Country Report: Rwanda - Measles & Rubella Initiative

Report
House-to-House Social mobilization
for Measles/Rubella SIAs in Rwanda,
March 2013
American Red Cross to RWANDA
RED CROSS
Rwanda Country Profile
Area: 26,338 km2
2012 census Population:
 Total estimate = 11,689,696
 Population growth rate
estimated at 2.75%
 Life Expectancy was 58.44 yrs
 Age structure:
•
•
•
•
•
0-14 yrs: 42.6% (4,974,609)
15-24 yrs: 19.2% (2,243,542)
25-54 yrs: 32% (3,740,308)
55-64 yrs: 3.8% (447,754)
> 65 years : 2.4% (283,483)
Country administrative structures
RWANDA As
Country
RRC HQ
Provinces = 4 + Kigali
City
Districts = 30
(Coordination level)
Sectors=416
(Implementation
level)
RRC Branch
RRC LC
Cells= 2184
Implementation
community
RRC LC
Villages=14841
(Implementation
community)
Model village
(10 volunteers
per village)
Rationale for introduction of Rubella vaccine
& Measles 2nd Dose in Rwanda
1. Increasing burden of rubella from febrile-rash illness
surveillance; Risk of Congenital Rubella syndrome as
public health problem
2. Consultative discussion by EPI, MOH and partners on a
program for sustaining the future purchase of MR
vaccine
3. Opportunity to introduce measles 2nd dose and MR
vaccines after the catch up SIAs
 Advantage of GAVI support to support MR introduction
campaign and vaccine supply for measles 2nd dose lasting
5yrs
 Eliminate burden of measles affecting young adolescents
 Preparation for MCV2 introduction
MR vaccine Introduction Campaign
Objectives
1. To give an opportunity to provide 2nd catch up
dose of measles and a unique dose of rubella
vaccine
2. To achieve at least 95% coverage among 9-15
years old children in every district during the
campaign with MR and HPV vaccines
• Integrated & targeted CRS and Cervical cancer prevention
3. To set stage for expansion of the scope of diseases
covered by EPI as MR vaccines will available to all
infants <1 year of age in the routine EPI following
MR campaign
Strategy for MR vaccine Introduction in
Rwanda
1. Comprehensive vaccination
o Measles and rubella (MR) catch-up campaign
o Linkages and expansion of current routine EPI schedule
o Linkages for introduction of measles 2nd routine dose.
2. Establish Surveillance
•Integration of Rubella surveillance with case-based measles
surveillance- Retrospective review of CRS ongoing
•Planning to establish sentinel site for CRS surveillance
• Adverse Event Following Immunization (AEFI) surveillance
3. Launch communication for RCV introduction
4. Supervision, monitoring, evaluation & reporting
Major Communication Activities
for MR SIAs in Rwanda
Advocacy:
• Involved all the line ministries, and development partners e.g
UNICEF, WHO, UNFPA, Red Cross etc.
• Involved district Mayors, Secretary of the Sectors
• Meeting with the Sector secretary, CHWs & teachers at HC level
Mass Communication:
• Engaged print and electronic media; emphasizing national and
community radios
• Engaged mobile telephone companies to send bulk SMS
• Developed and distributed IEC (posters, banners, leaflets)
• Dissemination MR campaign message in the Umuganda; a
month gathering of the community members in their sectors
Major Communication Activities
for MR SIAs Cont’d
Inter-personal Communication:
• MR campaign messaging in the Umuganda; informed agent
leading a community dialogue in a monthly gathering of the
community members in their sectors
• House -o-House Social Mobilization by Rwanda Red Cross
volunteers in selected high-risk, Urbanized and high-population
districts
Rwanda Red Cross Project for Houseto-House Canvassing for MR SIAs
Project Goal
To contribute to reductions in morbidity and mortality
due to Measles and Rubella diseases through increases
in MR vaccine utilization and coverage.
