Expanded program for immunization

Final PES covers the period 8/79-6/83 and is based on an attached special evaluation (XD-AAP-504-A). With project assistance, the Government of Rwanda (GOR) has established a greatly improved national immunization program. However, while the GOR now has in place the manpower, training, equipment, and drugs necessary to continue and expand immunization services, it would be financially unable to do so without continued donor assistance. The EPI delivery system is based on a combination of 150+ fixed health facilities and some 70 vaccinators who, while assigned to various facilities, also provide outreach to distant communes. Overall immunization coverage of about 21% has been achieved (vs. a targeted 30%); measles and BCG coverage (53% and 49% coverage, respectively) have far exceeded expectations. Both formal and inservice training have been provided, the former following WHO"s standard EPI curriculum. A total of 27 physicians received advanced EPI management and administrative training, 25 nurses attended the EPI intermediate training program, and over 350 health center personnel (including vaccinators) attended 1-2 day inservice training programs held in every prefecture. While it appears that EPI is having a significant impact in Rwanda on the incidence of childhood diseases, particularly measles and whooping cough, a more detailed evaluation is necessary to definitely confirm this result. The PACD has been extended through 2/84.