3. The health services’ job:
Plan and provide vaccination services at the
times and places planned
3
4. Which commonly leads to…
Health providers feeling that caregivers just won’t be
responsible parents and caregivers feeling that services
are inconvenient, unreliable, not friendly, and confusing.
4
5. A Proposed New Vision
Getting a community’s children vaccinated and
protected is a joint responsibility of health services
and the community. They should work together in
planning, providing, monitoring, and continuously
improving vaccination services and their utilization.
5
6. The Timor-Leste Experience
The country
The immunization
program
The project: Imunizasaun
Protege Labarik (IPL)
6
7. Government and Health Divisions
Administrative Divisions
13 districts
66 sub-districts
Sub-districts divided into
sucos (“villages”)
Sucos divided into
aldeias (“hamlets”)
Health System Organization
5 hospitals
66 community health
centers
Monthly integrated MCH
day in each suco
(SISCa), run by CHC staff
and CHVs
Health posts in some
sucos and aldeias; many
operate only one day per
month7
12. Uma Imunizasaun (Immunization
House)…what is it?
Tool developed in
India
Monitor every
vaccination of every
infant in the
community
Can generate “due
lists” and/or to
identify children
falling behind
The basic concept
12
13. Uma Imunizasaun…
how it worked in Timor-Leste
Volunteers list all infants and birth
dates
Monthly updating at suco level
Volunteers visit families
Post in a public place
Volunteers add newborns and
infants entering community
13
14. Brief History of UI in Timor-Leste
Late 2011/early 2012: tool introduced in one
suco in each of seven focus districts
Summer 2012: IPL partnered with Clinic Café
Timor to use UI in 26 additional sucos
2013, expanded to 21 additional low-
performing sucos
MOH intends to further expand via GAVI
funding
14
15. Assessing UI
May 2011, Monitoring
study
September/October
2013, Program review
Late 2013, data
analysis
15
16. Impact in Immunization Coverage
No clear effect; serious problems with data
completeness and accuracy
Apparently more infants “in the system” (236
vs. 155), but data too incomplete to make a
firm conclusion.
16
17. Timeliness of vaccinations
Positive although not uniform improvements
Higher %s of children vaccinated near ideal age and with
minimal intervals
17
Indicator Year before UI
(2011)
Year with UI
(2012)
Average age of OPV0 (should be given
>14 days)
27 days 18 days
% of children with BCG who received it
in >14 days (should be given ASAP
after birth)
37% 45%
% of children with Penta1 who received
it in within 1 month of recommended 6
weeks
41% 51%
% of children with measles vaccination
who received it within 1 month of
recommended 39 weeks
76% 81%
18. Other Useful Findings
Too many infants received invalid doses
13 of 77 children who received measles vaccine (2012), received it
before 39 weeks of age (average 36 weeks)
Too many infants received OPV0 after 14 days
Few missed opportunities to vaccinate
Major data problems
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19. General Conclusions
Collaboration between health services and communities can take
many forms.
Partnering with communities on tracking vaccinations can have
specific benefits on protection and broad benefits on perceptions.
Use of UI in Timor-Leste clearly affected relationships between the
participating communities and local health staff and the community’s
sense of shared responsibility.
IPL’s approach of engaging communities to become informed users,
to help plan and give feedback on services, and to motivate fellow
community members contributed to project success: The number of
infants vaccinated rose by 15-20% in IPL districts compared to ~5%
in other districts from 2011 to 2012.
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