1. 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

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. Coverage of Measles 1st and 2nd doses in Ghana, 2012 – 2015
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Strengthening 2YL Platform & Men A Introduction Plan

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

10. 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

11. Strengthening 2YL Platform & Men A Introduction Plan
Impact on Measles Control: Measles suspected cases & measles vaccination
No death from measles
Since 2003 (past 14 yrs)
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Strengthening 2YL Platform & Men A Introduction Plan

12. 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

13. 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
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Strengthening 2YL Platform & Men A Introduction Plan

14. 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

15. 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

16. 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
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Strengthening 2YL Platform & Men A Introduction Plan

17. 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

18. 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

19. 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
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Strengthening 2YL Platform & Men A Introduction Plan

20. Thank You