News @ JSI

Collaboration across JSI projects promotes synergy in solving problems in routine immunization systems

April 23, 2015

With stagnating coverage rates and new, life-saving vaccines being introduced each year in developing countries, the need for a strong routine immunization system capable of immunizing all children every year is more important than ever. This need comes at a time when partners in the global immunization community are struggling to define what is needed to move from the widely-used Reaching Every District (RED) strategy to the more ambitious Reaching Every Community/Child (REC) approach.

The governments of Uganda and Ethiopia, two of the five countries with the highest number of unimmunized children in Africa, have been making great strides towards adopting REC as their national strategy for routine immunization. Uganda's Ministry of Health adopted REC in 2008, and Ethiopia's Federal Ministry of Health is making concerted efforts to transition to the REC strategy within the coming year.

As a leader in routine immunization system strengthening, JSI has been working to develop and refine REC to incorporate quality improvement methods and tools, called the Reaching Every Child with Quality Improvement (REC-QI) approach. This evolved approach aims to operationalize REC 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 REC-QI approach promotes continuous learning and improvement within the routine immunization system.

To this end, JSI received grants from the Bill & Melinda Gates Foundation to support two related projects in Uganda and Ethiopia that leverage the REC-QI approach to strengthen routine immunization service delivery in both countries. First, JSI received funding in 2011 for Universal Immunization through Improving Family Health Services (UI-FHS), to explore what it could take to achieve universal coverage in both agrarian and pastoralist contexts using REC-QI in 3 learning “woredas” (districts) in Ethiopia. Then in 2014, UI-FHS was granted a supplement award to widely scale-up REC-QI implementation to 128 woredas across 6 regions. Additionally in 2014, JSI received funding from the Bill & Melinda Gates Foundation to implement REC-QI in 10 districts in Uganda, through the project Stronger Systems for Routine Immunization (SS4RI). Similar to the grants received by the Bill & Melinda Gates Foundation, the United States Agency for International Development (USAID) provided funding to JSI in 2012 to implement REC-QI programs in five districts in Uganda through the Maternal and Child Health Integrated Program (MCHIP). In 2014, they provided funding for 10 additional districts through MCHIP’s follow-on award, the Maternal and Child Survival Program (MCSP).

While these projects are operating in different contexts and with slightly different objectives, MCSP, SS4RI and UI-FHS will collaborate over the next five years to further understand how REC-QI can fit into the countries’ national strategies. A system of cross-learning between projects has been established in order to maximize efficiency, accelerate learning, and build evidence for the sustainability and applicability of the REC-QI approach.

Read more about the projects here:

Maternal and Child Survival Program’s REC-QI work (Uganda)

Stronger Systems for Routine Immunization (Uganda)

Universal Immunization through Improving Family Health Services (Ethiopia)