Skip directly to search Skip directly to A to Z list Skip directly to site content Skip directly to page options
CDC Home

Our Global Voices

Raising our voices to improve health around the world.

Share
Compartir

Selected Category: immunization

Strengthening Vaccination Systems – how it STARTs

Categories: immunization

On the road to Bukwo District (photo courtesy of George Momanyi)

On the road to Bukwo District (photo courtesy of George Momanyi)

George Momanyi, Public Health Nurse, START Consultant

George Momanyi, Public Health Nurse, START Consultant

George Momanyi, a public health nurse from Kenya, has twice served as a consultant with CDC’s Strengthening Technical Assistance for Routine Immunization Training (START) project in Uganda.  START, funded through a grant from the Bill & Melinda Gates Foundation, provides mentoring and on-the-job training to district-level immunization officers and service providers in areas with high numbers of unimmunized children. START consultants make regular visits to district health officers and service providers, delivering training and reinforcing the application of practical job skills.  START’s objective is to build the capacity of program staff and thereby strengthen the overall immunization system. 

As a START consultant, George worked in eastern Uganda from July-December 2013, and in northern Uganda from February-June 2014. As he was ending his service on the 2nd START team in June, he sent us this blog about his experience.

Getting Started

Delivering training at a health center (photo courtesy of George Momanyi)

Delivering training at a health center (photo courtesy of George Momanyi)

I came into the START project having worked in the Expanded Program on Immunization (EPI) in Kenya for more than 10 years and also after having served as a Stop Transmission of Polio (STOP) volunteer in Ethiopia in 2009.  With this background, I had quite some experience, but still was open to learning more from the Ugandan setting.  There were two important factors that enabled the START team’s success before deploying to the field.  The first was the pre-service training we received in Kampala, and the second was a meeting with all the Health Officers from the districts where our team would work to introduce the project and discuss how we would be working together.  In this way the health officers could see this would be a collaboration with them, and not a short-term project imposed on them from the outside.

After initial training of the district EPI officers, I accompanied them to the health centers, where vaccination services are delivered, to provide on-the-job training to the staff there.  It was not always easy for the district officer to offer training to the health center staff at the beginning, so I did initial health center trainings while the district officer observed, so he could become more familiar with the topics and training methods.  On the follow-up visits the district officer and I trained the health center staff together, increasing the officer’s confidence in doing this on his own in the future.

Training with district officer at a health center (photo courtesy of George Momanyi)

Training with district officer at a health center (photo courtesy of George Momanyi)

Many times, I sat together with the health center workers and led them through the group exercises.  I engaged health workers while building on what they already knew on the topic before introducing any new concepts.  One of my key mentoring approaches was to understand the workers’ knowledge and skill gaps and to focus on those during our time together.  In order to help slow-moving health centers, I often shared pictures of good practices seen in other facilities as a way to encourage them that it was possible to do even better.

In order to win their confidence and establish a positive relationship, I often reassured health workers that I was there not as a supervisor but rather as a colleague to support them to improve routine immunization performance.  In that way, the staff were always free to interact with me and even open up to me with details they had not told to their supervisors. One EPI staff person told me, “I admire the way you handle our staff, and they are able to give you details they would rarely mention to us.” While supporting the districts, I used every available opportunity to mentor the teams.  Health workers could call me to seek clarification or even request that I revisit their health facilities at any time, and I always made time for them.

Working in the field

I met this health center EPI officer on my way to another facility and I took a moment to appraise his EPI micro plan. (Photo courtesy of George Momanyi)

I met this health center EPI officer on my way to another facility and I took a moment to appraise his EPI micro plan. (Photo courtesy of George Momanyi)

As a START volunteer, I came across many challenges but managed to cope.  Many of these were related to routine immunization service delivery.  I often took time to help health workers understand how their own practice had a bearing on overall system performance – that their actions could contribute to the system either performing well or poorly.  Therefore I worked with the teams to try to accurately identify the reasons for problems, and then explore solutions.  Before providing my own suggestions, I always sought ideas from both the district or health center teams about the issues and what they thought they could do on their part.  Where appropriate, I engaged the district health officers for their support.  Some of the common issues encountered included were these:

