ffect of Health workers Strike on mmunization in Kenya

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1 26 April 218 ffect of Health workers Strike on mmunization in Kenya Peter Okoth enya Pediatric Association Conference 3-27 April 218 ombasa, Kenya UNICEF/UNI197921/Schermbrucker

2 Botswana Comoros Eritrea Ethiopia Kenya Lesotho Madagascar Malawi Mauritius Mozambique Namibia Rwanda Seychelles South Africa South Sudan Swaziland Uganda Tanzania Zambia Zimbabwe ISTESA 3rd dose of DPT cont. vaccine coverage in 215vs 216, IST ESA /2 countries achieved 9% in 216 Source:WUENIC

3 -391,353-33,693-3,99-5, ,488 4,899 1,514 5,437 4,781 19,256 38,75 17,25 18,729 3,461 2,586 56,99 123,842 24,651 1,652 24,996 6,519 8,724 18,376 84,739 87,687 29,871 4,256 91,445 47,796 78,287 23, , ,79 146,11 382, , , ,492 Un & under vaccinated children with DPT cont. vaccine in ESA 216 vs 217 6, 5, ,99,418(216), 2,34,373 (217) 4, 3, 2, 1, -1, -2, -3, -4, Source: IST/ESA

4 Overview of Immunization System Immunization services delivered through o HF o Targeted Outreaches, Mobile o Vaccination campaigns to bridge population immunity gap or respond to outbreaks 19 million (9mnths to 14 years) MR in million children <5 years in multiple round of polio Govt. spend $14m on vaccines and devices. Expected increase to $5m after Gavi transition

5 Immunizing HF County # Immunizing HF % Public # Immunizing HF % Public # Immunizing HF % Public # Immunizing HF % Public Baringo E-Marakwet Garissa Isiolo Kirinyaga Kisumu Makueni Marsabit Migori Narok Taita Taveta Wajir West Pokot Source: Counties

6 No. of facilities Availability of services-nairobi County Health Facilities (All) Health Facilities- Public Health Facilities- Private for profit Health Facilities- Not for profit (FBO, NGO) Total facility Immunizing facility Proportion (Immunizing) % 1% 7% 1% Source: Nairobi County

7 Baringo E-Marakwet Garissa Isiolo kilifi Kirinyaga Kisii Kisumu Makueni Marsabit Migori Narok Nyamira Taita Taveta Wajir West Pokot Baringo E-Marakwet Garissa Isiolo kilifi Kirinyaga Kisii Kisumu Makueni Marsabit Migori Narok Nyamira Taita Taveta Wajir West Pokot Sub-county eporting stock out of vaccine Health Facilities reporting stock out of Injection devices

8 Baringo E-Marakwet Garissa Hbay Isiolo Kilifi Kirinyaga Kisii Kisumu Makueni Marsabit Migori Narok Nyamira Taita Taveta Wajir West Pokot Number of Days of Strike- County Data

9 Coverage by Antigen (JRF) National Target Penta 1 Penta 3 Measles National Target not met since 213 Declining coverage since 213 across antigens

10 Distribution of coverage by HF ownership Public Non Public Public Non Public Public Non Public Public Non Public Public Non Public Penta 1 Penta 3 Measle Rubella FIC Majority of children seek immunization services from the Public sector Significant decline in vaccination in public HF, Increased care-seeking from Non public HF in 217

11 January February March April May June July August September October November December January February March April May June July August September October November December Penta coverage (%) Strike- doctors (Nurses short period) Strike-Nurses Penta 3 Coverage (%) Penta 1 Coverage (%)

12 Number of Unvaccinated children DHIS million unvaccinated million under vaccinated million vaccinated million under vaccinated Penta 1 Penta 3 Measles 1 FIC contributed to a third of all unvaccinated children between 214 and 217 across all the antigens

13 Mandera Nyandarua Kisii Kakamega Meru Kericho Bungoma Nandi Trans Nzoia Kitui Bomet Wajir Nairobi Hbay Baringo Kisumu Machakos Uasin Gishu Siaya kilifi Nakuru Busia Makueni Migori Narok Kirinyaga Vihiga Muranga Mombasa Laikipia E-Marakwet Nyamira Taita Taveta Nyeri Kwale West Pokot Embu Tana River Samburu Tharak Nithi Kajiado Isiolo Marsabit Total Unvaccinated children Penta 1 ( ) million unvaccinated

14 Mandera Kisii Narok kilifi Trans Nzoia Nyandarua Bungoma Kakamega Hbay Nairobi West Pokot Migori Meru Kericho Nandi Siaya Kisumu Nakuru Busia Bomet Wajir Kwale Kitui Baringo Mombasa Uasin Gishu Muranga Nyamira Vihiga E-Marakwet Machakos Makueni Samburu Tana River Kajiado Tharak Nithi Nyeri Marsabit Taita Taveta Laikipia Kirinyaga Embu Isiolo Lamu Mandera Kisii Nyandarua Trans Nzoia Kakamega Narok kilifi Nairobi Bungoma Hbay Nandi Siaya Kericho Migori Busia Bomet Meru Kisumu Baringo Wajir Kitui West Pokot Nakuru Kwale Nyamira Vihiga E-Marakwet Muranga Makueni Uasin Gishu Machakos Tana River Mombasa Nyeri Taita Taveta Kajiado Tharak Nithi Samburu Kirinyaga Laikipia Embu Marsabit Isiolo Lamu Unvaccinated children by County-217 Penta Measles

15 Kirinyaga County Machakos County Muranga County Trans-Nzoia County Embu County Meru County Tharaka Nithi County Kericho County Makueni County Isiolo County Vihiga County Nyandarua County Siaya County Kisumu County Kisii County Kiambu County Baringo County Kilifi County Kajiado County Nyamira County Kitui County Mombasa County Taita Taveta County Migori County Nyeri County Kenya Nakuru County Nairobi County Bungoma County Homa Bay County Busia County Nandi County Lamu County Kakamega County Narok County Garissa County Laikipia County Elgeyo-Marakwet County Tana River County Kwale County Turkana County Samburu County Marsabit County Uasin Gishu County West Pokot County Bomet County Wajir County Mandera County % point Drop in reported Coverage (Public HF) 217 compared to 216- Penta

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17 coverage Summary Immunization performance key indicator on strength of health system to deloiver basic life saving interventions Declining Immunization coverage since 214 High numbers of unvaccinated children and increasing year on year- Risk of VPD outbreaks. Mitigated by polio and MR vaccination campaigns Ensuring continuity of services in Public Health Facilities crucial to meeting the UHC for Immunization Strikes by Nurses and doctors have huge impact on overall coverage and effective

18 What should KPA membership do? Keep an eye on Immunization Be the frontline advocate Lookout for the unvaccinated child #vaccineswork

19 Help address MOV

20 African Vaccination week th April Slogan: Vaccinated communities, Healthy communities Theme: Vaccines work, Do your part! Let us tweet. Visit MOH-UNICEF Exhibition Stand

21 UNICEF/SUDA214-XX228/Noorani Thank You #vaccineswork 21 UNICEF for every child