“Last year I did not carry out routine immunization (RI) for 6 months,” says Alex Kwikiriza, In-charge and nurse at Nyamiryango HC II in Kabale district, Uganda. But due to lack of clearly demarcated service areas for each health facility—and, thus, target populations—the health facility’s under performance was not noticed.
However, when MCHIP/Uganda facilitated Kabale district local government to conduct macro mapping of populations against primary health care facilities throughout the whole district, this lack of activity became clear. Mapping facilitated the District Health Team (DHT) to clearly identify the service areas of each health facility and target population. Using the target population and local Expanded Program on Immunization data, each health facility’s performance for six months was assessed. Best and worst performing health centers on RI were identified using a national RI categorization tool being encouraged by the Uganda National Expanded Program on Immunization and partners.
And when Kabale DHT, with MCHIP/Uganda support, organized a district quarterly review meeting attended by political and religious leaders and health workers from all static health centers in Kabale district, “it was found out that my health center had not vaccinated any child for the past six months,” Alex says.
“The district chairperson asked me to stand amidst the meeting to explain why my health facility had not vaccinated a single child in the past six months despite having all that it takes to vaccinate children,” he adds. “It was a hard moment for me! They also showed me the effects of this poor performance. I was very touched and ashamed to be the in-charge of a health facility performing poorly and letting down the whole district.”
The district chairperson asked Alex to discuss with him the challenges he faces in the health facility and come up with solutions. “As a result of this meeting, [our] RI challenges were put in the spotlight of leaders of the district,” Alex says. “I met with the district chairperson, and the district health officer explained to them the various challenges faced by the health facility. Then these challenges were systematically addressed.”
As a result, the team has had many subsequent achievements and successes:
- September—Nyamiryango HCII successfully immunized 79 babies, all newborn to one year of age.
- October—the team immunized 121 babies of the same age from both static and outreach sites.
- July and August—Nyamiryango carried out one outreach session each month.
- September and October—two outreach sessions were carried out each month.”
All of this was done using existing resources at the health center.
“I thank MCHIP/Uganda for coming in, for without their intervention, Nyamiryango to date would still not carry out vaccinations,” Alex says. “We now know which villages to focus on and our target populations, we track and access and utilization issues and follow-up in strengthening immunization. MCHIP/Uganda has also helped us in identifying our immunization needs and challenges and we also understand that each health facility is accountable for providing health services to their identified community.”
Alex further asserts that, “through the continuous mentorship and training I have received over the past year from the DHT and MCHIP, the immunization rates of Nyamiryango HC II have steadily gone up and there is a great improvement in the service delivery at the health center.”
In the last 11 months, he has seen great improvement in RI at the health center, including:
- To address the storage problem of vaccines, the district has provided solar energy for the HC II. The fridge is fully functional and vaccines are brought on time and stored safely.
- The DHT has been routinely following the facility’s performance and frequently checking performance during supportive supervision.
- A support staff from HC III has been brought to assist with both static and outreach immunization sessions. A retired nurse, who is a volunteer vaccinator, also comes and assists with RI sessions on the days of static and outreach services.
- There has been sensitization of the community on RI services from both political and religious leaders, as well as health workers, and the parents and care takers of children are happy that we are immunizing again.
- Village Health Team coordinators have been oriented to RI and assist with mobilization of communities to attend outreach sessions.
- A Quality Improvement working team (comprised of 20 sub-county leaders, community development officers, health assistants, in-charges of health facilities and focal points for immunization, and parish coordinators) held a meeting supported by the DHT and MCHIP to identify and prioritize major problems, as well as indicators to measure the proposed solutions.