This year, I was supposed to but the pandemic stops most of the activities we planned in the provinces. Last year, I visited 3 provinces and it was very interesting to see and discuss with provinces and health managers. Most of the interactions I had with them were through emails and phone calls, so they were all like “ you are Christelle, finally we get to see you”. It was actually funny how all they knew me before even meeting me in person. Some EPI managers reported how famous I was in the provinces they visited.
We recommend the nurse supervisor to do the supervision during an immunisation session, that way we’ll be able to know if the activity was well carried out and without any stockout.
Prior supervisions in different facilities, the health zone through a monthly agenda organizes field visits in all its health areas, so the nurse supervisor can actually supervise a facility during an immunisation session
So first, the nurse supervisor meets the health manager of the facility and makes sure the center has a functioning refrigerator with at least one-week availability of each antigen and input. Basically, the supervisor counts the different doses of vaccines in the refrigerator with the health manager. The kind of supervision they realise is mostly supportive, so if the facility doesn't have enough vaccines, the nurse supervisor not only tries to understand the reasons why but also would help find solutions with the manager so that the facility never lacks one-week availability. All these data are of course encoded in the App, even offline. When the supervisor is the area with a good internet connection, he can then upload data collected.
I assisted myself in some immunisation sessions. The first thing a health manager does is some kind of sensitisation session with mothers during which he tells the importance of immunisation, and each vaccine, from BCG children, receive at birth, to OPV for polio, VAR for measles, and VAA for yellow fever to name a few. He also makes sure that mothers understand the fact that they need to come back for multi-doses vaccines following the immunisation calendar.
The nurse also attends immunisation sessions to collect data on the number of children present for different vaccines, on any stockout if there’s any during the session. On top of that, he also verifies if the session is realised according to the standards of routine immunisation, makes sure the health center realises the monthly required number of immunisation sessions (number based the size of the target population). If these are not, he advises the center to increase the number of sessions in order to reach more children.
We have lately added one more indicator of community engagement. During the immunisation session, the supervisor ensures that community volunteers are present. These are crucial for collecting children for multi doses of vaccines.
I haven’t had a chance to go to an immunisation session since the start of the pandemic in March, 2020. In the beginning, like everywhere else in the world, people were worried and we saw a small drop in the number of children in the immunisation sessions but EPI has done a lot of work through sensitisation campaigns on TV to encourage mothers to continue going to sessions.
Thanks to the Mashako plan, 8 000 immunisation sessions more have been organised monthly in 2019. Also, 3 independent surveys done in 3 of the 9 provinces revealed stunning results, just the first year, the project helps to immunise 70 000 more children.
One of my favourite moments is the gatherings with other Acasus teams. It’s really interesting to get to know other Acasus members, sharing experiences, most of which I could relate to. Sometimes, I feel like I am in some kind of bubble working on one specific project and get very frustrated when things are not going my way, changes require a lot of effort and consistency. So interacting with other teams makes me realise that they also face pretty much the same challenges as you and in the end, we always get great results despite some obstacles that can happen along the way.