system structure
• Community level structure
– administration with defined area &...
RED-QI: revitalize & operationalize RED by
adding quality improvement (QI) tools
• RED focuses on “WHAT” – to improve perf...
Putting the pieces together:
RED-QI to REC-QI
REC-QI
SupportiveSupervision
• QITs at management and service levels;
commun...
RED-QI: using Plan-Do-Study-Act (PDSA)
cycles
What are we trying to
accomplish?
How will we know that a
change is an impro...
RED-QI Continued
Quality Improvement Teams (QIT) in Ethiopia
• QITs at management and service levels.
• District Health Of...
RED/C-QI in action: examples
PDSA Experience in Hintalo Wajerate
district
A cluster of facilities (PHCU):1 HC, 6 HPs, ≈10 ...
PDSA Experience in HW district
CHANGE IDEA: visit each HH to register newborns,
unimmunized and defaulter children.
AIM: I...
Uganda: Mapping target populations
for facility catchment areas
• Macro mapping: a continuous process to identify and assi...
Macro-mapping process: How is it done?
1. District assembles key inputs
2. Prepare first draft of facility catchment area ...
Criteria for assigning communities to HF
1. Proximity of community to HF
2. Access to HF – geographic,economic
3. Capacity...
Micro-mapping process
1. Assemble key inputs (includes
macro map and list of static and
outreach RI service delivery point...
Results and Applications of Mapping Process
Enhances planning and monitoring:
– Provides accurate basis for RED microplann...
Results and Applications – District Example
RED/C-QI in Action: Examples
Zimbabwe: (Manicaland)
• Most populated province with low penta3 coverage of 52%
(2010 DHS)
•...
Operationalizing the REC Approach - Kenya
19
Continuous
monitoring process
includes essential
elements:
• Review meetings
...
Impact of REC in focus districts - Kenya
-1000
0
1000
2000
3000
4000
5000
6000
Bungoma
south
Vihiga Bungoma
North
Siaya Bo...
Conclusions
• Circumstances in Ethiopia and other countries are conducive
and timely for the transition of RED to REC.
• A...
Conclusions (continued)
• Brings together all EPI stakeholders,including non- traditional ones
– advocacy, resource mobili...
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Transitioning from reach every district to reach every community

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The presentation describes the expansion for routine immunization from district level to community level in Africa. Reaching remote communities is important to bring immunization to all children.

Publié dans : Santé & Médecine
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Transitioning from reach every district to reach every community

