Reaching Every Child with the COVID-19 Recovery Fellowship in Ghana

For Evans Jutta Kofi Attivor, each dot on the Google map represents an opportunity.

As Municipal Director of Health Service for Nkwanta South municipality of Ghana, Evans is working on catching up children who missed routine immunization during the COVID-19 pandemic in the Nkwanta South of Oti region, located in northeast Ghana. "Each dot represents the geolocation of a child who has missed vaccination, and was followed up through defaulter-tracing," he says.

Last summer, Evans joined the second cohort of the COVID-19 Recovery for Routine Immunization Programs Fellowship offered by the Sabin Vaccine Institute and the World Health Organization. He attended Phase I of the Fellowship, a five-week live engagement series, and then submitted a strategic proposal on his project, Reducing missed opportunities for vaccination: A COVID-19 immunization recovery project in four sub-municipalities in Nkwanta South.

One of 60 Projects Chosen

He was accepted to become one of the 60 individual or team Fellows chosen for Phase II, the mentorship program of the Fellowship. Supported with micro-grant funding to help bring his vaccination project to life, Evans and his team are using Google maps in the first round of the immunization project in the rural region.

He started the recovery effort in late 2023, with 12 Community Health Planning and Services (CHPS) facilities from four sub-municipalities out of 30 total. He hopes the project will eventually involve all 30, and possibly become a regional and even a national immunization tracking effort. "We have supervisors, unit heads and sub-municipal leaders from the four implementing sub-municipalities at monthly joint meetings, so all are aware of what's going on and we can reproduce these activities later," he says.

To start, the team focused on planning, partner development and resource mobilization, making certain that every facility had all supplies necessary, assuring that the cold chain structure was in place, and training  completed for health care workers. Since 2020, his team has been using an immunization follow-up tool called Nkwanta South Municipal Home Visit/Follow-up Reporting Tool that was designed and deployed on the KoboCollect app. For the Fellowship project, a new app was designed to aid monitoring and data collection, which all supervisors downloaded onto their phones to help capture real-time data in the field. This new tool is designed to record vaccination dates and services provided during supervision as well as to make reporting by the supervisors easy and convenient. "It's part of making certain that we get valid reports," says Evans.

"The catch-up campaign includes both static (facility-based) and outreach activities," he adds. "We want to be able to compare our numbers from the field with what the facilities submit and make certain that we can follow up on any discrepancies, to find out exactly what happened and address them."

Defaulter Tracing

The main strategy they are using, defaulter tracing, allows the various teams to identify missed children per the vaccination records in the Nutrition and Child Health Registers. In one CHPS zone, the project successfully traced and immunized 81.4% of missed children. Those missed were due to Ill health, vaccine not opened to avoid wastage and child vaccinated but not recorded. Reasons why children defaulted initially included that the child was not available when the vaccination team visited, the shortage of vaccine and breakdown of the motorbike used to transport vaccines. "We work in difficult terrain," he says.

Attivor notes that some of the challenges to service delivery have included transportation and competing activities that sometimes interfere with field work. "We are, however, finding ways to execute all planned activities as well as track our progress," he added.

Initial Success

Midway through the implementation of his Fellowship project, five (41.7%) of the facilities have achieved or exceeded their goals and another four (33.3%) are making good progress. For the three outliers, "We know this is within our reach. We will revisit the data and liaise with the national and regional office to resolve the challenges."

As part of the Fellowship, Evans has been able to check in monthly with his mentor, Katrina Kretsinger, a global immunization expert from WHO. "The monthly meeting with my mentor,  which I refer to as the M4 activity – Mentee-Mentor Monthly Meeting – has given me the chance to discuss opportunities and innovative ideas. I must say that Katrina has really provided me [with] technical advice, motivation and guidance."

Evans notes the commitment of his team of municipal and sub-municipal supervisors and the facility in-charges to continue tracing all missed children through home visits. They are also planning to continue conducting monthly reviews, data validation meetings and follow-up to address all issues of population discrepancy.

The Fellowship project, with its monthly group check-ins, training and results, has had a positive impact on everyone, says Evans. "The team is so excited about this project, and some say they are learning so much from it."

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This article was originally published by the Sabin Vaccine Institute on 21 February 2024.