The Ministry of Health and Sanitation has finalized an internal evaluation of its Child Health and Expanded Programme on Immunization (EPI) covering all districts.  The appraisal looked at progress on set targets for 2019 and first quarter of 2020, implementation challenges and the capacity of the Programme for effective service delivery at national, district and health facility levels.

Being the mainstay of every child survival in Sierra Leone, the Child Health EPI is one of the biggest health service delivery programmes in the country that provides lifesaving health services to an estimated 1.5 million children under 5 years as well as maternal health services to pregnant mothers.

Sierra Leone has made considerable strides in maintaining active immunization and child health services despite the obstacles posed by the COVID-19 outbreak. However, health facility record reviews have shown evidence of decline in coverage in the first quarter of 2020 mainly due to the decline in hospital attendance during the COVID-19 pandemic. Integrated supportive supervision and community mobilization have been intensified to improve best practices and mobilize mothers and caregivers to utilize immunization and child health services available at health facilities.

There are currently 12 antigens in the national routine immunization system in Sierra Leone with planned introduction of Human Papillomavirus Vaccine and 2^nd dose of Inactivated Polio Vaccine in 2021 to protect against vaccine preventable disease. With support from WHO, Gavi and partners in June 2019, the country introduced measles-rubella vaccine for the first time into its routine immunization services through a catch-up campaign. A post-campaign evaluation of this massive countrywide exercise revealed 93.2% national coverage with seven out of then 14 districts (50% of the districts) achieving over 95% coverage. The success of the catch-up campaign is demonstrated by not experiencing Measles or Rubella disease outbreaks till date as revealed by the review.

This is the first time a dedicated EPI review meeting is conducted with the participation of national and district level immunization experts to assess the organization of immunization activities, functionality of existing structures including cold chain system, stock management, fixed and outreach services utilization. The process aimed to identify and eliminating risks impeding attainment of the required level of performance at different levels of the national immunization system particularly in the context of coronavirus pandemic.
Previously, all review activities of the Programme were conducted jointly with the National Integrated Disease Surveillance and Response (IDSR) programme. “We needed to have a deep dive into the issues for a better understanding of the progress and challenges so that we could come up with concrete actionable recommendations for sustainable improvement plan in immunization service delivery across the board”, say Thompson Igbu, Immunization Programme Expert at the WHO Sierra Leone. Given the high degree of decentralization of the Immunization Programme, the review involved all the districts to assess their performance against set targets with participation of national level MoHS Child Health officials with funding by Gavi through UNICEF and technical support from WHO and ICAP.

The cold chain system was identified as one of the major challenges in the implementation of EPI services particularly in health facilities serving remote and hard to reach rural communities. Areas without cold chain facilities rely on the nearest health facility for the storage of their stock. In some cases, the distance could be long, rough and challenging. “Making sure that the antigens remain potent is very important because we do not just want to vaccinate children, we want them to be fully immunized against preventable diseases”, says Evans Liyosi, WHO Representative in Sierra Leone. “Hence improving the cold chain system is a major priority for resource mobilization to ensure that the vaccines remain potent and safe”.

WHO recommends regular reviews of progress to ensure high quality service delivery, ensure transparency and accountability of resources, identification of gaps and challenges and to help facilitate critical recommendations and decisions for improvement.

To ensure continuity of immunization services, WHO recently supported the review and development of tools and national guidelines to guide the conduct of immunization services at health facilities and outreach sites during the COVID-19 pandemic.