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Immunization at the International Rescue Committee

WHO WE ARE

The mission of the International Rescue Committee (IRC) is to help people whose lives and livelihoods are shattered by conflict and disaster to survive, recover and gain control of their future. Our vision is that the IRC will lead the humanitarian field by implementing high-impact, cost-effective programs for people affected by crisis, and shape global policy and practice by sharing our learning and experience with others. All IRC programs are designed to achieve meaningful change in people’s health, safety, education, economic wellbeing and ability to influence the decisions that affect their lives.

As part of this work, the IRC is committed to bringing life-saving immunization to children in the most challenging and hard-to reach areas. We work in 18 fragile, crisis-affected countries to ensure that caregivers and infants can access immunizations. This includes harnessing the power of technology, tools and creative strategies to identify and follow up with children in challenging and hard-to- reach areas by. But identifying what works is not enough; we work to generate evidence that can take these solutions to scale.

In acute emergencies, the IRC works to improve local epidemiological surveillance to help prevent outbreaks and further spread of disease. We also work directly with Ministries of Health to conduct mass immunization campaigns and rebuild routine services.

As countries evolve from emergencies to rebuilding, the IRC strengthens health systems to ensure immunization services can be provided sustainably. This includes supporting cold chain maintenance in facilities, community outreach and trainings for thousands of health workers on vaccine and data management. We also design improved and creative service delivery approaches—particularly focused at the community level—to promote increased use of immunization services.

WHY OUR WORK MATTERS

More children can access immunization now than ever before. Thanks to advances over the past decade, approximately 85% of children worldwide have received their basic vaccines. As a result, the lives
of approximately 2 to 3 million children are saved every year, and countless more are protected from debilitating illness.

But despite this progress, access to immunization services remains out of reach for millions of children who need it most. Children affected by crisis make up a significant portion of the 19 million children unable to receive live-saving vaccines. We believe that three key barriers stand in the way of reaching the last 15% of unvaccinated children:

  • Weak, ineffective health systems: Many lower income countries lack the ability to deliver immunization services due to poor political and financial commitments, shortage of well- managed health care workers, weak monitoring and information systems, and difficulties managing vaccine stocks.
  • Poor quality and mistrust: Immunization services are one of the first contact points between the caregivers and health providers. Too often, the poor quality of services—compromised by long-waiting times, vaccine stock-outs and a scarcity of trained health workers—impacts trust in these health services and leads to low use.
  • Absence of information and communication: Many caregivers lack the information necessary to ensure their child receives the doses necessary to complete their immunization. Community-based health workers often know which infants have missed their immunizations. Unfortunately, this information is often not effectively communicated, or available, to service providers.

WHAT WE DO

IRC practitioners provide technical assistance to more than 30 country programs. Technical advisors are charged with staying abreast of the best available research and practices in their respective fields and sharing these with the IRC’s frontline teams. They also lead advocacy strategies to encourage partners and policy makers to adopt the interventions proven to be effective based on our research and experience.

Bringing services closer to communities

The IRC is committed to increasing both the coverage and equity of immunization programs. We want to ensure that every child, no matter where they live, has an equal chance of receiving timely vaccines. This requires addressing the major causes of low or stalled immunization coverage rates, particularly in crisis-affected contexts.

Long distances and financial and opportunity costs remain key barriers for caregivers who need to access health facilities five times before their child’s first birthday. The IRC believes that we cannot wait for health systems in crisis-affected areas to become strong enough to deliver a package of fixed and outreach immunization services. That is why the IRC has task-shifted critical and appropriate elements of service delivery to community health workers. By bringing services directly to the caregiver, we have worked to slash the direct and indirect costs for caregivers who want to immunize their children. Accordingly, we advocate for Ministry of Health structures and policies to incorporate community-based health workers into the delivery of immunization services.

Harnessing solutions for health workers and caregivers

Health workers are often best placed to identify the most appropriate, simple and practical solutions if equipped with the right information on who they need to reach and how they are performing. Unfortunately, many health workers do not have the sufficient tools and strategies to access this critical information.

To address this gap, the IRC has developed a mobile health platform, the mReach defaulter tracing data platform, that enables health workers in communities and health facilities to register all eligible children and track their immunization status. Furthermore, it provides automatic alerts for children who have missed an immunization appointment. This approach allows for more accurate immunization targets and an improved ability to track progress. In northern Uganda, this initiative resulted in the immunization of more than 5,600 children. Over 95% of children who had dropped out of their immunization schedule were successfully traced and vaccinated.

In Ethiopia, we also developed a color-coded calendar to help caregivers plan their children’s follow up visits to health facilities. We also make sure that local community health workers are aware of the appointment dates of the children in their villages, so they can provide reminders for those who have missed an appointment. In 2015, this strategy enabled the IRC to fully immunize over 4,600 children.

Expanding evidence on community-based programming

We do not simply want to benefit those we serve directly. We aim to inform our own work globally and, ultimately, the larger humanitarian community. The IRC is committed to implementing programs based on the best available research and testing cost-effective, high-impact solutions that contribute to a more comprehensive evidence base. Our approach is supported by incorporating research and development to design solutions, focusing particularly on task-shifting additional immunization activities such as defaulter tracing and referral to community-based health workers.

The IRC is leading a consortium that launched a cluster-randomized controlled trial evaluating the impact of an IRC project reaching over 12,000 infants across three districts in Uganda. The aim of the “Fifth Child” project is to increase immunization by 10% in a single year through three strategies: 1) detailed immunization service microplanning at the health facility level 2) use of IRC’s tailored mobile reach defaulter tracing data platform; and 3) improved community engagement strategies. We aim to encourage policymakers to incorporate key elements of the strategy into national guidelines using our evaluation results and cost-effectiveness data. 

Available documents & links