National Supportive Supervision Report: Integrated EPI Supportive Supervision

The supervision aimed to monitor the implementation of immunization activities and provide technical on-job assistance to health workers in health centers and districts. The specific objectives of the supervision were to review the management of routine immunization services, assess the adoption of safe injection practices, assess cold chain management, assess social mobilization activities, and assess the stock levels of vaccines and injection materials at health facilities. The supervision was conducted in 78 health centers and 28 district health offices, with a total of 73 facilities visited. The discussions were held with staff involved in immunization, mainly health surveillance assistants (HSAs) and clinicians/nurses for disease surveillance activities. Observations were made on some items, and reviews of documents were conducted to collect information. A standardized checklist was used to guide the discussions and collect data. The findings of the supervision revealed that 95% of the facilities had EPI focal persons, and almost all HSAs were involved in EPI activities. However, only 30% of the facilities held meetings with emphasis on immunization, and some reported to have held the meetings but minutes could not be produced. Community sensitization was also a concern, with only 27% of the facilities having covered immunization issues in their health talks. Involvement of local leaders in immunization was seen as a lost opportunity to promote services with the community, with only 19% of the facilities holding meetings with community leaders. The supervision also assessed cold chain equipment, with 95% of the fridges being prequalified. However, 33% of the refrigerators were not working due to unavailability of kerosene and breakdown of refrigerators. The national level was recommended to distribute specifications for prequalified fridges to district level, and DHOs were advised to procure and replace faulty parts. With the challenges of kerosene in the country, there was a need to replace these refrigerators with electrical or solar-powered refrigerators. Vaccine management was also assessed, with 90% of refrigerators having thermometers to monitor temperature. However, 57% of the refrigerators had the recommended temperature of +2°C to +8°C, and records for the past 3 months. The recording of temperature was done twice daily in 54% of the facilities. Vaccine quality was also a concern, with 4% of facilities having frozen vaccines, 4% having VVM stage 3 and 4, 16% having unreadable labels, and 12% having expired vaccines that were still kept in refrigerators. Stock outs of PCV, Penta, and OPV were also reported, with 28% of facilities reporting stock out of PCV, 10% of facilities reporting stock out of Penta, and 23% of facilities reporting stock out of OPV. The knowledge of HW in indicators and practices of keeping vaccines in good quality was low in most facilities, with only 44% able to explain the shake test, 67% able to interpret VVM, 33% able to explain MDVP, and 57% able to explain how to precondition ice packs. Discrepancies between physical stock levels of Penta and PCV vaccines in the fridge and in vaccine stock books were observed in 57% of facilities. The push system of vaccine delivery was also noted, with 40% of HW knowing their allocations, which were determined by districts. However, some facilities reported that these allocations were not adequate. Overall, the supervision highlighted several areas of concern, including the need for improved management of routine immunization services, adoption of safe injection practices, cold chain management, social mobilization activities, and vaccine management. Recommendations were made to address these concerns, including the need for improved documentation, training of health workers, and procurement of prequalified refrigerators.