Patricia Taylor

This evaluation was undertaken in 2005, in the African region, to better understand the reaching every district (RED) implementation process that provides a framework for strengthening immunization services at the district level. In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners conducted site visits to the national, district and health facility levels using standardized qualitative questionnaires. RED was implemented in a similar manner in all five countries, i.e. starting with training and micro-planning. All RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside fixed immunization sites), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used. Evaluation of the RED implementation process provided evidence of improvement in delivery of routine immunization services. The RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions.

To assess the progress made towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunization between 2001 and 2005. We reviewed data from national infant immunization programmes in the 46 countries of WHOs African Region, reviewed the literature and analysed existing data sources. We carried out face-to-face and telephone interviews with relevant staff members at regional and subregional levels. The African Region fell short of the target for 80% of countries to achieve at least 80% immunization coverage by 2005. However, diphtheria-tetanus-pertussis-3 coverage increased by 15%, from 54% in 2000 to 69% in 2004. As a result, we estimate that the number of nonimmunized children declined from 1.4 million in 2002 to 900,000 in 2004. In 2004, four of seven countries with endemic or re-established wild polio virus had coverage of 50% or less, and some neighbouring countries at high risk of importation did not meet the 80% vaccination target. Reported measles cases dropped from 520,000 in 2000 to 316,000 in 2005, and mortality was reduced by approximately 60% when compared to 1999 baseline levels. A network of measles and yellow fever laboratories had been established in 29 countries by July 2005. Rates of immunization coverage are improving dramatically in the WHO African Region. The huge increases in spending on immunization and the related improvements in programme performance are linked predominantly to increases in donor funding.

Even where resources are plentiful, efforts to achieve full immunization coverage fail if staff and users are misinformed and unmotivated. A highly practical study in Lagos pinpoints some of these failures and suggests ways of overcoming them.