  • Getting quality time, especially with the key district EPI officers, was a challenge, because of competing activities
  • EPI data at the facilities was not always available
  • Shortage of data collection forms
  • Health center staff absenteeism  

And there were factors outside the health system like poor road networks, especially as a result of rain. At times we had to spend long hours driving and pulling our vehicle out of the mud, which delayed movement to facilities. Despite this, my spirit grew each day, as a new challenge meant developing newer coping strategies, and this is what kept me moving.  Building a good working relationship with the district teams and my drivers was especially helpful.

Challenging roads during rainy seasons

Getting a hand from other road users in Kween District and Bukwo District (photos courtesy of George Momanyi)

Getting a hand from other road users in Kween District and Bukwo District (photos courtesy of George Momanyi)

Reflections on my work on the two START teams

Mentorship at a health center (photo courtesy of George Momanyi)

Mentorship at a health center (photo courtesy of George Momanyi)

Working in Uganda has been a great achievement and a big learning experience for me. Working as a START consultant requires a lot of patience, flexibility and consistency in everything you do. You need to build and gain the confidence of the district teams and staff at the health centers from the outset, and respond to their inquiries promptly.  The START experience exposes one to working closely with the district and health center teams, and one learns what works well and what doesn’t.  The bottom line to me has been to effect some positive change in terms of the teams working consistently towards achieving agreed-upon deliverables and sustaining these interventions, which I call the “START effect.”

There are times when things went well and other times when nothing seemed to move.  I felt low whenever the teams were slow to implement new techniques.  However, I never showed my frustration to them. Rather, I encouraged them by sharing best practices I seen elsewhere, and used these times as opportunities to share such feedback to the district health officers who I felt had responsibility over their own staff and could hold them accountable.  The most encouraging aspects of working in START were meeting teams who appeared enthusiastic about START and revisiting them to see the wonderful progress they made.  I came across very brilliant health workers who were doing great, and I often made reference of the good work they were doing and even shared their work with others as encouragement.

Observing a group exercise during health center training (photo courtesy of George Momanyi)

Observing a group exercise during health center training (photo courtesy of George Momanyi)

Despite the challenging situations, some comments from the health workers I interacted with kept my spirits high:

As a medical doctor I did not know what to supervise in routine immunization, but now I am more skilled in supervision of RI activities” – Medical Superintendent – Bukwo General Hospital

“These training materials have been very nice and useful for my jobWilliam – DranyaHealth Center

“The micro-planning process has helped us build a better understanding of our performance, and we will move ahead to develop a micro-plan for FY 2014/15” Alfred – YumbeHealth Center

While providing feedback to the Koboko District Health Team, the regional officials reported, “There is a big difference in health facilities already supported by the START trainings compared to the other facilities not yet trained.”

I feel I’ve learned a great deal being on the two START teams.  I gained the ability to interact fairly with people I’m working with.  For future jobs I am better prepared to embrace listening, patience, and courtesy.  My communication skills are stronger too, because I’ve had to mentor and train health workers in a new country.  Working as a START consultant has also increased my intellectual capacity by gaining more expertise about EPI service delivery and its underlying principles.  I can confidently reflect on the differences between where I found health centers at the beginning and the improvements I observed by the end of my mission!  While the impact of START may not be felt immediately, it has enormous potential.  Continued collaborations and support at all levels should continue.  It is my sincere hope that the districts supported by the first two START teams in Uganda will endeavor to sustain the initiatives we began in order to achieve the “START Effect.”

START is funded through 2016 by a grant from the Bill & Melinda Gates Foundation. The next START teams will be in Uganda and Ethiopia during the second half of 2014.

Processes improved after mentorship interventions:

Left: This is where we found the immunization monitoring chart at one health center before we began training. Right: Here is the monitoring chart after training – filled out and on the wall! (Photos courtesy of George Momanyi)

Left: This is where we found the immunization monitoring chart at one health center before we began training. Right: Here is the monitoring chart after training – filled out and on the wall! (Photos courtesy of George Momanyi)

Did you enjoy this blog? Share it on Twitter!