Specific Project Objectives
1. Train at least 1,700 community volunteers in social
mobilization for MR vaccination
2. Conduct house and school visits to at least 90 percent of
households and the schools in 4 selected districts before
the March 2013 MR vaccination campaign
3. Assist all vaccination teams in 4 selected districts to
reach at least 95% of all children <15yrs with MR
vaccines
4. To determine the major information sources on MR
vaccination
Rwanda Red Cross Project Districts for
House-to-House Canvassing
GASABO
15 sectors
73 cells
486 villages
KICUKIRO
10 sectors
39 cells
332 villages
GISAGARA
13 sectors
59 cells
524 villages
NYARUGENGE
10 sectors
47cells
357 villages
48 sectors; 218 cells ; 1699 villages
Major Activities of Rwanda Red Cross
Project for H2H Canvassing for MR SIAs
Pre-Campaign
 Developed a guide for H2H Canvassing (including recording and
reporting tools)
 Training of Red Cross volunteers as MR Promotional Agents
 Conducted H2H visits for mobilization of community and registration
targeted children in the 4 selected districts
During the Campaign Days
 Red Cross Volunteers supported vaccination teams at all established
service delivery points,
Post Campaign
 Red Cross volunteers conducted H2H visits in purposefully selected
households to trace for
a)
b)
c)
d)
MR SIAs defaulters,
Evaluate the community coverage of MR vaccination,
Determine the most reliable sources of information and
Detect any bad (adverse) events following immunizations
Rwanda Red Cross H2H Canvassing
Project achievements (1)
• Recruited, trained and
deployed 3,400 volunteers
(two per village) in 4
districts.
• 213,159 households
visited (70,4 % of
households in the four
districts) prior to the MR
SIAs with 386,322 children
aged 9 months to 14 years
were pre-registered.
Rwanda Red Cross H2H Canvassing
Project achievements (2)
• Sensitisation/dialogue
sessions were conducted
in all registered
Kindergarten, Primary
and secondary schools in
order to reinforce the
uptake of MR and HPV
vaccines.
Rwanda Red Cross H2H Canvassing
Project achievements (3)
• Rwanda Red Cross procured
25,000 leaflets and 2,000 Tshirts to be used as
identification and visibility
materials for volunteers
deployed to conduct the
house to house canvassing
for the integrated
Measles/Rubella vaccination
week
Rwanda Red Cross H2H Canvassing
Project achievements (4)
RRC Volunteers
support Crowd
control at the posts
Holding children
during vaccinations
Provision of
Vitamin A and
recording of
children to be
vaccinated
Rwanda Red Cross H2H Canvassing
Project achievements (5)
Red Cross
Volunteers
supported
provision of
Vitamin A
Rwanda Red Cross H2H Canvassing
Project achievements (6)
Red Cross Volunteers recording of children to be vaccinated
Bugesera
Burera
Gakenke
Gasabo
Gatsibo
Gicumbi
Gisagara
Huye
Kamonyi
Karongi
Kayonza
Kicukiro
Kirehe
Muhanga
Musanze
Ngoma
Ngororero
Nyabihu
Nyagatare
Nyamagabe
Nyamasheke
Nyanza
Nyarugenge
Nyaruguru
Rubavu
Ruhango
Rulindo
Rusizi
Rutsiro
Rwamagana
National
Rwanda Red Cross H2H Canvassing
Project Outcomes (1)
MR vaccination coverage among 9 months to
14 years old children
120%
110%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Rwanda Red Cross H2H Canvassing
Project Outcomes (2)
Post Campaign H2H
visits showed:
 12,112 of the 12,220
(99%) children assessed
reported to have
received MR vaccines
 10,686 of 12,220 (89%)
children evaluated had
written proof (MR Card)
of vaccination
 No major AEFI detected
Household sources of Information on
MR SIAs in Rwanda; March 2013
30%
28%
25%
25%
20%
20%
15%
10%
10%
5%
0%
8%
4%
2%
3%
Rwanda Red Cross H2H Canvassing
Project Outcomes (3)
Post Campaign H2H visits Cont’d:
 108 children found to have missed the MR SIA
dose
Reasons for vaccination failure were tallied as:
a)
b)
c)
d)
e)
f)
Child was sick (31%),
Lack of time (18%),
Wrong ideas or misconceptions on MR vaccine (5%),
Not knowing the place/site for vaccination (3%),
Place for vaccination too far (2%) and
Not knowing the need (1%).
Conclusions
• H2H canvassing by Red Cross Volunteers reaches an
additional 25% of households with information on
SIAs
• Vaccination site support by Red Cross volunteers
improves the vaccination experience of HWs,
parents & children
• Three out of the 27 districts in Rwanda did not attain
95% MR coverage
Recommendations
1. Support Periodic H2H canvassing for
Tracing routine MR and MCV-2 vaccination defaulters as a
strategy to sustain the highest possible coverage
Establishing a community surveillance system for febrileRash illness
Exploring community surveillance for CRS
2. The three districts that did not attain 95% MR
coverage should be evaluated in-depth to inform
targeted and additional support to raise coverage
3. Support training of Rwanda Red Cross Branch staff
in Measles/Rubella elimination

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