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Learning across borders: boosting immunisation coverage in Ghana

Felix Adipare has drawn inspiration from colleagues all over the world in his efforts to improve vaccination coverage in his district in Ghana. These learnings helped boost vaccine coverage from 60% to 99% in just a year.

  • 21 February 2024
  • 4 min read
  • by Ian Jones ,   Charlotte Mbuh
Vaccine outreach in Gomoa East District, Ghana (Credit: Felix Adipare)
Vaccine outreach in Gomoa East District, Ghana (Credit: Felix Adipare)
 

 

Felix Adipare is District Director of Health Services in Gomoa East District, Ghana. Felix's challenge was comparatively low vaccination coverage in his district. Coverage of Penta3 – the third dose of pentavalent vaccine, a standard formulation of five different antigens in one vaccine given to infants – was 60%, a drop of 20 percentage points since 2020 and significantly lower than in other areas of Ghana.

In March 2022, he joined the Movement for Immunisation Agenda 2030 (IA2030) – a collective of more than 16,000 health workers committed to achieving the goals set out in IA2030, the world's immunisation strategy. Members share ideas and experiences across borders to help each other with the challenges they face. The Movement for IA2030 is facilitated by the Geneva Learning Foundation (TGLF), a Swiss non-profit organisation that implements large-scale, locally led peer learning programmes for health.

A big part of this underperformance was the complex and dynamic human geography of Gomoa East. It includes a semi-permanent slum that originally housed displaced people from Liberia, people attracted by a large and popular market and multiple gated communities housing workers who travel to the capital, Accra, every day. Overall, the population almost doubled between 2020 and 2022.

"Parts of the district are densely populated areas, but we also have some rural areas and nomadic populations. So, the range of challenges we have is huge!"

– Felix Adipare, District Director of Health Services in Gomoa East District, Ghana

Drawing his team together, including community nurses who were most familiar with the situation on the ground, Felix organised a SWOT (strengths, weaknesses, opportunities and threats) analysis. This flushed out several reasons for underperformance, including the lack of outreach sites, particularly around the urban slum, poor take-up of services by those living in gated communities, and lack of service availability at convenient times.

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No single solution could address these challenges, so Felix adopted a multi-pronged strategy. He was able to increase the number of outreach points, redesign services so that they were available at convenient times, increase the number of vaccinators and decrease waiting times, and extend vaccination to private facilities. Additional social mobilisation activities were also organised, in partnership with a local NGO, which has also supported the other new activities.

"We recognised that existing private facilities could help us reach more people. As vaccination is free, we needed to come up with an incentive, so we offer them free HIV, malaria and syphilis testing kits, and in return they provide us with space and, in some cases, fridge space too."

– Felix Adipare

The efforts have proved tremendously successful. According to administrative data, Penta3 vaccination is now nearly universal within the district.

"Administratively reported Penta3 coverage increased from 59.5% in 2021 to 113% in 2022 and MR2 [second dose of measles-rubella vaccine] coverage from 53.7% in 2021 to 98.9% in 2022."

– Felix Adipare

According to Felix, participation in the Movement for IA2030 was crucial to this success. The aftershock of the COVID-19 pandemic placed enormous stress on him and his team. Connecting with peers in a similar situation helped him realise he was not alone and provided a vital peer support network. And participation in the Movement's peer learning activities exposed him to many new ideas he could adopt locally – the use of private facilities, for example, was a strategy he learned from the "IA2030 Ideas Engine", a repository of ideas and activities shared by Movement members.

"Hearing what others had done sparked us into thinking about whether we could do something similar."

– Felix Adipare

Felix's story is just one of many that illustrate how success on the frontline can be based on motivated and committed immunisation workers helping each other, through the Movement for IA2030 platform established by TGLF. Official guidance can be useful, but often the best solution to a problem can be found by dialogue and discussions with peers who have faced and overcome similar challenges.

Learn more

IA2030 Case study 24. Felix Adipare. A tailored approach – Multiple innovations in service delivery to improve coverage in Ghana https://doi.org/10.5281/zenodo.8398637

Learn more about the Movement for IA2030
Movement for Immunisation Agenda 2030 (IA2030): grounding action in local realities to reach the unreached
https://redasadki.me/2024/02/05/movement-for-immunisation-agenda-2030-ia2030-an-opportunity-for-global-partners-to-learn-how-to-ground-action-in-local-realities-to-reach-the-unreached/

Jones, I., Sadki, R., Brooks, A., Gasse, F., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Movement Year 1 report. Consultative engagement through a digitally enabled peer learning platform. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7119648

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