Strengthening the 2YL Platform & Men A Introduction Plan in Ghana Accelerating Progress towards Measles and Rubella Elimination Hotel Royal, Geneva, Switzerland, 21 – 23 June 2016 Dr George Bonsu National EPI Manager Ghana

Strengthening 2YL Platform & Men A Introduction Plan Outline Background Second Year of Life platform in Ghana(2YL) Achievements Challenges 2YL Project Progress towards introduction of Men A into routine EPI Lessons Learnt 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Strengthening 2YL Platform & Men A Introduction Plan Country Information Population (2016): 28,688,100 Pop <1 : 1,147,524 Regions : 10 Districts : 216 Sub-districts : 1,296 CHPS zones : 2,565 Bordering countries: North: Burkina Faso East: Togo West: Cote d’ivoire 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Mandate of the EPI Programme The EPI Programme aims at reducing morbidity and mortality by controlling, eliminating or eradicating vaccine preventable diseases (VPDs) through immunization; an essential component of Primary Health Care The Programme currently vaccinates against 12 VPDs in routine immunization Year Antigen BCG OPV DPT Measles Total: 6 +TT YF Total: 7 HB Hib into PENTA Total: 9 PCV Rota MSD Total: 11 (M)R Td Total: 12 1978 1992 2002 2012 2013 Men A IPV HPV RTS,S 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Rationale for establishing the 2YL Platform Establish an additional schedule for the second dose of measles at 18 months (>95% protection after 12 months) Establish a platform for the introduction of new vaccines; Men A and RTS,S Provide missed vaccines to children after one year Opportunity to strengthen growth monitoring, vitamin A supplementation and other childhood interventions 18 months was selected for measles second dose to coincide with the 3rd dose of vitamin A 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Interventions delivered in 2YL The following interventions are currently provided in the 2YL; Provision of missed vaccines to children Measles Second Dose (MSD) Vitamin A Supplementation Growth monitoring Provision of Long-lasting Insecticide Net (LLIN) The provision of long-lasting insecticide net (LLIN) was strategically fixed at 18 months to ‘pull’ caregivers to vaccination sites 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Preparatory Activities: 2YL National level advocacy with key stakeholders, ICC Revision of data collection and analysis tools; tally sheet, Child Welfare Clinic register (CWC), monthly vaccination report, child health record booklets and soft wares Training of health staff at all levels Dissemination of health education messages 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Coverage of Measles 1st and 2nd doses in Ghana, 2012 – 2015 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Routine Measles Vaccine Coverage - 2015 Measles 1st dose Measles second dose 72 % Ghana 94 % Ghana

Children vaccinated by age category in 2015   2015 Antigen 0-11 mons 12-23 mons 24-59 mons Measles 1 1,001,571 5,954 872 Measles 2 765,068 41,531 OPV3 1,028,619 472 95 PCV3 1,026,231 586 321 Penta3 1,015,872 436 100 Yellow Fever 1,017,378 8,417 1,673

Strengthening 2YL Platform & Men A Introduction Plan Impact on Measles Control: Measles suspected cases & measles vaccination 1994-2015 No death from measles Since 2003 (past 14 yrs) 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Strengthening 2YL Platform & Men A Introduction Plan Challenges Low coverage rates for interventions in the 2YL: MSD, 3rd dose vitamin A, growth monitoring and catch up on missed children Varied understanding of the 18 month MSD schedule among health staff Inadequate information among caregivers and decision makers at the community level on 2YL Incentivizing MSD with LLINs became a challenge: some caregivers refused vaccination wherever and whenever LLINs were not available No clear national policy and guidelines on catch up vaccinations in the second year of life 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Addressing challenges: 2YL Project This is a project which seeks to offer protection for children from vaccine preventable disease (VPD) by strengthening the second year of life (2YL) immunization platform It is supported by CDC in collaboration with WHO and UNICEF 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Special Strategies: 2YL Project Rationale for the project: To strengthen second year of life visit for immunizations: To improve Measles second dose coverage, To facilitate rapid uptake of meningitis A vaccine into routine To reduce inequities by allowing opportunities to catch-up children missing infant vaccinations 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Special Strategies: 2YL Project Six (6) Intervention Areas; Communications/Demand generation Healthcare worker training/supervision Data reporting and recording: Expansion of electronic data management for immunization registration and reporting at the district and/or health facility level Programme integrations VPD surveillance Special innovations for reducing inequities and improving coverage among hard-to reach populations 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Algorithm for Measles Vaccination Assess age of child Child is less than 9 months Do not give MR1 Check CHRB and give age appropriate vaccines, counsel mother to return after 4 weeks Child is 9 months or more Has the child received MR1? Yes Child is less than 18months Do not give MR2. Inspect CHRB and give any missed vaccines; counsel to return after 4 weeks Child is 18 months or more Has child received MR2? Inspect CHRB. Give any missed vaccines; counsel to return to CWC at the appropriate age No Give MR2/Vit A and any missed vaccines; counsel to return to CWC at the appropriate age Give MR1 with other missed vaccines, inform caretaker of due date for MR2 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Plan for Men A Introduction-1 Ghana has received approval to introduce MenAfriVac™ into routine immunization All data collection tools as well as the data management system (DHIMS) have been revised to incorporate Men A Routine introduction is scheduled for November 2016 One dose schedule at 18 months to coincide with MSD The routine introduction of the vaccine will be preceded by a mini catch-up campaign in July 2016 targeting chn. aged 1-4 years 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Plan for Men A Introduction-2 Timelines for mini catch-up campaign; Distribution of vaccines to regions : 01 – 03 June 2016 Planning and training of Regional teams : 22 – 23 June 2016 Training of District teams : 27 – 30 June 2016 Distribution of vaccines to districts and below : 04 – 08 July 2016 Distribution of tools and other logistics : 04 – 08 July 2016 Training of vaccinators and volunteers : 11 – 15 July 2016 Advocacy and Social Mobilization : 01 – 26 July 2016 Regional level Press Briefing : 18 – 19 July 2016 Campaign Implementation : 20 – 26 July 2016 Post Campaign Review Meeting : 17 – 18 August 2016 Nationwide Routine introduction of Men A : 1 November 2016 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

Strengthening 2YL Platform & Men A Introduction Plan Lessons Learnt Updated policy and field guide to cover vaccinations in second year of life very necessary Cascaded training for all health workers including managers essential Advocacy at all levels: national, regional and community Sustained communication on interventions in 2YL needed to create demand Revision of all tools and databases to include 2YL indicators- (services recorded by age categories- 0-11, 12-23mo, >= 24months) Enhanced supervision and feedback 5/23/2018 Strengthening 2YL Platform & Men A Introduction Plan

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