Polio Eradication, Microplanning and GIS

Categories: child health, immunization, polio

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Geospatial data have been used in public health since John Snow mapped cholera cases around the Broad Street water pump during the London cholera epidemic of 1854.  And, while global positioning system technologies (GPS) are so ubiquitous in the United States that virtually all new smartphones, tablets and cars have this technology embedded, in many areas of the world, health care workers in the field are often without the most basic two-dimensional paper maps.

So what do maps and map literacy have to do with polio?  Polio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. Therefore, the strategy to eradicate polio is based on preventing infection by immunizing every child to stop transmission of the virus that causes polio, and ultimately make the world polio free.   The four pillars of polio eradication all rely on “microplans”— detailed logistical blueprints that guide the planning and implementation of vaccination campaigns, routine immunization outreach, and surveillance for polio cases by providing critical data on the size and location of the target population in a given geographic area.  These target population numbers determine the amount of vaccine required, the number of health care workers and supervisors to deliver the vaccine, and the cost of transportation to get the vaccine and health care workers where they need to go.

Voices from the Central African Republic: FELTP residents remain committed to strengthening disease surveillance and outbreak response in CAR

Categories: child health, immunization, infectious disease, refugee health

CAR refugees forced from their homes by rebels

CAR refugees forced from their homes by rebels

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

The Central African Republic (CAR) is a landlocked country in Central Africa, bordered by Chad in the north, Sudan in the northeast, South Sudan in the east, the Democratic Republic of the Congo and the Republic of the Congo in the south and Cameroon in the west.  CAR is one of the world’s least developed nations and has experienced several periods of political instability, as well as deadly attacks and violence by rebels that have forced nearly 1 million people from their homes in search of refuge.  With so many civilians fleeing to refugee camps in the capital, Bangui, and the provinces, there is an increased need to strengthen disease surveillance and response.

Vaccination: Your best shot

Categories: child health, immunization, infectious disease, measles

World Immunization Week Banner

In 2002, I was in Maracaibo, Venezuela assisting with the investigation of the last measles outbreak in South America when the news arrived: Ministers of health from the region agreed that a synchronized week of vaccination in the hemisphere would help prevent future outbreaks and increase access to immunization for many who would miss this opportunity. The idea of Vaccination Week in the Americas ignited 12 years ago and is now a global initiative: World Immunization Week! Since 2003, more than 465 million people in the Americas have been vaccinated under the framework that emerged from the original idea of Vaccination Week in the Americas (VWA), which takes place the last week in April every year.

Carla Lee, MA, Public Health Advisor, CDC Global Immunization Division

Carla Lee, MA, Public Health Advisor, CDC Global Immunization Division

VWA is truly a collaborative effort led by countries and territories of the Pan-American Health Organization (PAHO) to improve equity and access to vaccination for families. VWA activities strengthen the national immunization programs in the Americas by reaching out to families with little access to routine immunization programs. The focus is to find people living in urban peripheries, rural and border areas and in indigenous or other hard-to-reach communities and offer them vaccines.

The work has saved lives.

The Region of the Americas encompasses the entire Western Hemisphere (from Canada in the very north all the way down to the southern tip of South America, and all the countries in between), was certified polio-free in 1994. It interrupted the spread of indigenous measles in 2002 and rubella in 2009. However, globally these viruses are still circulating.  A huge global sporting event – the World Cup— takes place in Brazil this summer, attracting millions of travelers from around the world. That adds a new element of risk, increasing the risk of importation of vaccine-preventable diseases into the Americas. In light of the World Cup, VWA will highlight the importance of vaccination to protect the health of the people of the Americas, using slogans like “Vaccination: Your best shot,” and “Go on offense: Get vaccinated!”

Stopping rubella in its tracks: CDC works with countries to introduce rubella vaccine

Categories: immunization, infectious disease, rubella

 

Cambodian children show off their purple marked pinkies, showing that they are protected from measles and rubella, during an immunization campaign in 2013. (Photo courtesy of Sue Chu, CDC.)

