Evaluation report of the expanded program of immunization in Rwanda : May 30th to June 18th, 1983

Special joint evaluation (WHO, UNICEF, A.I.D., GOR) covers the period 8/79-6/83 and is based on document review, indepth interviews with EPI officials and workers, studies of immunization coverage, and mortality and morbidity data. Key findings are: (1) Administration - At present the EPI lacks the core staff which will be needed to assure program continuity. Problems at the supervisory level include: lack of personnel stability; insufficient gasoline rations; failure to work out a systematic surveillance plan, which has led to underuse of some centers and/or vaccinators; and slow reimbursement of staff expenses. (2) Operations - The vaccine cold chain meets EPI criteria. All but 2 of the 31 health centers visited are equipped with electric refrigerators/freezers. All centers have a fixed immunization program which includes health education and 17 have a mobile unit program as well. Eight out of 10 regional EPI supervisors have an assistant, meeting acceptable personnel levels. About 58% of field personnnel have had inservice training. Many health center personnel are poorly trained in cold chain management, organization of immunization sessions, and supply management. (3) Immunization coverage - A study of 854 randomly selected households indicates that the EPI has gone beyond its coverage objectives for individual vaccinations (except the third administration of polio vaccine - which, due to poor planning, was in low supply) in both 1982 and 1983. Some 21% of children were completely vaccinated (vs. a targeted 30%). (4) Epidemiological surveillance - Countrywide incidence of measles and whooping cough in 1982 was the lowest recorded since 1973. Statistics from 3 centers known for having active immunization programs show an even sharper drop, but more data are needed in order to confidently attribute this decrease to the EPI program; only a few centers distinguish when reporting between vaccinated and non-vaccinated cases of a disease. It is recommended that donors continue to financially and technially support EPI in Rwanda. Several operational recommendations are also made.