Tuesday, March 18, 2008

An evaluation of the implementation of the Reaching Every District (RED) approach, Sudan, Africa, 2007

Tove Ryman, El Tayeb Ahmed El Sayed, Amani Mustafa, Nisreen Musa Widaa, and Awad Omer. Global Immunization Division, NCIRD, Centers for Disease Control and Prevention, 1600 Clifton Rd MS-E05, Atlanta, GA, USA

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Understand RED and its evaluation

Global immunization goals include DPT3 coverage of 90% nationally and 80% in all districts. The Reaching Every District (RED) approach aims to improve routine immunization services using five strategies: planning and management, supportive supervision, outreach, community linkages, and monitoring for action.

This evaluation's objective was to assess the extent of RED's implementation since 2003 and the effect on immunization coverage.

The evaluation was conducted in all districts of Northern Sudan, excluding Darfur due to ongoing conflict (n=70). District RED implementation data for 2006 were collected using district staff self-completed worksheets and a comprehensive peer-review of district level data. Based on these data every district was given an implementation score (IS) using a weighted 10-point scale, with 10 being fully implemented.

RED IS ranged from 1.6 to 8.7 (average 5.7). Of the components, the highest score was for Monitoring for Action (6.9) and the lowest for Community Linkages (4.4). Findings included: immunization monitoring charts were found in all but one district; ≥90% of planned outreach sessions were held in 45% of districts; quality microplans were found in 31% of districts; ≥4 supervisory visits were received by 42% of districts; and only half of districts had ≥3 planned mobilization activities for communities.
Between 2002 and 2006, DPT3 administrative coverage in evaluated districts increased from 77% to 90%. Although DPT3 coverage was not significantly correlated with IS (r=0.09, p= 0.42), 52% of districts with DPT3 coverage ≤90% (13/25) had medium/high RED IS (>5.28) compared to 75% of districts with >90% (34/45) (chi-square=4.04; p=0.04).

Sudan is making progress towards achieving global immunization goals, however improved performance is needed in those districts with <90% coverage. Efforts are underway to improve evaluation of district implementation using a simplified tool.