‘Reaching Every District’ (RED) is the name given to a strategy of district capacity building to address common obstacles to increasing immunization coverage, with a focus on planning and monitoring.
The first steps in developing the RED strategy were taken in July 2002 at a meeting of immunization partners, who identified common obstacles and ways to improve access to immunization, in order to achieve the global immunization goal 80% coverage in all districts, and 90% nationally by 2010.
Description of the five RED operational components
1. Re-establishing outreach services
In many countries a large proportion of the population can only be reached regularly though outreach sessions. Outreach is any delivery strategy that requires health facility staff to leave their facility to deliver immunization. Ideally a minimum of four contacts per year are required to fully immunize an infant. For some communities, access can only be provided irregularly, and may require mobile teams to provide outreach, which will involve resources beyond the health facility and district level. Outreach sessions, especially mobile teams present opportunities to provide other interventions with immunization.
2. Supportive supervision
Supportive supervision implies providing on site training to health workers at the time of a supervisory visit, or at regular district meetings. To be supportive, supervisors should make regular schedules for visits, help to solve problems locally and follow up regularly with supply and resource issues. Supervisors will themselves need training to adapt their own approaches to supervision.
3. Linking services with communities
Involving the community with the planning and delivery of the service will encourage community ownership and improve attendance. Identifying community volunteers providing them with a role, such as follow up of defaulters, and holding regular meetings is an important step towards building a link with the community.
4. Monitoring and use of data for action
Monitoring and use of data for action implies not only the timely collection of data at district level, but the use of the data to solve problems. Some simple tools, including wall charts that display access and utilization need little training, but are very useful to take action according to monthly progress. Not only do districts collect coverage data, but also a large amount of other information, including logistics, supply, surveillance, all of which should be used to improve the immunization system. Some qualitative data may not be available in regular reports and may need to collected though supervisory visits.
5. Planning and management of resources
The district micro plan is the key to the RED strategy. The micro plan should be based upon a local situation analysis which involves every health facility and through them the community that they serve. At the national level, there is a responsibility to ensure the needed financial and human resources are available to the district, while the district must ensure the resources are efficiently used, through regular monitoring and adjusting the micro plan. Continuing to fund the RED strategy for more than the first year of implementation is vital for sustainability of coverage increase.
There are 10 steps to making a health facility microplan:
- STEP 1: Quantitative analysis of local immunization data
- STEP 2: Preparing and reviewing an operational map
- STEP 3: Identifying special activities for the hard-to-reach and problem areas
- STEP 4: Preparing a health facility session plan
- STEP 5: Problem solving using the RED strategy
- STEP 6: Making a workplan for one quarter
- STEP 7: Using a monitoring chart
- STEP 8: Working with the community and tracking defaulters
- STEP 9: Managing supplies
- STEP 10: Making use of the monthly report
There are six steps to making a district microplan by putting together all the health facility microplans:
STEP 1: Analyses of district level data to identify priority areas
STEP 2: Making a map to show all health facilities and outreach sites
STEP 3: Making a district workplan
STEP 4: Making an estimate of resource requirements
STEP 5: Conducting regular monitoring and review of progress
STEP 6: Taking action based on a review of progress