Cambodian children show off their purple marked pinkies, showing that they are protected from measles and rubella, during an immunization campaign in 2013. (Photo courtesy of Sue Chu, CDC.)

 

Pop quiz: What vaccine-preventable disease, whose name means “little red”, can cause severe birth defects if pregnant women become infected? If you answered rubella, also known as German measles, you are right.

Gavin Grant, MD, CDC Global Immunization Division

Gavin Grant, MD, CDC Global Immunization Division

Susan Reef, MD, CDC Global Immunization Division

Susan Reef, MD, CDC Global Immunization Division

It’s okay if you didn’t know, since rubella is mostly a distant memory in the United States thanks to a comprehensive and effective immunization program that’s been in place for decades.

Sadly that’s not true everywhere.

Each year there are thousands of rubella cases around the world, a number that’s made all the more tragic when there is a safe, effective vaccine. And while the number of cases has fallen, the threat remains. Rubella is spread in the same way as the common cold, through sneezing and coughing. In children rubella is typically a mild disease that may include a rash, fever and sore throat. Adults can get rubella as well—usually they experience symptoms such as rash, headache, pink eye, joint pain and general discomfort. 

How Nigeria Is Helping Stop Polio for Good

Categories: child health, immunization, polio

 

This blog was originally posted in the Huffington Post on January 2, 2014.

 

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are three places in the world where wild poliovirus has never stopped killing and disabling children: Afghanistan, Pakistan, and Nigeria.

As with other health threats, polio doesn’t stay neatly within a country’s borders. In the case of Nigeria, polio has spread from there to 25 polio-free countries in the past 10 years.

The Nigerian government recognizes this as a public health threat that can be tackled. Last year they put a national emergency action plan in place to eradicate polio and activated an emergency operations center for the work.

The Nigerian plan includes improving immunization activities, outreach to underserved populations, special approaches in security-compromised areas, outbreak response, and improved routine immunization and disease tracking.

In December I had the chance to visit Nigeria and observe firsthand the progress they’re making.

What I saw was impressive. Here are a few highlights from the trip:

November 12th Marks World Pneumonia Day

Categories: immunization, infectious disease, pneumonia

World Pneumonia Day - Fight Pneumonia. Save a Child. November 12th - http://www.worldpneumoniaday.org

Last year, in observance of World Pneumonia Day, Cynthia Whitney, Branch Chief for Respiratory Diseases in the Division of Bacterial Diseases (DBD) and I co-authored a commentary for the CDC Journal of Emerging Infectious Diseases in which we urged the global community to consider the massive problems of pneumonia and to take a moment to consider what we each could do to help solve the problem of pneumonia claiming far too many children. Indeed 2013 has been a very busy year for all committed in the fight against pneumonia—which is part of an urgent and historic global effort to save lives and improve health for millions of women, newborns, and children outlined in the United Nations Millennium Development Goals (MDG).

Rana Hajjeh, MD, Director, CDC Division of Bacterial Diseases

Rana Hajjeh, MD, Director, CDC Division of Bacterial Diseases

The National Center for Immunization and Respiratory Diseases’ (NCIRD) DBD leads the agency’s pneumonia activities by engaging in research and promoting best practices that address pneumonia everywhere.

Through DBD staff collaboration with partners here at CDC and globally with health care providers, researchers, policy makers, and the greater public health community, we are seeing progress toward reducing disease and deaths due to pneumonia. DBD works with the Advisory Committee on Immunization Practices (ACIP)—which provides advice and guidance to CDC’s Director regarding vaccine use and related agents for control of vaccine-preventable diseases in the United States—and was front and center during the Committee’s meetings this year. Our scientists’ research helped inform the ACIP recommendation on pneumococcal conjugate vaccine (PCV13) for immunocompromised children aged 6-18 years. PCV13 covers 13 pneumococcal serotypes which cause the majority of pneumococcal infections in young children. DBD’s research demonstrated an 88% decline in PCV13-type pneumococcal disease among children less than five years of age in the United States, and 45-65% decline in other age groups due to herd immunity. This year, we completed studies of PCV effectiveness against invasive pneumococcal disease in South Africa and Uruguay and completed the review of vaccine schedules to guide global policy makers adopting PCV into childhood immunization programs. The findings of this comprehensive analysis support the use of either 3 or 4 dose schedules of PCV, and will be published in the Pediatric Infectious Disease Journal in the next few months. We continue to collaborate with partners to assess the effectiveness of PCV in the United States and select developing countries.

