The expanded program on immunisation

The Expanded Program on Immunization (EPI) began in 1974 when the World Health Assembly pledged to ensure that all children in all countries receive life-saving vaccines. Each year, immunisation now prevents more than 2.5 million deaths among children worldwide. An additional 2 million lives could be saved if available vaccines reached every child.

Ethiopia started the EPI in 1980 to reduce mortality and morbidity from vaccine-preventable diseases among children and mothers. The immunisation coverage rate has been increasing since that time, but not as fast as the original target. The Ethiopian Federal Ministry of Health (FMOH) has prepared a plan to increase the immunisation coverage rate to 80% of the population in 90% of the woredas (districts) in the country. Health Extension Practitioners like you can play a major part in the success of this plan.

Vaccine-preventable diseases in the EPI in Ethiopia

Vaccine-preventable diseases included in the EPI in Ethiopia are:

• Tuberculosis (TB).
• Poliomyelitis (polio).
• Diphtheria.
• Pertussis (a whooping cough).
• Tetanus.
• Measles.
• Pneumonia and meningitis caused by Haemophilus influenza type b bacteria.
• Liver disease caused by hepatitis B viruses.
• Pneumonia and other infections caused by Streptococcus pneumonia bacteria.
• Diarrheal diseases caused by rotaviruses.

To achieve the EPI objectives, the FMOH has outlined five strategies that are applicable throughout the country (see Box below). Next, we will examine each of them in turn and consider what you can do to progress these strategies

Increasing and sustaining high immunisation coverage

The key to increasing and sustaining high immunisation coverage rates is to increase the accessibility of immunisation services, particularly by opening more vaccination delivery sites at times when mothers can bring their infants. As you know, many children are not immunised because they live far away from health facilities. These children could be given the opportunity to be vaccinated through establishing outreach services, supported by mobilisation Teams going from house-to-house identifying children (and mothers) who need vaccinations.

You might also have seen health workers giving immunisations in your community in well-published campaigns, which encourage parents to bring children to the kebele office or the Health Post for vaccination.

Planning and managing your routine immunisation activities are described in detail in Study Session 5, and communication for an effective immunisation service is in Study Session 6.

Increase the quality of immunisation services

A successful immunisation service has to be of high quality. This means that you must use safe injection practices, and all the required vaccines and other supplies must be available in good condition, and on a regular and timely basis. Poor quality vaccines will not prevent illness. Therefore, to improve the EPI, you need to keep the vaccines at the proper temperature, take good care of the injection equipment, and ensure reliable vaccine stock control.

In Study Sessions 4, you will learn how to maintain the quality of vaccine to improve the efficiency and quality of the immunisation service at your Health Post.

Reduce missed vaccination opportunities and trace defaulters

It is common in Ethiopia to see many children and mothers who have been to a health facility but have not been immunised. Thus, another important strategy is to reduce missed opportunities and trace defaulters.

Improve public awareness and community participation in immunisation programs. In the EPI, you are expected to improve public awareness through intensive, regular social mobilisation and health education campaigns, in order to:

• Maximise participation of community members in EPI activities
• Increase public demands for immunisation and the vitamin A supplements that are routinely given to infants during the immunisation programme.

It is very important to involve the whole community, including political and religious leaders, through seminars, public meetings and direct contacts. You should aim to work with and fully utilise women's groups, youth associations and ideas (self-help associations at village level) so that they support and help to promote the immunisation service (see Study Session 6).

Ensure prompt reporting and improved control of vaccine-preventable diseases

It is a key part of your role to identify cases of vaccine-preventable diseases, such as measles, polio, neonatal tetanus and bacterial pneumonia and meningitis and report them to your supervising Health Centre, who will report to the District (woreda) Health Office. Control of these diseases is largely the result of effective immunisation campaigns achieving high immunisation coverage rates, and the isolation and treatment of people who are infected, to reduce the risk of the infection spreading into the susceptible population.