An evaluation of the reaching every district (RED) to reach every child (REC) immunisation strategy in Mberengwa District, Midlands Province 2007-2010

Abstract

Introduction: The immunisation program for Mberengwa district has been experiencing a decline in coverage and high dropout rates despite it having adopted the Reaching Every District strategy in 2004. This study investigates reasons for this program failure. Methods and Materials: The Logic Model Conceptual Framework was used to evaluate the program. Data were collected using questionnaires from health workers, key informants and a separate questionnaire used to collect data from mothers of children under five years old. Focus group discussions were conducted with women in the community. A checklist was used to assess program resource availability. Data were analysed using EPI info statistical software. Qualitative data were analysed thematically Results: Forty six health workers and 56 mothers were interviewed. Ten health workers had been trained in Reaching Every District. Less than half knew the tool that is used to monitor program progress. None of the health centres had zoned catchment area maps for offering the different EPI services. Program resources were reported to be inadequate. None of the facilities were conducting regular EPI meetings with the community. Main barriers to immunisation were religious objectors, unavailability of vaccines and unavailability of outreach services Discussion: Resources put into the program were inadequate. Health workers were not conversant with the operations of the strategy. Community involvement in the program was poor. Efforts to improve program performance should be aimed at training health workers in Reaching Every District, revitalising strong links with the community and re-establishing Expanded Program on Immunisation outreach services. © 2014 Muchekeza M, et al.