Academic journal article Journal of Health Population and Nutrition

Assessing the Effectiveness of House-to-House Visits on Routine Oral Polio Immunization Completion and Tracking of Defaulters

Academic journal article Journal of Health Population and Nutrition

Assessing the Effectiveness of House-to-House Visits on Routine Oral Polio Immunization Completion and Tracking of Defaulters

Article excerpt

INTRODUCTION

The Global Polio Eradication Initiative (GPEI) is a collaboration of World Health Organization (WHO), national governments, Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children's Fund (UNICEF). Since 1988, the GPEI has implemented a four-pronged strategy across the globe to detect and stop the transmission of poliovirus through surveillance and immunization: acute flaccid paralysis (AFP) surveillance, oral polio immunization through the routine immunization system that provides vaccination for all antigens, supplementary polio immunization, and mop-up campaigns in which teams return immediately after a supplementary immunization campaign to areas shown to have inadequate coverage of oral polio vaccination (OPV). The CORE Group Polio Project (CGPP) has supported the objectives of the GPEI since 1999 when it began implementing (i) community-based AFP surveillance, (ii) support for OPV provision through the routine immunization system by promotion in the community and system strengthening for healthcare providers, and (iii) participation in supplementary immunization campaigns. The CGPP works only in high-risk areas as determined jointly with each country's Interagency Coordinating Committee, using objective criteria, such as routine immunization rates, campaign quality indicators, and polio transmission history. The CGPP is a USAID-funded project of the CORE Group, a membership organization of more than 50 US-based non-governmental organizations working in community-based maternal and child health. At the time of this evaluation, the CGPP was active in three countries (Angola, Ethiopia, and India), implementing activities in communities through 12 US-based NGOs, and 9 local NGOs, with World Vision acting as administrative host and CARE providing technical support at the global level. Funding available for the activities discussed here was up to 30 million US dollar over five years, distributed over these 21 NGOs in subgrants that ranged from approximately 50,000 US dollar to 300,000 per year per NGO. Allocations to NGOs were determined based on factors, such as local costs, population covered, and intensity of activities.

Strengthening routine immunization is a cornerstone of the GPEI (See Box for methods of vaccination in the GPEI). The GPEI aims to ensure high routine coverage of all OPVs in the national immunization schedules. Because of the poliovirus's ability to circulate undetected for long periods of time, immunization coverage must be quite high (80 to 85% in Africa and greater than 95% in Asia) even in subpopulations--not just at the national or provincial level--to interrupt transmission.

The CGPP uses a variety of social mobilization/ communication strategies to promoting routine immunization and complementing mass media's social mobilization activities conducted by GPEI partners among hard-to-reach populations. A key element of the CGPP approach is to complement mass media's social mobilization activities conducted by partners, providing one-on-one interpersonal communication (IPC) visits to the households most at risk of missed vaccination. Community workers (paid a monetary stipend in some contexts, volunteers receiving only non-monetary rewards in others) maintain a list of children younger than five years of age in their catchment areas and visit the households to encourage the family to bring their children to receive OPV as well as other antigens at routine immunization opportunities. Community workers target families based on the level of risk determined, in part, by the immunization status of the children living in each household as well as by quality of routine services in the area and demographic risk factors.

Box. Principles of immunization opportunities in Angola, Ethiopia,
and India

Routine Immunization-Offered in a fixed site (clinic or stationary
booth at central location) by permanent staff of the Ministry of
Health (MoH). … 
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