Progress in reducing maternal mortality in developing countries has been rather slow to meet the Millennium Development Goal (MDG) target number 5, aiming to improve Maternal Health by reducing maternal mortality by 75% between 1990 and 2015 and achieving universal access to reproductive health by 2015 . Developing countries account for 99% of maternal death worldwide, representing one of the widest health gaps between developed and developing countries. These deaths could be avoided if the proper health resources and services were made available to women.
Immunization is a program whose success or failure in achieving public health impact is often judged on the basis of data generated on a daily, weekly, or monthly basis by health workers in facilities ranging from remote health posts to regional hospitals. Because immunization is a service that can be scheduled (unlike, for example, treatment of ill children) its data can be used by health workers to answer such key management questions as: Are we reaching the people in each locale who need immunization? Are we making progress? Who are we not reaching? Are children starting the immunization schedule but then dropping out? How well do outreach services work? In principle but not always in practice, the answers to these questions can be found by health workers themselves with data that are readily available to them. The importance of data use is highlighted by the inclusion of facility-level microplanning as a core component of the WHO/UNICEF Reaching Every District strategy, used by most countries to strengthen routine immunization (RI).
In 2009, the Bill & Melinda Gates Foundation created the ARISE project, managed by JSI, to assemble the evidence on what drives improvements in RI performance in Africa. To amass such evidence, ARISE conducted in-depth, mixed methods comparative case studies in Cameroon, Ethiopia, and Ghana. It employed an assets-based approach to identify common drivers of improvements in RI performance at the district level, describe the pathways by which they improve coverage, and identify contextual factors affecting performance.
The purpose of this Guide is to stimulate interest in improving and sustaining high levels of immunisation coverage in all districts and to give health program managers (governmental and non-governmental), supervisors and health workers practical information about the RED approach. The Guide is intended for adaptation and use by national immunization programmes, as one of several resources that can be used to introduce district health teams and immunisation partners to the RED approach. Once adapted, it can also be used by district health teams and health workers as a quick reference to the five RED components and core monitoring indicators. Another important use for the Guide may be in explaining RED to local officials and other potential supporters of immunisation and PHC services.
This reference book, jointly produced by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), presents detailed statistics on the performance of national and district-level immunization systems in 195 countries and territories. It provides an overview of key aspects.
In 2011, ARISE conducted in-depth case studies in three countries (Cameroon, Ethiopia, and Ghana) to explore and describe the factors underlying performance improvement in routine immunization in Africa.4 The studies aimed to define the pathways through which specific drivers improved RI system performance (as measured by coverage with the third dose of DTP/Pentavalent vaccine)5 by investigating the experience of 12 districts. This ARISE research brief reports the results of these in-depth studies.
Closing the equity gap for routine immunizations requires harnessing community resources, including social, political, and in-kind support, to augment those of the health system. How can those resources be brought together productively, and to accomplish what? The ARISE Project, created by the Bill & Melinda Gates Foundation to assemble the evidence on what drives improvements in RI performance in Africa, conducted in-depth studies in Cameroon, Ethiopia, and Ghana to gain a better understanding of these dynamics. ARISE
Through the use of RapidSMS mobile technology, Project Mwana delivers test results for diagnosis of human immunodeficiency virus (HIV) in infants in real time to rural clinics and facilitates communications between clinics and community health workers.