1. Immunization service delivery – immunization management prospective

3. Service delivery A step within the immunization system Immunization service delivery : a service based on principles, standards, policies, strengths and weakness All children have the right to get vaccinated with safe vaccines at the right time at the right place.

4. Setting the standards -Vaccinations are offered : -Primary care centers – baby clinics, health posts (fixed post sites and outreach activities) -Outreach activities – community participation -Private sector – primary and secondary care -Main standards for all of them: cold chain, administration of vaccine, injection safety and trained personnel.

5. Primary care Getting the vaccine – PLANNING (knowing the community, monthly plans etc) Empower nurses and doctors Primary care service standards and duties ( immunization service delivery: planning, management, coordination, vaccine administration, supervision, trained staff) Financing

6. - Planning and coordination of primary care services with district immunization management -vaccines, syringes, safety boxes, cold chain monitoring devices -Instructions related to the vaccines, producers etc. -Ensuring vaccine quality – central level Vaccine supply and quality

7. Planning

8. Planning and supervision by district manager

9. Logistics Transportation of vaccines to primary care centers Cold chain Ensure vaccination of every child from maternity to primary care services SMS Door to door activities performed by fixed posts nurses

10. Coverage Identification of unvaccinated children AEFI Info about supplies Registries Information Immunization system - Piloted in 2010 -2012 - Scale up activities since 2013 Surveillance and monitoring

11. Why IIS Questions about data quality Overall coverage data alone is not enough to manage program Lack of timeliness of information New expensive single dose vaccines need to be better managed Workload for nurses, district officers and reduction of staff No access to immunization records for other districst ( internal migration) Lack of effective collaboration between nurses

12. How? 1. Track individual children’s schedules to: Ensure timely vaccination of all registered children Improve coverage data quality Supply vaccine based on real demand Learn reasons for non- vaccination Track vaccine lots down to the child record

13. Vaccines are distributed together with the list of children to be vaccinated

14. Where the problem is- beyond 5%

15. Analytical reports Cohort coverage: immunization status of all registered children in a certain cohort Fully immunized children: FIC coverage as well as drop-out rates between certain antigens Coverage compared to plan: % vaccinated in a certain year compared to the number of children that was planned for vaccination in that year Vaccination activities: vaccinations administered by a certain health Stock balances: available stock balance in the store by vaccine, compared to preset minimum and maximum levels. Vaccine wastage: how many doses of each vaccine were used, administered, and wasted by facility. Wastage by reason: reported as wasted by reason code Lot tracing: shows were each vaccine lot was distributed, and to which children it was administered.

16. Empower nurses and parents Training of nurses and collaboration Parents with their ID have their account and may learn more about vaccination of their children, timing, and may print vaccination cards

17. Financial incentives Performance based bonus - Incentives for good immunization coverage for primary care centers Incentives for community outreach

18. Other Immunization card and nursery, kinder garden and school registration Collaboration with Roma organization and offering vaccines in their communities

19. Private sector Part of immunization servce delivery Offered in primary and secondary care National standards applied for them Identification and registration of vaccination activities Following the same schedule with more expensive vaccines Ensure cold chain, injection safety and education standards Provide information to public clinics when needed

20. A cadre of trained staff on immunization A package of information for each health care center -Gaps on training but in general every nurse in the country must have a basic vaccination training and know the vaccines they are administrating -Lack of communication big cities – Tirana capital -More advocacy, communication training Training, Advocacy and communication

21. Thank you