Among countries in Africa, Ethiopia ranks highest in terms of the number of unimmunized children. This means 773,750 children go unprotected from such vaccine-preventable diseases as pertussis, tetanus, and diphtheria. While national coverage rates for Penta3 stand at 83%, there is significant variation among the country’s nine regions, with pastoralist regions historically lagging behind. For example, the DTP3 coverage rate for the arid, pastoralist region of Afar in the northeast of the country is just 47%. As such, the Ethiopian government, along with its non-governmental partners, have concentrated effort and attention to improve the routine immunization system in Afar through implementation of the Reaching Every District (RED) strategy. RED focuses on five components: planning and management of resources, reaching target populations (including mobile services), linking services with communities, supportive supervision for health staff, and monitoring data for action.
As a leader in routine immunization system strengthening, JSI Research & Training Institute, Inc. (JSI) has been working to refine RED by incorporating quality improvement methods and tools. This approach, called Reaching Every District with Quality Improvement (RED-QI), aims to operationalize RED and strengthen the capacity of health managers and service providers to diagnose their immediate situations, identify root causes of problems, and find solutions that are workable within their own context. By incorporating quality improvement elements, the RED-QI approach promotes continuous learning and improvement of the routine immunization system.
Since July 2011, JSI’s Universal Immunization through Improving Family Health Services (UI-FHS) project, supported by the Bill & Melinda Gates Foundation, has been working in Afar to explore and document what it takes to achieve universal immunization within a pastoralist context. Working in partnership with the Federal Ministry of Health (FMOH), UI-FHS has supported Assaieta woreda (district) and two woredas in two other regions to implement RED-QI and develop evidence for its effectiveness, feasibility, and sustainability. In 2014, UI-FHS was granted a supplement award by the Bill & Melinda Gates Foundation to widely scale-up RED-QI implementation in 128 woredas across 6 regions, including 25 woredas in Afar. The supplement award will build upon the success and learning from the original grant and will focus on equity and quality within the country’s varying contexts.
In light of this focus on pastoralist regions, federal and regional officials are planning several high-profile activities in Afar for World Immunization Week, April 24-30, 2015 (known in Ethiopia as Africa Vaccination Week). To kick off the week, on Thursday April 23rd FMOH and other government officials witnessed routine immunization sessions in action in Semera and at a health center in Logia, about ten kilometers from Semera. Later that afternoon, a panel discussion was held to examine immunization performance in Afar and identify strengths and gaps. At this event, the Regional Health Bureau (RHB) officially recognized partner organizations by issuing a traditional “gille” as a present. UI-FHS was encouraged to be among recognized partners to receive the present.
Additionally, the Afar Regional Health Bureau organized a two-day sensitization workshop for all 34 woredas in the region, an event designed for woreda administrators, woreda health office heads, and other relevant cabinet members to focus on strategies to improve routine immunization in their areas. UI-FHS provided support to RHB for the workshop, and the UI-FHS regional team participated by introducing the RED-QI approach to other woredas and explaining project plans for scaling-up in up to 25 woredas in the region over the next four to five years. UI-FHS’s scale-up plans were well-received by woreda health leaders, who expressed the desire for thorough RED-QI implementation across all of Afar.
UI-FHS participation in this workshop represents an important first step in developing relationships with regional and woreda officials to pave the way for successful RED-QI implementation in additional woredas in Afar. By participating in broader World Immunization Week activities, UI-FHS aims to support government efforts in highlighting Afar as a key region in the country’s focus on equity and quality and the direction towards stronger routine immunization systems and improved coverage.
 Unimmunized children refers to children who have not received their full three-dose course of either Pentavalent or DTP vaccine, which are often used as indicators of routine immunization performance.
 Richard Mihigo, “Updates on Routine Immunization and New Vaccines Introduction in AFR” (presentation, Immunization Partners’ Meeting, Brazzaville, Congo, March 2-3, 2015).
 WHO. “Ethiopia: Immunization,” WHO Regional Office for Africa, Accessed April 23, 2015, http://www.afro.who.int/en/ethiopia/country-programmes/topics/4594-ethiopia-immunization.html.
 Federal Ministry of Health (FMOH). Ethiopia National Expanded Programme on Immunization: Comprehensive Multi-Year Plan 2011-2015. Addis Ababa: FMOH, 2010. Accessed April 16, 2015. http://www.gavi.org/Country/Ethiopia/Documents/CMYPs/Comprehensive-multi-year-plan-for-2011-2015/.
 A “gille” is a sword, a traditional gift in the Afar region.
Learn more about the Universal Immunization through Improving Family Health Services (UI-FHS) Project.