The Reaching Every District (RED) strategy. Re-establish outreach services Conduct supportive...
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Transcript of The Reaching Every District (RED) strategy. Re-establish outreach services Conduct supportive...
![Page 1: The Reaching Every District (RED) strategy. Re-establish outreach services Conduct supportive supervision Establish community links with service.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649e1f5503460f94b0aac0/html5/thumbnails/1.jpg)
The Reaching Every District (RED) strategy
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· Re-establish outreach services· Conduct supportive supervision· Establish community links with service
delivery· Monitor and use data for action· Improve planning and management of
resources
Reaching Every District: 5 RED Components
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History of RED strategy• Officially created by WHO African regional office (WHO-AFRO) in early 2000s• Created in response to stagnant immunization performance in the African
region– A focus on national coverage was masking the variation sub-national coverage i.e.
many districts had less than 80% immunization coverage• Most immunization programs had the most basic elements: human
resources, facilities, vaccine supply chain and money– These programs had reached the “easy to reach” children but now needed to reach
the “hard to reach” children• Objective
– To reach the “hard to reach”, needed to address the identified challenges with a package of strategies:
• Improve planning and resource management, monitor the program better, use monitoring data better, improve links with all communities, improve availability of immunization services in hard to reach communities (outreach)
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Disclaimer…• RED focuses on district-level results
– Traditionally too much focus on national results– Importance of decentralization– Identification of and improvement in poorly
performing districts critical to reduce outbreaks• Really want to reach every:
– Village or health center catchment area– Child
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Matching RED strategies to barriers
Poor access
High dropout/ poor utilization
Missed Oppor-tunities
Manage-ment
Community barriers
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Matching RED strategies to barriers
Poor access
High dropout/ poor utilization
Missed Oppor-tunities
Manage-ment
Community barriers
+++ ++ + + ++
+ + ++ ++ +
+ + + +++
+ +++ +++ ++ +
+ + + +++ +
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Matching RED strategies to barriers
Poor access
High dropout/ poor utilization
Missed Oppor-tunities
Manage-ment
Community barriers
Outreach +++ ++ + + ++
Supportive supervision
+ + ++ ++ +
Community links
+ + + +++
Monitoring, use of data
+ +++ +++ ++ +
Resource management
+ + + +++ +
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1) Re-establish Outreach Services
• Conduct initial analysis to assess status• Make a map in every district and every health
facility showing population, communities, roads etc.
• Develop session plan showing how every community will be reached regularly
• Implement workplan showing activities, persons responsible and timetable, including supervisory visits
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MAKING A DISTRICT
MAP
For every health center:
Decide delivery
strategy for each village:
fixed, outreach,
mobile team
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Village / Town
Total popula-
tion
Target population
(4% of total population for this exercise)
Distance from
Health Center /
other obstacles
Session type:
Fixed / Outreach / Mobile
Injections per year
(target population X
5)
Injections per
month (injections per year
divided by 12)
Sessions per month (Fixed
>50 injections per session, or
Outreach >25 injections per
session)
I II III IV V VI VII VIII A 10,000 400 0 F 2000 167 4 - each Monday
B 5000 200 2 F 1000 83 2 - first, third Tuesday
C 3750 150 2.5 F 750 63 2 - second, fourth Tuesday
D 1250 50 6 O 250 21 1 - first Wednesday
E 2500 100 3 F 500 42 1 - first Thursday
F 250 10 2.5 F 50 4 1 - first Thursday
G 1250 50 10 O 250 21 1 - second Wednesday
H 625 25 8 O at G 125 10 1 - second Wednesday
I 750 30 river passable in dry season
M 150 At least 4 times a year
TOTAL 25,375 1015
Session Plan - reach each village regularly
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Clinic Fixed and Outreach plan
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Outreach Challenges• Cost/Logistics
– Per diem– Transport– Cold chain– Access
• Organization• Low return (few children)• Frequency
– Need at least monthly to match schedule
• Missed sessions
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2) Conduct Supportive Supervision• Supervision that combines on-site training, problem
solving, and monitoring • Focus on priority issues for follow-up at district and
health facility level:– map– session plan– workplan– monitoring chart– stock/supply records– deciding on corrective action for the quarter
• Supportive Supervision is more than just a check-list
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Supportive Supervision Challenges
• Resources– Staff– Time– Per diem– Transport and fuel
• Organization• Frequency
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3) Establish Community Links• Assist with organization of services
– Planning convenient services – Session volunteers, informing mothers and crowd
control– Defaulter tracing– Vaccine transport
• Community attitudes– Father’s permission– Who else influences mothers’ decision making– Who else can facilitate vaccination?
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Community Links: Lady Health Workers in Pakistan
Duties:
• birth registration
• defaulter follow-up
• ‘catch-up’ routine immunization (including TT)
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Community Links - Challenges
• Attitudes– Community– Health Staff
• Language• Organization
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4) Monitor and Use Data for Action
• Compile data• Analyze data to identify problems• Decide what activities needed to solve
problems: existing resources or extra resources
• Go back to your work plan and add these activities, prioritize
• Monitor and evaluate impact
• Topic of another talk…
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5) Planning and Management of Resources
• Ensure effective use of human, financial and material resources
• Development of national, provincial, and district POA/work plans
• Capacity building of staff• Systematic vaccine forecasting, supply and
distribution• Effective management of the cold chain• Mobilization of resources
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RED Guides
• The AFRO Reaching Every District Guidelines• The AFRO RED microplanning guidelines