Final report : expanded program on immunization

The project has contributed significantly to Liberia"s EPI. It has provided 41 months of TA, at central, county, and district levels, in program planning, financial and supply management, and supervision; helped to implement new approaches for data collection and ongoing program assessment; strengthened the cold chain, particularly upcountry, by providing spare parts and vaccine transport equipment; and made available 80,000 doses of measles vaccine. In addition, a 1-week training course was held for 48 mid-level health staff and a series of workshops and inservice programs for some 450 county health workers, a training handbook was published, and EPI content was incorporated into curricula at two medical colleges. Perhaps the project"s greatest impact has been in redirecting the EPI to emphasize provision of immunizations through regular health care channels, as it soon became apparent that completely mobile delivery was neither practical nor economically feasible. Lack of retrospective data, coupled with a continuing lack of reliability in mortality and morbidity reporting, make it difficult to assess the project"s health impacts. However, it appears that Bong and upper Lofa counties, both with well-established community health departments, are capable of achieving, in the near future, the optimistic coverage objectives established at the birth of the EPI in 1978. In several other counties, immunization is well below those expectations. Several major problems occurred during the project, some (e.g., long delays in receiving commodities, confusion as to the role of the project technician, and frequently inadequate field supervision by senior EPI staff) amenable to resolution, others (inadequate and erratic host government funding, problems of logistics and communication) more intractable. Many more years are needed to complete the development of the Liberian EPI. Recommendations focus on the need to: encourage community awareness and involvement; continue to strengthen mid-level management; and seek area-specific strategies to overcome transportation and communication problems, using existing resources.