Strengthening the 2YL Platform & Men A Introduction Plan in Ghana

1. Strengthening the 2YL Platform & Men A Introduction Plan in Ghana Accelerating Progress towards Measles and Rubella Elimination Hotel Royal, Geneva, Switzerland, 21 – 23 June 2016 Dr George Bonsu National EPI Manager Ghana

2. Outline • Background • Second Year of Life platform in Ghana(2YL) • Achievements • Challenges • 2YL Project • Progress towards introduction of Men A into routine EPI • Lessons Learnt Strengthening 2YL Platform & Men A Introduction Plan

3. Country Information Population (2016): 28,688,100 Pop <1 : 1,147,524 Regions : 10 Districts : 216 Sub-districts : 1,296 CHPS zones : 2,565 Bordering countries: • North: Burkina Faso • East: Togo • West: Cote d’ivoire Strengthening 2YL Platform & Men A Introduction Plan

4. Mandate of the EPI Programme • The EPI Programme aims at reducing morbidity and mortality by controlling, eliminating or eradicating vaccine preventable diseases (VPDs) through immunization; an essential component of Primary Health Care • The Programme currently vaccinates against 12 VPDs in routine immunization Year 2002 1978 1992 2012 2013 Antigen HB Hib into PENTA Total: 9 PCV Rota MSD Total: 11 (M)R Td Total: 12 BCG OPV DPT Measles Total: 6 +TT YF Total: 7 Men A IPVHPV RTS,S Strengthening 2YL Platform & Men A Introduction Plan

5. Rationale for establishing the 2YL Platform • Establish an additional schedule for the second dose of measles at 18 months (>95% protection after 12 months) • Establish a platform for the introduction of new vaccines; Men A and RTS,S • Provide missed vaccines to children after one year • Opportunity to strengthen growth monitoring, vitamin A supplementation and other childhood interventions • 18 months was selected for measles second dose to coincide with the 3rd dose of vitamin A Strengthening 2YL Platform & Men A Introduction Plan

6. Interventions delivered in 2YL • The following interventions are currently provided in the 2YL; • Provision of missed vaccines to children • Measles Second Dose (MSD) • Vitamin A Supplementation • Growth monitoring • Provision of Long-lasting Insecticide Net (LLIN) • The provision of long-lasting insecticide net (LLIN) was strategically fixed at 18 months to ‘pull’ caregivers to vaccination sites Strengthening 2YL Platform & Men A Introduction Plan

7. Preparatory Activities: 2YL • National level advocacy with key stakeholders, ICC • Revision of data collection and analysis tools; tally sheet, Child Welfare Clinic register (CWC), monthly vaccination report, child health record booklets and soft wares • Training of health staff at all levels • Dissemination of health education messages Strengthening 2YL Platform & Men A Introduction Plan

8. Coverage of Measles 1st and 2nd doses in Ghana, 2012 – 2015 Strengthening 2YL Platform & Men A Introduction Plan

9. Routine Measles Vaccine Coverage - 2015 Measles 1st dose Measles second dose 72 % Ghana 94 % Ghana

10. Children vaccinated by age category in 2015

11. Impact on Measles Control: Measles suspected cases & measles vaccination 1994-2015 No death from measles Since 2003 (past 14 yrs) Strengthening 2YL Platform & Men A Introduction Plan

12. Challenges • Low coverage rates for interventions in the 2YL: MSD, 3rd dose vitamin A, growth monitoring and catch up on missed children • Varied understanding of the 18 month MSD schedule among health staff • Inadequate information among caregivers and decision makers at the community level on 2YL • Incentivizing MSD with LLINs became a challenge: some caregivers refused vaccination wherever and whenever LLINs were not available • No clear national policy and guidelines on catch up vaccinations in the second year of life Strengthening 2YL Platform & Men A Introduction Plan

13. Addressing challenges: 2YL Project • This is a project which seeks to offer protection for children from vaccine preventable disease (VPD) by strengthening the second year of life (2YL) immunization platform • It is supported by CDC in collaboration with WHO and UNICEF Strengthening 2YL Platform & Men A Introduction Plan

14. Special Strategies: 2YL Project • Rationale for the project: • To strengthen second year of life visit for immunizations: • To improve Measles second dose coverage, • To facilitate rapid uptake of meningitis A vaccine into routine • To reduce inequities by allowing opportunities to catch-up children missing infant vaccinations Strengthening 2YL Platform & Men A Introduction Plan

15. Special Strategies: 2YL Project • Six (6) Intervention Areas; • Communications/Demand generation • Healthcare worker training/supervision • Data reporting and recording: Expansion of electronic data management for immunization registration and reporting at the district and/or health facility level • Programme integrations • VPD surveillance • Special innovations for reducing inequities and improving coverage among hard-to reach populations Strengthening 2YL Platform & Men A Introduction Plan

16. Algorithm for Measles Vaccination Strengthening 2YL Platform & Men A Introduction Plan

17. Plan for Men A Introduction-1 • Ghana has received approval to introduce MenAfriVac™ into routine immunization • All data collection tools as well as the data management system (DHIMS) have been revised to incorporate Men A • Routine introduction is scheduled for November 2016 • One dose schedule at 18 months to coincide with MSD • The routine introduction of the vaccine will be preceded by a mini catch-up campaign in July 2016 targeting chn. aged 1-4 years Strengthening 2YL Platform & Men A Introduction Plan

18. Plan for Men A Introduction-2 • Timelines for mini catch-up campaign; • Distribution of vaccines to regions : 01 – 03 June 2016 • Planning and training of Regional teams : 22 – 23 June 2016 • Training of District teams : 27 – 30 June 2016 • Distribution of vaccines to districts and below : 04 – 08 July 2016 • Distribution of tools and other logistics : 04 – 08 July 2016 • Training of vaccinators and volunteers : 11 – 15 July 2016 • Advocacy and Social Mobilization : 01 – 26 July 2016 • Regional level Press Briefing : 18 – 19 July 2016 • Campaign Implementation : 20 – 26 July 2016 • Post Campaign Review Meeting : 17 – 18 August 2016 • Nationwide Routine introduction of Men A : 1 November 2016 Strengthening 2YL Platform & Men A Introduction Plan

19. Lessons Learnt • Updated policy and field guide to cover vaccinations in second year of life very necessary • Cascaded training for all health workers including managers essential • Advocacy at all levels: national, regional and community • Sustained communication on interventions in 2YL needed to create demand • Revision of all tools and databases to include 2YL indicators- (services recorded by age categories- 0-11, 12-23mo, >= 24months) • Enhanced supervision and feedback Strengthening 2YL Platform & Men A Introduction Plan

20. Thank You