  1. 1. Transitioning from Reach Every District (RED) to Reach Every Community (REC) Dr. Zenaw Adam Universal Immunization through Improving Family Health Services (UI-FHS) – Ethiopia/ JSI Research &Training Institute Inc. EPI Manager’s Meeting for East and Southern Africa March 9-13 2015,Victoria Falls- Zimbabwe Ethiopia
  2. 2. WHY from District (RED) to Community (REC)? • Almost all districts have been reached with RI • There are still unreached pockets of areas and children who are un/under- vaccinated • The need for new & flexible approaches focusing on equitable services in underserved areas Reaching target populations Linking services with communities Supportive supervision Monitoring for action Planning and management of resources
  3. 3. Concepts in moving from RED to REC • Customize the approach to suit the context • Address the “HOW” (facility level analysis,prioritization..etc.) • Build capacity & partnership between health teams,local governments and communities • Build capacity of local health teams to analyze & use own data to improve situation
  4. 4. How to operationalize these concepts? Main examples to be discussed Ethiopia: Using Quality Improvement (QI) methodology to mobilize volunteers to identify all children needing vaccination Uganda: Mapping target populations and health facility catchment areas for effective immunization microplanning
  5. 5. Ethiopia: RED to REC supported by health system structure • Community level structure – administration with defined area & population • Community part of local administration – Membership in kebele cabinet, command post,steering committee • Health service structure to community level – Primary Health Care Unit (PHCU) – HCs and HPs • New Community structures: HDAs & 1-5 network
  6. 6. RED-QI: revitalize & operationalize RED by adding quality improvement (QI) tools • RED focuses on “WHAT” – to improve performance • QI focuses on “HOW” - the process of problem analysis, prioritization and seek local solutions – Break large problems to smaller,more “do-able” pieces – Identify small scale changes, promising practices and data to share with peers on a regular basis – Process improvements: find positive deviance examples, local solutions,contextualize and test others’ successes
  7. 7. Putting the pieces together: RED-QI to REC-QI REC-QI SupportiveSupervision • QITs at management and service levels; community membership • Bottom-up microplanning : key in district and facility planning • Data analysis using RED categorization tool,and its use at district,HC and HP levels • Supportive supervision (PBSS/ISS) • Quarterly and monthly review meetings (QRMs)
  8. 8. RED-QI: using Plan-Do-Study-Act (PDSA) cycles What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement PlanAct DoStudy • Identify problems and detailed analysis (fishbone analysis) • Prioritize the problems • Select a problem and list change ideas for solutions • Implement one change idea for a short period & study results • Then Adopt,Adapt (orAbandon) the change ideas
  9. 9. RED-QI Continued Quality Improvement Teams (QIT) in Ethiopia • QITs at management and service levels. • District Health Office (management only) • Health Center (management and service) • Health Post at community level (service only) • QIT at community level is particularly crucial • Women with their network(s) are key members
  10. 10. RED/C-QI in action: examples PDSA Experience in Hintalo Wajerate district A cluster of facilities (PHCU):1 HC, 6 HPs, ≈10 OR – 25,000 population • 4,600 women aged 15-44 • 560 children <1 yr – Providers:6 HEWs,24 community volunteers – Support by women’s group (WDA),each leading sub-groups of ‘one-to-five’ networks
  11. 11. PDSA Experience in HW district CHANGE IDEA: visit each HH to register newborns, unimmunized and defaulter children. AIM: Increase coverage from 85% to 95% in 3 months • Plan: QIT meetings:health workers and community • Do: EnlistedWDAs to go house to house to list <1 children • Study: • 25 defaulters found and vaccinated • 68 newborns and never-immunized found; follow up with 45 of unimmunized starting vaccination • Productive community effort improved coverage • Act: Adopt the change idea and apply for other programs
  12. 12. Uganda: Mapping target populations for facility catchment areas • Macro mapping: a continuous process to identify and assign communities (parish level) to facilities to enable effective health service delivery • Micro mapping: a continuous process to identify and assign communities (village level) within a health facility catchment area to RI service delivery points,both static and outreach
  13. 13. Macro-mapping process: How is it done? 1. District assembles key inputs 2. Prepare first draft of facility catchment area macro map 3. Build consensus on macro map
  14. 14. Criteria for assigning communities to HF 1. Proximity of community to HF 2. Access to HF – geographic,economic 3. Capacity of HF to serve communities - RI • Transport • Health workers • Adequacy of vaccines & supplies 4. HF already providing services
  15. 15. Micro-mapping process 1. Assemble key inputs (includes macro map and list of static and outreach RI service delivery points) 2. Prepare first draft of facility micro map: 3. Harmonize and build consensus on micro map
  16. 16. Results and Applications of Mapping Process Enhances planning and monitoring: – Provides accurate basis for RED microplanning – Enables identification of communities previously unreached with RI – Improves efficiency of resource allocations – Strengthens community links to RI services – Improves convenience of RI services to caretakers and fosters better communication – Provides target populations for other services
  17. 17. Results and Applications – District Example
  18. 18. RED/C-QI in Action: Examples Zimbabwe: (Manicaland) • Most populated province with low penta3 coverage of 52% (2010 DHS) • MCHIP PHO collaborated to implement RED components – RED micro planning in all districts – VHWs mobilize eligible infants and trace defaulters – Conducted regular supportive supervision – HFs updated monitoring chart monthly – HFs defined target population-counting of kids usingVHWs • Provincial penta 3 coverage >80% in 2013 (c.survey)
  19. 19. Operationalizing the REC Approach - Kenya 19 Continuous monitoring process includes essential elements: • Review meetings • Peer-learning • Self-assessment
  20. 20. Impact of REC in focus districts - Kenya -1000 0 1000 2000 3000 4000 5000 6000 Bungoma south Vihiga Bungoma North Siaya Bondo Rachuonyo Kisumu East No.Ofchildren District Number of under-vaccinated children (with Penta 3), 2009-2012 2009 2010 2011 2012
  21. 21. Conclusions • Circumstances in Ethiopia and other countries are conducive and timely for the transition of RED to REC. • Applying QI to REC provides an effective tool to operationalize and revitalize the strategy • REC-QI approach combines ‘WHAT’ & ‘HOW’ to strengthen the RI system and fosters local solutions and ownership of the program
  22. 22. Conclusions (continued) • Brings together all EPI stakeholders,including non- traditional ones – advocacy, resource mobilization • RED-QI encourages innovation and is applicable to all other family health services • Peer learning on REC-QI and incorporation of innovations into national policies,guidelines and tools is enhanced by working at national and subnational levels

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