ETHIOPIA NATIONAL EXPANDED PROGRAMME ON …

1 ETHIOPIA NATIONAL EXPANDED PROGRAMME ON. IMMUNIZATION. COMPREHENSIVE MULTI- MULTI-YEAR PLAN 2016 - 2020. Federal Ministry of Health, Addis Ababa April, April, 2015. 2015. A. TABLE OF CONTENTS. TABLE OF CONTENTS _____ I. LIST OF TABLES _____ III. LIST OF FIGURES _____ IV. ACKNOWLEDGMENT _____ V. LIST OF ACRONYMS _____ VI. EXECUTIVE SUMMARY _____ VIII. CHAPTER ONE _____ 12. COUNTRY INFPORMATION _____ 12. General profile and demography _____ 12. Administrative profile and Governance _____ 2. Socio-economic Situation _____ 3. General Health Status _____ 4. Health System Organization _____ 5. EPI Services Delivery _____ 6. Justification for the development of new cMYP _____ 6. CHAPTER TWO _____ 8. SITUATIONAL ANALYSIS _____ 8. The EXPANDED PROGRAMME on Immunization in ETHIOPIA _____ 8. NATIONAL Immunization Policy_____ 9. Immunization Service Delivery _____ 10. Implementation of cMYP 2011 -2015 _____ 10.

2 Routine Immunization _____ 10. Reaching Every District (REC) Approach _____ 13. Populations at risk of missing immunization services _____ 13. Supplemental Immunization Activities _____ 14. Polio SIAs: _____ 14. Measles SIAs:_____ 15. Maternal and Neonatal Tetanus Elimination _____ 16. Men A Elimination campaign _____ 17. Disease Surveillance and Accelerated Disease Control_____ 19. Disease surveillance _____ 19. Surveillance for New Vaccines_____ 27. Accelerated Disease Control _____ 29. Laboratory Services _____ 31. GAVI support _____ 32. New Vaccines Introduction _____ 32. GAVI HSS _____ 32. GAVI CSO support _____ 32. Immunization logistics _____ 33. NATIONAL Cold Chain Equipment inventory _____ 33. Effective Vaccine Management Assessment _____ 34. The cold chain Rehabilitation Plan _____ 34. Rehabilitation Plan: Implementation _____ 35. I. Transition Plan _____ 40. Available storage capacity _____ 43.

3 Injection Safety and Waste Disposal _____ 47. Vaccine, Supply and Quality _____ 47. AEFI surveillance and monitoring _____ 48. EPI Advocacy, social mobilization and program communication _____ 48. Management and Human resources _____ Error! Bookmark not defined. PROGRAMME Management _____ Error! Bookmark not defined. Human Resources for EPI (HRE) _____ Error! Bookmark not defined. Summary of the situation analysis _____ 54. Strengths, weaknesses, opportunities and threats _____ 60. CHAPTER THREE _____ 65. GOALS, OBJECTIVES, KEY ACTIVITIES AND MILESTONES NIP 2016-2020 _____ 65. Introduction _____ 65. Goals of the cMYP _____ 65. PROGRAMME Objectives _____ 66. Strategic Areas/Approches _____ 67. Anticipated Coverage Targets _____ 70. Planning by immunization system component _____ 79. CHAPTER FOUR _____ 91. COSTING, FINANCING AND FINANCING GAPS _____ 91. Macroeconomic Information _____ 91.

4 Methodology for costing the cMYP _____ 91. Costing of cMYP 2016-2020 _____ 93. Vaccines and injection equipment _____ 93. Personnel costs (EPI specific and shared) _____ 94. Cold chain equipment procurement and maintenance _____ 94. Operational costs for campaigns _____ 94. Costs for immunization by components cMYP (2016-2020)_____ 95. CHAPTER FIVE _____ 97. MONITORING AND EVALUATION _____ 97. Indicators for monitoring the cMYP _____ 98. Financial Indicators _____ 98. PROGRAMME Indicators _____ 98. Surveillance System _____ 98. Monitoring and Evaluation framework cMYP _____ 100. Immunization PROGRAMME Annual work plan for 2016 _____ 104. II. LIST OF TABLES. Table 1: Immunization Schedule .. 9. Table 2: Immunization Coverage in ETHIOPIA 2004-2014 .. 11. Table 3: Polio SIA in Somali Region outbreak of WPV in the HOA from June, 2013 to November, 2014.. Error! Bookmark not defined. Table 4: Regional Polio NID Data of 2013 and 2014, ETHIOPIA .

5 14. Table 5: Showing Measles SIAs Data from 2011-2013 .. 16. Table 6: TT SIA coverage 1999-2013, ETHIOPIA (High risk strategy) .. 17. Table 7: Data of phase I and II Meningitis "A" campaign in 2013 and 2014 .. 18. Table 8: Summary of AFP surveillance indicators ETHIOPIA , 2011-2014 .. 21. Table 9: Measles surveillance indicator, 2011-2014, ETHIOPIA .. 23. Table 10: Rota Virus sentinel surveillance indicators, 2007-2014, ETHIOPIA .. 28. Table 11: Situational analysis by accelerated disease control initiatives, ETHIOPIA 2011 to 2013 .. 30. Table 12: Available net storage capacity & future requirements for positive CC storage at central level .. 44. Table 13: Location and storage capacity of currently available EPI vaccine cold rooms .. 45. Table 14: Current available & future requirements for net positive cold storage at regional level .. 46. Table 15: Situational analysis by ADS, based on previous years' data (2011-2014).

