Syria- Strategies to reach
- Anonymous
- Jan 22, 2018 at 10:44 PM
TRANSFORMATIVE INVESTMENT
Strategies to reach: Invest in tailored strategies that identify undervaccinated and unvaccinated persons and regularly provide them with the vaccines they need.
in Syria 1 out of 3 children not reached by routine vaccination. DTP3 coverage in some hard to reach areas dropped to 45%, drop out rate is not within the recommended acceptable norms as it exceed 35%.
Polio outbreak took place in Oct 2013, index case was from Aleppo, and last case was registered in Jan 2014 in Hama. Still in Polio risk assessment Syria is classified as high risk. Reaching undervaccinated and unvaccinated persons is paramount as the country reported many cDPV which shows continuous circulation of polio.There was measles outbreak in Dec 2012 and still the countrey continue to report cases. Around 70 per cent of primary health care services are damaged and out of services.
Prioritization
Prioritization
my initial set of 10 strategies were:
- Detecting and serving unreached or marginalized populations,communities and individuals.
- Identify and examine reasons for unvaccinated and undervaccinated populations.
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Update microplans to ensure that all communities are included and targeted within session plans.
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Apply Periodic Intensification of Routine Immunization (PIRI) in settings requiring rapid, short-term coverage improvement or “catch up” missed vaccinations.
- Building the capacity, motivation and professional development of vaccinators and mid-level managers.
- Ensuring excellence in national programme leadership and management.
- Maintain a functioning cold chain and vaccine distribution system.
- Monitoring programme performance and disease occurrence.
- Engaging communities and creating demand for vaccination
- Mobilizing and communicating for vaccination.
from my initial 10 strategies I selekted these three:
strategy 1: Detecting and serving unreached or marginalized populations, communities and individuals.
The situation in Syria is very complicated as we have a lot of fighting forces on ground even within the same group, this makes access very dificult in some hard to reach or besieged areas. furthur more some extrimities groups set immunization as a forbidden action and people are not allowed to vaccinate their children. detecting and serving children in such condition is a vital intervention in order to provide immunization equity and maximize the reach.
strategy 2: Engaging communities and creating demand for vaccination
Lack of access and insecurity of health workers; they are targeted all over the country and no matter where they are, brain drainage outside the country and loss of profissionals raise the need for better involvement of communities and better engagement of very good accepted local authorities mainly head of clans and religious leaders in particular in in hardly and besieged areas.
strategy 3: Maintain a functioning cold chain and vaccine distribution system.
Around 70 per cent of primary health care services are damaged or out of services completely or partialy, lack of electricity and fuel has its implications on cold chain which raise the need for other sustainable solutions to maintain functional cold chain such as solar system.
Activity Plan
Activity planing
strategy 1: Detecting and serving unreached or marginalized populations, communities and individuals.
| Activity | Activity details | stakeholders | integration (yes/no/maybe) |
|---|---|---|---|
| Activity 1: identify and detect unreached populations and Assess the reasons |
Conduct a work shop on national and subnational level to review existing data and reaserchs such as EPI survey 2015, KAP study 2015, post campaigns neutral assessment to do analyse the current situation. duration of this activity with its implementation is a month. |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs | maybe |
| Activity 2: Set a microplan to ensure all communities are reached through realistic microplan. |
set a new microplan to ensure equitable access to all areas and all children on two parts: the first one on the routine immunization activities and the other is periodic intensification of routine immunization in HTR and besieged areas. national and subnationals level microplans are to be ready within a month. |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs |
maybe |
| Activity 3: support immunization activities with focus on unserved, HTR and besieged areas |
Support routine supplementary immunization activities for polio and measles, and catch-up campaign with focus on the areas highlighted in the work shop of activity 1. national and subnational level. duration: on monthly basis for a year |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs |
maybe |
strategy 2: Engaging communities and creating demand for vaccination
| Activity | Activity details | stakeholders | integration (yes/no/maybe) |
|---|---|---|---|
| Activity 1: conduct a barrier analysis |
Conduct a barrier analysis with disaggregation on three levels: easy to reach areas, hard to reach areas and besieged areas. this to be conducted on sub national level depending on bottom-up approach. duration: one month |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs |
maybe |
| Activity 2: capacity building of CWs |
Conduct Two trainings: Interpersonal communication and communication for immunization targeting community workers. conduct orientation on importance of immunization targeting head of clans and religious leaders sub national level duration two months. |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs |
maybe |
| Activity 3: awairness raising sessions and community moblization. |
conduct awairness raising cosultations on three ways: group sessions, individual consultaions and peer to peer sessions. subnational level, duration: year |
WHO, UNICEF, Ministery of health on both national and subnational level officers, SARC and local NGOs |
maybe |
strategy 3: Maintain a functioning cold chain and vaccine distribution system.
| Activity | Activity details | stakeholders | integration (yes/no/maybe) |
|---|---|---|---|
| Activity 1: coduct inventory counting of current cold chain. |
conduct inventory counting of current cold chain as an assessment to know our basline. national and subnational duration: one month |
WHO, UNICEF and MoH | no |
| Activity 2: capacity building of HWs |
conduct a training on vaccines stock management to HWs whom are involved. national and subnational duration: one month |
WHO, UNICEF and MoH | no |
| Activity 3: procurement of needed supplies, installation and maintainance of suitable cold cahin equipment |
procure, install and maintain equipment needed to ensure temperature consistency has to be fit-for-purpose and should be selected from WHO-tested and ecommended equipment with focus on solar system for Syria context. national level contracts procurment once a year and regular quartrly checks. |
WHO, UNICEF and MoH. | no |
Monitoring and Evaluation
Monitoring and Evaluation,
in Syria monitoring &evaluation will be done through two ways:
in easy to reach areas monitoring the program will be done through surviellance system, EPI survey, post campaigns neutral assessments and supervisors of MoH, WHO and UNICEF. Each activity or combination of activities will be monitored from the health facility level, sub-national level and the national level
in hard to reach areas and besieged areas monitoring of program will be done through surviellance system and EPI surveys, post campaigns neutral assessments, and through third party moitors. Each activity or combination of activities will be monitored from the health facility level, sub-national level and the national level
annual plan indicators for impact that would be related to the proposed activities:
- Number of children under 1 receiving measles vaccination.
- Number of children under 1 receiving DTP3 vaccination.
- Number of children under 5 receiving polio vaccination.