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

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

Background:
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.

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

Methods:
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.

Results:
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).

Conclusions:
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.