6 55. Table 16 : Situational analysis of routine EPI by system components (2011-2014) .. 56. Table 17 : SWOT 60. Table 18: Baseline and coverage targets 2016 to 2020 .. Error! Bookmark not defined. Table 19: NATIONAL problems, priority, objectives and milestones, AFRO regional and global goals .. 73. Table 20: Service delivery .. 79. Table 21: Advocacy, social mobilization and program communications.. 81. Table 22: Surveillance .. 82. Table 23: Vaccine supply, quality and 83. Table 24: Program management/Health system .. 84. Table 25: Activity timeline .. 86. Table 26: Macroeconomic information, current and projected, ETHIOPIA .. 91. Table 27: Costs for the different cMYP components (shared and EPI specific) .. 96. Table 28: Indicator for financial monitoring .. 98. Table 29: Monitoring and Evaluation frame work for cMYP .. 100. Table 30: Immunization program annual work plan for 2016.

7 104. III. LIST OF FIGURES. Figure 1: Map of ETHIOPIA , its location in 12. Figure 2: Routine EPI coverage (Penta3& Measles) 2003 to 2014, ETHIOPIA .. 12. Figure 3: ETHIOPIA : EPI Coverage by Region, Coverage Survey, 2012 .. 12. Figure 4: Number of zones with coverage <50%, 50-79%, and 80-89% and >=90%, 2004-2009.. Error! Bookmark not defined. Figure 5: Measles SIA prioritized woredas, Sept-Nov2011, ETHIOPIA .. 15. Figure 6: Phase1, Phase2 and Phase Men A campaign sites in the country, ETHIOPIA .. 18. Figure 7: NATIONAL Disease surveillance performance, interims of completeness and time lines .. 19. Figure 8: WPV/VDPV and SIAs Response, ETHIOPIA , Jan 2010-Dec 2014, .. 21. Figure 9: Measles campaign coverage and measles incidence rate 2005-2014, ETHIOPIA .. 23. Figure 10: Distribution of confirmed Rubella cases, ETHIOPIA , 2011-2013 .. 24. Figure 11:CSF Culture results of suspected PBM cases, 2002-2014, 26.

8 Figure 12: Etiologies identified for PBM, 2002-2014, ETHIOPIA .. 27. Figure 13: Rotavirus Positivity Rate, 2007-2014, ETHIOPIA .. 28. Figure 14: Effective Vaccine management Assessment report at different levels, 2013 .. Error! Bookmark not defined. Figure 15: EFFECTIVE Vaccine Management Assessment, 2013 .. Error! Bookmark not defined. Figure 16: New vaccine introduction plan and estimating the need for vaccine storage volume .. 35. Figure 17: Immunization Program projection of future resource requirements, 2016-2020 .. 92. Figure 18: Costing baseline profile of routine immunization in ETHIOPIA , 2014 .. 93. IV. ACKNOWLEDGMENT. Immunization cMYP is a key strategic and management document for NATIONAL immunization programs that provide NATIONAL goals, objectives and strategic directions that address all components of immunization system relevant to the country. The new cMYP (2016-2020) is the result of the collaborative work of the Federal Ministry of Health and partners working in health.

9 The Federal Ministry of Health would therefore like to express its special thanks for the tireless efforts of the technical team supporting the NATIONAL immunization program for the successful preparation of the document in the shortest possible time. Our appreciation goes also to CHAI, WHO and UNICEF, for their financial as well as technical support without which it would have not been possible to prepare this document. The Maternal and Child Health (MCH) directorate would also like to acknowledge the ICC members and the cMYP review team for their active participation and constructive comments. V. LIST OF ACRONYMS. AD Auto Disabled Syringes AEFI Adverse Events Following Immunization AFP Acute Flaccid Paralysis BCC Behavioural Change communication BCG Tuberculoses Vaccine (Bacillus-Calmette-Guerin). BPR Business Process Re-engineering CDC Centres For Disease Control and Prevention CMYP Comprehensive Multi Year Plan CSO Civil Society Organization DCI Development Cooperation of Ireland DHS Demographic and Health Survey DPT Diphtheria-Pertussis-Tetanus Vaccine DQA Data Quality Audit EHNRI Ethiopian Health and Nutrition Research Institute EOS Enhanced Outreach Strategies EPI EXPANDED PROGRAMME on Immunization ESARO Eastern and Southern African Regional Office for UNICEF.

10 FMOH Federal Ministry of Health GAVI Global Alliance for Vaccine and Immunization GIVS Global Immunization Vision and Strategies HAPCO HIV/AIDS Prevention and Control Office Hepatitis B. HEW Health Extension Workers HF Health Facility Hib Haemophilus influenza type B. HMIS Health Management Information System HPN Health, Population and Nutrition group HPV Human Papilloma Virus Vaccine HSDP Health Sector Development Program HSEP Health Service Extension Program HSS Health Service Support HW Health Worker ICC Inter-Agency Coordinating Committee ICST Inter-country Support Team IDS Integrated Disease Surveillance IEC Information Education Communication IIP Immunization in Practice IMR Infant Mortality Rate IPC Inter Personal Communication IPV Injectable Polio Vaccine ISS Immunization Service Support ITN Insecticide Treated Bed Net JRF Joint Reporting Form KABP Knowledge, Attitude Behaviour and practice MDG Millennium Development Goal MDVP Multi-Dose Vial Policy MLM Mid-Level Management MNT Maternal and Neo-natal Tetanus FMOH Ministry of Health NGO Non-Governmental Organization VI.