Strengthening immunization program through involvement of graduating health care professional students and health extension workers

Strengthening Immunization Programs through Involvement of Graduating Health Care Professional Students and Health Extension Workers.

Background:  EPI coverage remains low in many Ethiopian kebeles (population 5000) for many reasons, including mothers being uninformed and inadequately prepared Health Extension Workers (HEWs).  Health care professional (HCP) students can address some gaps as part of their community-based team training program.

Objectives: Strengthen EPI program by improving capacity of: 1) graduating HCPs in social mobilization, advocacy and evidence based planning, and 2) HEWs related to immunization.

Methods: In 2007 and 2008, 140 students participated from Gondar and Haramaya universities: one group covering 1-3 kebeles per site per year.  Students did detailed needs assessments via household survey and focus group discussion with HEWs, then planned and implemented needs-based strategies. 210 non-participating students did limited assessment and planning, but no interventions. Evaluation data were collected from students, managers, HEWs and community members.

Results: Students gained experience in data collection methods and management: one group surveyed 825 households. Interventions included community education and mobilization, and outreach for vaccination and defaulter tracing. One group gave 1550 vaccine doses to children and 845 TT doses; coverage improved to >75-85%, varying by antigen and site.  Refresher training was given to over 110 HEWs, and students collaborated with HEWs and public health staff in problem identification, planning and implementation.  Managers reported improved performance by HEWs in project and other kebeles, and stronger links between teaching institutions and public health sector.

Conclusions: This is an innovative collaborative model for strengthening HCPs’ skills.  Public health benefited from stronger links between levels, more skilled HEWs, availability of EPI promotional material and assessment tools, and actions to begin addressing identified problems.  The universities contributed to public health by producing more skilled graduates and sharing expertise and adapting programs to needs.