International Review of the Expanded Programme on Immunization in Solomon Islands, November 2012
In November 2012, representatives of the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), GAVI Alliance, and Japan International Cooperation Agency (JICA) conducted a review of Solomon Island’s Expanded Programme on Immunization (EPI), which marked the first programme review in the country. The agencies confirmed a high level of international commitment and support for the programme, and identified a number of issues and recommendations that are highlighted in this report. The review focused primarily on operational analyses rather than on reporting or analysing new data on coverage rates or other performance indicators.
An accessible and well-functioning immunization programme should be a key component of public health services in every country. Strengthening routine immunization services is crucial to achieve the Millennium Development Goal 4 of reducing deaths among under-five children by two-thirds by 2015 compared to 1990. Immunizations are highly cost-effective, and as such, they are a useful benchmark for measuring the effectiveness of government investments in public health and should be one of the highest priorities for government health expenditure. The Solomon Islands’ achievements in immunizations are considerable.
Over the past few years, routine vaccination coverage has shown improvement. The country has remained polio-free. Supplementary immunization activities have successfully enabled control of measles, and Solomon Islands is likely to have achieved the regional goal of measles elimination. The incidence of polio, measles and maternal and neonatal tetanus (MNT) has been sustained at zero level across the country. New life-saving vaccines like Haemophilus Influenzae type b (Hib) vaccine have been added to the national immunization schedule. Despite this progress, however, routine vaccination coverage in many areas remains low, and many children are vaccinated late.
The key findings of the review include: different estimates for the number of target children; inadequate cold chain; weak vaccine management; inadequate earmarked funds for outreach, supervision and transportation at health facility level; delayed arrival of funds and lack of knowledge about EPI funds; weak data management; lack of guidelines on adverse events following immunization (AEFI); lack of appropriate equipment for disposal of immunization waste; lack of EPI microplanning; and insufficient regular supportive supervision.
The review team identified several priority areas for consideration by the Government to expand the scope and increase the impact of EPI in Solomon Islands.
Priority recommendations are as follows:
- Establish a national system of birth registration.
- Reassess the cold chain status of health facilities, develop a replacement plan with costing, and designate and protect the budget planned for maintenance at health facility level.
- Forecast and procure vaccines based on targets and needs.
- Develop a national EPI plan including costings for outreach, supervision and transportation at subnational level and earmarking sufficient funds for the above needs for each province.
- Strengthen data management at all levels.
- Develop national guidelines and conduct training for health staff from national to health centre levels on AEFI management and reporting.
- Provide waste disposal equipment (e.g. drums, incinerators) to health facilities, and strengthen capacity-building at all levels.
- Ensure all health facilities develop EPI microplans to identify and vaccinate more eligible children.
- Strengthen regular supportive supervision.