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 groups.
To calculate the percentage of children less than one year of age and percentage of pregnant women in population they used 3% and 4 % respectively.
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Summary of the group discussions
Health Catchment Other HFs in the Target Annual target Monthly Facility area Catch. Area population popul target popul
U1 PW U1 PW U1 PW
MCH Hole district Nil 3000 4000 2400 3200 200 267 Bossaso
MCH Hole district Nil 1500 2000 1200 1600 100 133 Gardo
MCH Hole district Kala-bayr, 750 1000 600 800 50 67 Garoe Sun-jiif
MCH Hole district Nil 300 400 240 320 20 27 Burtinle
MCH Hole district Harfo; B/weeyn 3600 4800 2880 3840 240 320 Galkaio South Galkaio
Resources presently available
Location Health personnel Cold chain Cold Vaccine Ice packs
Two nurses, four central cold One three Enough Bossaso
Two nurses tow 1 ILR, 1 freezer Two Three Enough Gardo
auxiliaries and 1 generator
2 nurse 2 aux. One 1 ILR, 1 freezer One Three Enough Garoe
cold chain and 1 generator
other four HWs
from SRCS clinics
One nurse two 1 Siber not One Three Enough Burtile
Two nurses two 1 ILR, 1 freezer One Three Enough Galkaio
auxiliaries, one and 1 generator
other six HWs
From SRCS clinics
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In the fourth day, Dr Abdirahman Said DG of MOSA chaired the meeting, and the day started with wrap-up of plans then proceeded to the agenda for the day as following:
a) Social mobilization
b) Rules and responsibilities at different levels
c) Monitoring and evaluation
For social-mobilization after some discussions the following points were agreed:
1. Establish national committee for social-mobilization which composed of MOSA –
health department, UNICEF, Ministry of information and local government. 2. Develop package of messages and IEC materials like posters and videocassettes. 3. Social-mobilizes should be selected from people who are trained 4. Social-mobilization should be started from the schools.
5. Messages should be delivered regularly through mass, printed media and mosques
6. The ministry of interior should take their role for social mobilization.
Roles and responsibilities at different levels
1- Government Role
A- MOSA-Health Department Level:
- To develop health policy
- To allocate funds for health services
- Prepare training for manpower
- Nomination of health staff
- Solving problems between MOSA- health department and other ministries - Advice and approve the projects supported by donors and international agencies - Supervision and auditing of health resources
B- Regional level:
- The RMO is representing the health department of MOSA in the region. - RMO is member of development and security committee in the region. - He is responsible to fulfill the instructions from MOSA health department. - Responsible to solving problems between MOSA- health department and other
ministries at regional level.
- He is the only official person who can raise health problems to the health
department of MOSA and he has the right to advice the health department about
the nomination of health staff in his region.
- He is responsible to evaluate health activities in his region and give report to the
health department of MOSA.
- He is responsible to make regular supervision to all health facilities in his region.
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2- UNICEF Role
UNICEF’s role is to support MOSA and other partners in health and nutrition sector
(giving especial emphasis to the EPI program) with its limited available resources, using following guiding principals:
- Political neutrality, respect for Somali culture and values.
- Close collaboration with MOSA
- Close collaboration with sister United Nations agencies, NGOs and other partners - UNICEF supports partners to support children and their caretakers. - UNICEF is supporting agency not implementing agency.
Monitoring and Evaluation
Director of PHC and training program for MOSA Dr. Ahmed Haji Abshir and Dr. Abdirahmen Y. Muse (UNICEF) make presentation on how to monitor and evaluate immunization activities.
Monitor- to look closely at immunization activities or the results of activities, to decide whether good progress is being made. For example monitoring immunization services may include checking regularly to see that activities are carried out as planned, quality immunization practices are used, and the number of people receiving immunization is increased.
Monitoring is different from supervision, monitoring is management tool which can help us to increase immunization coverage and identify where the problems are.
The participants were introduced to an immunization monitor chart and explained
how to complete and analyze it. Two immunization monitoring charts should be prepared at all health facilities providing EPI at beginning of each year and monthly updated:
- One to monitor infants antigens ( BCG, DPT/OPV3,measles)
- And another one to monitor TT immunization activities (TT2+ for pregnant
It was also discussed about drop-outs and how to calculate drop-out rates. Drop-
outs is defined: children and women who do not return for subsequent immunizations.
Evaluation: Evaluation of immunization activities should be done weekly, monthly and quarterly. This allows you to assess your success and plan future activities to improve your services. EPI evaluation checklist was introduced to the participants. The EPI evaluation checklist should be reviewed with all the staff at health facility, at least quarterly.
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Besides the EPI acceleration activities in the major towns following points were recommended:
1. Equal treatment/ support of Puntland and other parts of Somalia by UNICEF.
2. Catchment area of all health facilities should be defined.
3. Maps with demarcated sections for major towns should be developed.
4. Target population for immunization should focus on the age group below 2 years
and especially below one year and pregnant women.
5. Accurate data of the target population in each catchment area should be generated.
(Using pre-registration, community assessment or counting the number of the
6. Set annual and monthly targets for each health facility and monitor regularly by
using monitoring charts.
7. Incentives (payment services) and transport for supervision (motorcycles) to the
EPI coordinators and other staff should be provided.
8. The role of private sectors should be considered.
The Director General of MOSA Dr Abdirahman Said has delivered the closing remarks of EPI planning meeting thanking to all participants, particularly to the Mayors and UNICEF who supported the meeting. UNICEF Resident Project Officer for Puntland Hermosa Nakai was present in the closing period.
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