Every Last Child: Reflections on World Polio Day in Nigeria

Categories: child health, immunization, infectious disease, polio

Photo of Maimuna Umar, 35, a Volunteer Community Mobilizer in Nigeria

Maimuna Umar, 35, a Volunteer Community Mobilizer with her pictorial flipbook, is trying to convince the community of the importance of polio immunization and other key household practices. Credit: UNICEF Nigeria/2012/Andriamasinoro

October 24th is World Polio Day, a global health observance for the global polio eradication community to renew its promise of a polio-free world to future generations. World Polio Day is held on the birthday of Dr. Jonas Salk, the man who led the first team to develop a vaccine against polio. The development of the polio vaccine reduced polio worldwide by 99% with only Afghanistan, Nigeria, and Pakistan as the remaining polio endemic countries in 2013. In the spirit of World Polio Day, polio eradication program epidemiologist Wick Warren describes his work over the past year in Nigeria.

‘Every last child’ – this is one of the long-running slogans and ideals of the Global Polio Eradication Initiative (GPEI). The Initiative began in 1988, and while incredible progress has been made, (13 million cases of paralytic polio and more than 500,000 deaths prevented in 25 years), the fact that polio has not yet been eradicated proves that we are still not reaching every last child.

Strengthening Immunization Systems: Making a Difference, Sustainably

Categories: child health, immunization

Children at a rural health post in South Sulawesi, Indonesia

Children at a rural health post in South Sulawesi, Indonesia

I came to CDC to make a difference.

Samir Sodha, MD, MPH, Doctoral Epidemiologist, CDC Global Immunization Division

Samir Sodha, MD, MPH, Doctoral Epidemiologist, CDC Global Immunization Division

I am the team lead of the Routine Immunization Team (RIT) which is part of CDC’s Global Immunization Division.  GID is well known for the essential role it plays in eradicating polio and eliminating measles/rubella. The goal, and driving memory, is to replicate the historic eradication of smallpox, an achievement that is among the top-tier events in public health history.

The goal for the Routine Immunization Team is no less lofty and in many respects is equally challenging even if it’s less well known. Our mission is to strengthen immunization programs around the world to ensure that the crucial foundation for preventing disease is maintained and even strengthened.

CDC Works with Partners Around the World to Combat Hepatitis

Categories: child health, hepatitis, HIV/AIDS, immunization

Francisco Averhoff

Dr. Francisco Averhoff, Associate Director for Global Health - Division of Viral Hepatitis

Dr. John Ward, Director, Division of Viral Hepatitis (DVH)

Dr. John Ward, Director, Division of Viral Hepatitis (DVH)

On July 28th, the United States joins countries around the globe to observe the third annual World Hepatitis Day. One of only eight health campaigns recognized by the World Health Organization (WHO), this health observance raises awareness of the silent yet growing epidemic of viral hepatitis worldwide. Each year, 1.4 million persons lose their life to viral hepatitis, similar to the number of deaths from HIV/AIDS (1.5 million), tuberculosis and malaria (1.2 million each).

Deaths from viral hepatitis are caused by one of five hepatitis viruses. Hepatitis A and hepatitis E, which are spread fecal-orally either by person-to-person contact or contaminated food or water, are major causes of acute hepatitis, particularly in areas of the developing world suffering from lack of access to clean water and poor sanitation and hygiene. A report in this week’s Morbidity and Mortality Weekly Report describing an outbreak of hepatitis E in a refugee camp in South Sudan reminds us of this often neglected disease that disproportionately kills expecting mothers in many of the poorest countries of the world (see this week’s MMWR).

Older Posts

Pages in this Blog
  1. [1]
  2. 2
  3. 3
 
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #