Building on EPI to Establish a Modern Management Framework for Child

Survival IIOr, Why Re-invent the Wheel? EPI High Coverage & Working Continent-Wide M&E System Can Be Used for CS II

Child Survival II, IMCI, and RBM do not have a management information framework for districts and

health facilities

IMCI and RBM not reaching high proportion of African districts, nor achieving high coverage with interventions, commodities, or messages

EPI management information system reaching nearly all countries and districts in Africa

Background

EPI information system reaching nearly every district in Africa

EPI reaching high coverage with two platforms Routine

– 45% African countries reached >=80% coverage in 2004

– 40% countries increased routine coverage by >=20% from 2000 to 2004

– Angola (+59%), Burkina Faso (+31%), Chad (+22%), CAR (+21%), Congo (+28%), Mali (+54%), Mauritania (+39%), Niger (+37%), Senegal (+35%), SLE (+37%), Togo (+21%), Uganda (+34%)

Mass campaigns

Recommendations

Child Survival II should build on EPI management information system to get coverage and impact data from every district every month

Child Survival II should use EPI contacts and delivery methods to deliver child survival interventions

Department of health and human servicesCenters for disease control of prevention

Mac W. Otten, Jr., MD MPH, CDC, motten@cdc.gov; Deo Nshimirimana MD, WHO African Region; Rose Macauley MD, WHO African Region; Vance Dietz MD MPH, CDC, Global Immunization Division

– <5 year old nationwide mass campaigns every

three years

– >90% coverage in nearly all countries

– Equity ratio = 1 (highest & lowest economic

quintile have same coverage)

Country

2000 2004

% change in 2004 vs. 2000

Year of DQA DQA score

Cohort Year % DTP3

1 Botswana 97 97 0 Not GAVI‡2 Rwanda 90 89 -1 2002 89 2002 923 Eritrea 88 83 -5 2004 100 2001 794 Ghana 84 80 -4 2002 87 2002 875 Gambia 83 92 9 2002 87 2002 876 Lesotho 82 78 -4 2004 787 Benin 79 83 4 No ISS§ 2000 798 Namibia 79 81 2 Not GAVI‡9 South Africa 79 93 14 Not GAVI‡

10 Tanzania 79 95 16 2002 90

1 Malawi 75 89 14 No ISS§2 Burkina Faso 57 88 31 2002 58 2002 773 Uganda 58 87 29 2002 794 Senegal 52 87 35 2003 795 Zimbabwe 77 85 8 2003 676 Swaziland 77 83 6 Not GAVI‡ 2002 977 Zambia 78 80 2 2003 798 Ethiopia 56 80 24 2002 81 2000 569 Guinea-Bissau 42 80 38

1 Mali 40 76 36 2002 75 2000 402 Burundi 74 74 0 2003 72 2001 733 Kenya 75 73 -2 2004 85 2002 724 Cameroon 53 73 20 2004 895 Mozambique 68 72 4 2002 55 2002 726 Togo 64 71 7 2004 89 2000 647 Mauritania 40 70 30 2004 69 2000 33

1 Guinea 55 69 14 2004 952 Congo 33 67 343 DRCongo 40 64 24 2004 874 Niger 31 62 31 2003 93 2000 315 Madagascar 57 61 4 2003 586 Sierra Leone 44 61 17 2004 98 2000 447 Angola 31 59 28 2000 348 Côte d'Ivoire 72 50 -22 2002 59 2000 709 Chad 28 50 22 2005 79 2001 26

10 CAR 37 40 3 2004 83 2001 4011 Gabon 38 38 0 Not GAVI‡12 Equatorial Guinea 33 33 0 Not GAVI‡13 Liberia 55 31 -24 2005 7814 Nigeria 24 25 1 2002 25† O. Ronveaux, D. Rickert, S. Hadler, H. Groom, J. Lloyd, A. Bchir, & M. Birmingham.

‡ Not GAVI = Not GAVI eligible (per capita income >1000 USD)§ No ISS = No immunization stengthening support from GAVI

The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems. Bulletin of the World Health Organization 2005; 83:481-560

WHO-UNICEF best estimate* of % DTP3

coverageScore of latest GAVI data quality audit†

Latest population-based survey since cohort year 2000,

card + history method

Table 1. Estimated change in DPT3 routine immunization coverage, 2004 compared to 2000, Global Alliance for Vaccines and Immunization (GAVI) data quality audit scores, and latest population-based survey result, WHO African Region, 2000-2004.

23 Nov 2005 Report; data as of Sept 2005