2. OUTLINE
1. Introduction to EPI
2. External environment and immunization programmes
3. Immunization operations
4. Supportive components of immunization services
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3. 1. Introduction to EPI
• The Expanded Programme on Immunization is a global programme
for the control of vaccine-preventable diseases (VPD).
• Its goal is to eradicate poliomyelitis, eliminate neonatal tetanus (NT)
and measles and reduce morbidity and mortality due to all other
vaccine-preventable diseases
• In line with global targets set by WHO, EPI has expanded its focus on
immunization coverage to include disease surveillance and
eradication/elimination activities.
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4. • Today, EPI is a well-established public health programme.
• It has various components that include
• vaccines and their handling,
• cold chain to keep them potent,
• service delivery,
• disease surveillance,
• social mobilization to ensure community support,
• monitoring and evaluation to assess the impact of the programme on disease
and child mortality reduction.
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5. • Currently, EPI is facing new challenges related to:
• carrying out supplementary immunization activities or mass campaigns (e.g.
national immunization days),
• incorporating new vaccines and injection safety devices,
• and increasing and sustaining immunization coverage levels through the
RED/REC strategies and other reference strategies (GVAP, GAPPD, etc.).
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6. • The global EPI therefore has the following three orientations:
1. Achieve and sustain high immunization coverage among target populations
(90% and above) for all vaccines included in the programme.
2. Establish reliable disease surveillance for detection of disease cases and
outbreaks and ensure an adequate response.
3. As a result of the first two strategies, implement disease eradication and
elimination initiatives.
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7. • Following GIVS (2006–2015), the Regional EPI Strategic Plan (2014–
2020), GVAP (2011–2020) and GAPPD (2011–2025) are focusing on
the following objectives:
1. To increase and sustain high vaccination coverage.
2. To complete the interruption of poliovirus transmission and ensure
virus containment.
3. To eliminate measles and advocate for the elimination of rubella
and congenital rubella syndrome.
4. To attain and maintain elimination/control of other vaccine-
preventable diseases.
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8. • In the context of capacity building, the following areas of action are
emphasised under the objectives:
1. To improve immunization coverage beyond the current levels:
2. To complete interruption of poliovirus transmission and ensure virus
containment:
3. To eliminate measles and advocate for the elimination of rubella and
congenital rubella syndrome:
4. To attain and maintain elimination/control of other vaccine-
preventable diseases:
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9. 2. External environment and immunization
programmes
• Like other programmes, the immunization systems are constantly
undergoing internal changes, notably those related to the
introduction of new vaccines and new technologies.
• Immunization programmes also have to face external changes related
to ongoing decentralization, using vaccines beyond childhood and
other health sector reforms.
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10. • To ensure the continuity of immunization programmes, EPI staff has
to understand and manage those internal and external changes.
• It requires specific skills in;
• problem solving,
• setting priorities,
• decision-making,
• managing time and human,
• financial and
• material resources.
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11. • The health system and the external environment form the framework
within which the immunization services function.
• To plan, implement and evaluate functions, the EPI staff must take
into account the context in which the management of services in
health centres, hospitals and administrative units is carried out.
1. Political leadership
2. Traditional leadership
3. Community leadership
4. Gatekeepers
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12. 2. OPERATIONS OF IMMUNIZATION SYSTEMS
Immunization systems comprise five key operations
1. Vaccine Supply & Quality
2. Logistics
3. Service delivery
4. Surveillance
5. Communication
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13. 1. Service delivery covers the strategies and activities to ensure
provision of immunization services to target populations. Service
delivery is exercised with pre-determined strategies depending on
various situations and priorities in a country.
2. Logistics include delivery of vaccines and other equipment to the
place of use, provision of transport, management of cold chain and
disposal of immunization waste (used syringes and needles,
discarded vaccines and diluents, etc.).
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15. 3. Vaccine supply and quality comprises forecasting vaccine needs,
procuring vaccines, monitoring vaccine quality, utilization and
vaccine safety.
4. Disease surveillance includes monitoring of disease incidence,
laboratory testing, record keeping, reporting, case and outbreak
investigations and response.
5. Advocacy and communications comprises social mobilization,
advocacy, community education on immunization and programme
promotion.
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16. 3. Supporting components of immunization
services
• Immunization operations are sustained through the following
supporting components:
1. management,
2. sustainable financing and
3. human and institutional resources strengthening.
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17. 1. Management includes policy-making and standard setting,
planning, coordination, information collection and sharing,
collaboration with other partners, quality assurance, monitoring
and evaluation.
2. Sustainable financing comprises budgeting, identifying funding
sources, actions leading to adequate allocation of financial
resources to immunization programmes.
3. Strengthening human and institutional resources includes staffing,
training, supervision and institutional support (including supply of
technical information, support to research projects etc.).
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