Integrated child survival interventions

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Integration of health services has been defined as the process of bringing together common functions within and between organizations to solve common problems, developing a commitment to a shared vision and goals, and using common technologies and resources to achieve these goals.

In countries with weaknesses in the health systems, it is necessary to use innovative delivery mechanisms to scale up effective child survival interventions in a manner complementary to ongoing efforts to strengthen national health systems.

Integrating immunization with other health interventions in the context of health system strengthening is one of the four strategic areas of Global Immunization and Vision Strategy (GIVS). Integration of additional child survival interventions with immunization is being promoted in order to achieve:

  • Improved efficiency and productivity
  • Improved health status
  • Improved user satisfaction and convenience, and
  • Improved equity

The various platforms for delivering additional child survival interventions with immunization are (a) routine immunization services, (b) Periodic Intensification of Routine Immunisation services (PIRI) and (c) Supplemental Immunisation Activities (SIAs). PIRI activities (eg., Child Health Days) represent an intensified "one stop" delivery of broad packages of child survival interventions usually conducted twice or three times a year.

The selection of interventions to be integrated is done based on programmatic factors including the burden of disease, the availability of resources (operational funds, supplies, human resources, etc), the cost-effectiveness and feasibility of interventions, the presence of partnerships that support the interventions, and the acceptability of interventions by community and political leaders.

Interventions often linked with immunisation services include vitamin A supplementation, growth monitoring, ITN distribution, ITN re-treatment, health education on home management of fever, HIV/AIDS awareness, family planning services, distribution of iron tablets as well as the distribution of anti-helminthics.

The Role of the Immunization and Vaccine Development (IVD) Programme
The IVD program in WHO AFRO actively promotes integrated child survival interventions by:

  • Supporting advocacy with governments and partners
  • Assisting in resource mobilization
  • Developing the framework for the delivery of multiple child survival interventions through the immunisation platform
  • Setting the standard methods and tools for the monitoring and evaluation of interventions provided using the immunisation platform
  • Sharing experiences with regards to planning, implementation and monitoring of integrated interventions
  • Providing technical support for the planning, implementation, monitoring and evaluation of integrated interventions

Challenges:

  • Coordination among different stakeholders and partners
  • Timely availability of adequate supplies (e.g. ITNs, drugs, vaccines )
  • Forecasting supplies needs
  • Accuracy of denominators
  • Staff work load
  • Operational difficulties when different interventions are targeted at different age groups
  • Difficulties with developing a clear social mobilization message for several interventions at once
  • Weak documentation
  • Accuracy of monitoring of the service delivery data

What WHO AFRO is doing to overcome these challenges:
The IVD program, WHO AFRO, continues to support countries in conducting a series of activities in order to tackle the challenges, and these include:

  • Advocacy and consensus-building between programme managers responsible for the various interventions
  • Clarification of roles and responsibilities of the different players/stake-holders
  • Development of planning and implementation guidelines
  • Development of appropriate training materials
  • Technical and financial support for SIAs and PIRI activities
  • Supporting the documentation of experiences and sharing of best practices

Achievements:

As of June 2009, more than 80% of countries at risk for Vitamin A deficiency in the African Region have already integrated Vitamin A supplementation with routine immunization services.

Polio and measles SIAs have been major vehicles for the delivery of essential child survival interventions. For example, between 2006 and 2008, 40 of the 41 measles SIAs in the African Region have integrated at least one additional child survival intervention. Of these, 32 of 41 SIAs of measles SIAs have integrated the distribution of vitamin A, while 21 and 20 SIAs respectively have integrated the distribution of de-worming medicine and insecticide-treated bed nets.

As of June 2009, at least 28 countries in the African Region have started providing integrated child survival interventions through PIRI activities.