Report on EPI Planning Meeting in Garoe 18 - Somali - JNA

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Report on EPI Planning Meeting in Garoe 18 - Somali - JNA

    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 .

     - 1 -

    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

    back )

    ; 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



     - 2 -

III. Drop-outs

    ; 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

    women come.

    ; 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.

Possible Solutions:

    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.


     - 3 -

    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.


     - 4 -

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

    boxes carriers

    Two nurses, four central cold One three Enough Bossaso

    auxiliaries chain

    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

    manager plus

    other four HWs

    from SRCS clinics

    One nurse two 1 Siber not One Three Enough Burtile

    auxiliaries reliable

    Two nurses two 1 ILR, 1 freezer One Three Enough Galkaio

    auxiliaries, one and 1 generator

    cold chain

    manager, seven

    Volunteers plus

    other six HWs

    From SRCS clinics


     - 5 -

    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

    on Fridays.

    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.


     - 6 -

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.


     - 7 -


    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.

Closing Remarks

    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.


     - 8 -

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