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Stories From Sierra Leone

New tracking tool increases vaccination rates in Sierra Leone

Extended Program of Immunization (EPI) Outreach story
Volunteer Dakota collaborates with a community health center that has implemented a new tracking system to increase vaccination success in Sierra Leone.

As a Community Health Promoter in eastern Sierra Leone, I focus on maternal and child health issues. Recently I collaborated with a local community health center (CHC) to develop a new tool to improve immunization rates in my area.

The Extended Program of Immunization (EPI) program

Routine childhood vaccinations in Sierra Leone are a part of the Extended Program of Immunization (EPI), an initiative started by the World Health Organization (WHO) and managed by the Sierra Leone Ministry of Health. EPI makes vaccines readily available to infants and children. Vaccinations protect individuals from bloodborne illnesses, respiratory infections, and diarrheal diseases. Vaccines are always in stock at the district’s main hospital and ready for distribution to peripheral health units. Child health nurses manage our local CHC’s stock and ensure the supply of vaccines will meet the monthly demand.

The challenge of low vaccination rates

Despite the availability of vaccines to the community, there continues to be low vaccine coverage in our CHC’s catchment population of nearly 12,000 people. We expect to see about 350 new infants begin a course of vaccines every year. Between May 2023 and January 2024, only 49 percent of children in the EPI register were up to date on vaccines, of 259 children who started EPI during that time. When my supervisor and I saw these numbers, we knew something had to be done.

A new tracking tool

In January 2024, we began to closely monitor vaccination registers in our chiefdom in order to identify people missing the required number of vaccine doses (called “defaulters”). To identify defaulters more effectively, we created an EPI tracking tool that collects all clients’ demographic data, autogenerates visit dates, and alerts us when a client has defaulted. The tracking tool makes data analysis much easier. If a single client defaults, we will visit the client's home. When vaccination rates become low in a particular village we conduct outreach vaccine clinics.

Community health workers increase outreach

This project has increased the effectiveness of our outreach and also strengthened the capacity of our community health workers (CHWs). CHWs are an instrumental part of health work in Sierra Leone. They live and work in areas where a health facility is not easily accessible. They provide health counseling, first-line treatments, and referral services. Every month, the CHWs come to our center to give reports and discuss public health matters.

We started giving CHWs lists of defaulting clients so they can ensure clients are aware of their next vaccine visit. The CHWs have mobilized their communities to take the vaccines. As a result of the CHW’s outreach, clients often arrange to make the journey to the center together, splitting the cost of taxis.

Outreach about new malaria vaccine

Notably, a new malaria vaccine was added to the EPI program in February 2024. Malaria disproportionately affects children under five years old. The vaccine decreases the severity of symptoms, which is crucial in a country where malaria is widespread. The vaccine is given in four doses and must be administered at specific ages, due to the vaccine’s novelty and for research purposes. Our tracking tool helps community health workers communicate the vaccination dates to mothers before the child becomes ineligible for the vaccine.

Vaccination rates improve

The project is showing success. Between January and May 2024, the total amount of up-to-date clients has increased from 49 to 61 percent. In five months, we have reached 155 mothers and children through house-to-house counseling, outreach clinics, and CHWs. We hope to reach the nationally mandated 80 percent vaccine coverage among EPI clients this year.

As the project progresses, we continue to learn how to improve our work. Looking ahead, we are adapting the EPI tracking tool to other facets of our work. We recently developed a prenatal tracking tool and have begun to chart health counseling sessions of pregnant women. By closely monitoring our clients’ health, we hope to improve service quality and community health.