Report on EPI Planning Meeting in Garoe
18-21 February 2001
EPI planning meeting was held in Garoe, Puntland State of Somalia, February 18-21, 2001. The primary objectives of the meeting was to give chance health workers from health facilities to participate in the planning procedure in order to reflect their major concerns in the plans. To conduct participatory analysis of the factors causing low EPI coverage in five major towns and come up recommendations to improve the coverage. This meeting was organized and conducted jointly by MOSA and UNUCEF.
Total of 28 participates representing MOSA –health department officials, Regional
Medical Officers, EPI coordinators, District Medical Officers, MCH head nurses; Mayors from five major towns; officials from Ministry of Information and representative of Radio Galkaio and local news papers attended the meeting.
The agenda of the meeting was structured to help participants
; To review the essential elements of EPI program
; Analyze and discuss factors causing low EPI coverage and possible solutions to
improve the coverage in major towns.
; To discuss roles and responsibilities at different levels
; Access information on important elements of success in EPI program.
The Director General of MOSA Dr Abdirahman has officially opened the meeting in the first day. In his remarks, Dr Abdirahman reminded participants the importance of EPI program and mentioned that EPI program is the first priority for MOSA. He continued his remark and said that the presence of the Mayors from five major towns is a sign indicating the importance of the meeting. He reminded the participants that the EPI coverage in Puntland is very low, for this reason we need all of us (Government, agencies and community members) to put together our efforts and commitments in order to raise and sustain EPI coverage in puntland.
After this meeting there will be two weeks of EPI acceleration activities in the five major towns, and this can be good example of the joint efforts and commitments. For social mobilization purposes, MOSA has named this EPI acceleration activity in memory of Dr Mohamed Warsame Ali, a renowned Puntland Gynecologist, who was murdered in Mogadishu in 1993.
After the opening remark, the Director of PHC and training, Dr. Ahmed Haji Abshir who was chairing the meeting had presented the objectives of the meeting as follows:
; Review and update the essential elements of EPI program
; Through participatory process, identify factors responsible low EPI coverage in
five major towns.
; In light of above factors, develop recommendations to improve EPI coverage in
the five major towns.
; Define rules, responsibilities at different levels .
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Director General of MOSA DR. Abdirahman Said Mohamed and Dr Abdirahman Y. Muse from UNICEF had presented the background of EPI program in Puntland. Essential elements of EPI program was presented by MOSA (PHC and training Director, Dr. Ahmed Haji Abshir) and UNICEF (Hodan Mire Ismaiil and Dr. Abdurahman Yusuf Muse) giving emphasis following topics:
; Global goals and strategies for EPI
; Facts about EPI target disease
; Strategies for delivering vaccination
; Missing opportunities
; Vaccine Schedule and contraindications
; Logistics and Cold chain system
In the second day, Dr Abdirahman Yusuf Muse from UNICEF Bossaso chaired the meeting and there was a group discussion and presentation sessions for hole the day. The participants were divided in to five groups according to the districts they are representing and following areas were discussed:
; Reasons for low EPI coverage in five major towns
; How to increase EPI coverage in five major towns
The results of the group discussions was clustered as following:
I. Lack of Geographical Access:
; Lack of adequate resource (e.g. transport, EPI equipment, and materials for social
mobilization, regular EPI supplies, poor infrastructure of health facilities). ; Lack of adequate skills ( e.g. insufficient training for health workers) ; Lack of motivation ( incentives, payment services, regular supervision and feed
; Lack of clear responsibilities (there is no clearly defined catchment area for health
; Lack of accurate estimate of target population for immunization in the health
II. Some People are Never Reached:
; Ineffective mobilization of the population in area served (some of the community
members are unaware whether services are available).
; Population are not seeking immunization (community members expecting that
immunization campaign will come to their houses )
; Community members have confused routine EPI with NIDs
; Poor use of services offered (People dose not value the service provided). ; Community members believe health services are harmful (religious groups “Tima
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; Some times Health workers forgot to inform the mothers, the need to return for
additional immunizations, or date to return.
; Health facilities have no system to follow up defaulters.
; Health facilities are poorly managed. (Due to lack of motivation and regular
; Health facilities are not frequently open or are open at inconvenient times ; Some of the health workers are unsympathetic to the people, and there is a long
wait for services.
; Inadequate health education with in the community (immunization schedule, time
to return for the other doses, contraindications and side effects for the vaccines). .
IV. Missed opportunities:
; Health worker do not know that they should screen all sick people in the clinic at
every contact and immunize as necessary, regardless the reason the children or
; Not all OPD/MCH centers provide immunization.
; Out Patient Departments in the hospitals do not provide immunization services. ; Mothers are not usually immunized when their children are immunized. ; Health workers do not follow the immunization schedule.
a) Motivation of the health staff (Refresher training courses, encouragement, regular
monitoring, and giving payment for services (incentives) on time. b) Effective social mobilization of the population in served areas.
c) Training on EPI management for supervisors and health workers
d) Regular supervision and monitoring
e) Continues health education
f) Obtaining additional resources (transports for EPI coordinators, new cold chain
equipment working with electric power to replace those working with kerosene
and social mobilization materials like video, video casts and posters). g) Regular outreach services
h) Acceleration of immunization activities
i) Rehabilitation of health facilities
j) Equal support (policy) for puntland and other parts of Somalia from UNICEF.
In the third day, Hodan Mire Ismaiil from UNICEF Bossaso chaired the meeting and following two main issues were discussed.
1. Important elements of success in EPI program
2. How to plan EPI activities in your catchment area.
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Director of PHC and training program for MOSA Dr. Ahmed Haji Abshir and Dr. Abdirahmen Y. Muse (UNICEF) presented important elements of success in EPI program. Emphasis were give on the following points:
a) The definition of clear catchment area
b) Identification of target population in the catchment area
c) Setting and monitoring of specific targets with defined time of period. d) Routine assessment of coverage levels and the analysis of factors that prevent or
favor the delivery of service (using 75 household survey).
e) Mapping and how to use map in the major towns and districts.
In the group discussion and presentation session, the participants were divided in to five groups according to the districts they are representing, and discussed how to plan EPI activities in their catchment area.
Group discussions on How to plan EPI activities in your catchment area
； Draw map
； Define your catchment area
； Identify target population
； Set coverage targets (Annual, monthly)
； Describe resources presently available
Due to lack of accurate population figures, they take guess estimates of population in each location for this exercise as follows:
Bossaso 100,000 persons
Gardo 50,000 persons
Garoe 25,000 persons
Burtinle 10,000 persons
Galkaio 120,000 persons
Each group has developed map showing the Catchment area of the health facility however, there is need of improvement on how to draw and use maps for all the group