HousetoHouse Social mobilization for MeaslesRubella SIAs in Rwanda

House-to-House Social mobilization for Measles/Rubella SIAs in Rwanda, March 2013 American Red Cross to RWANDA RED CROSS

Rwanda Country Profile q Area: 26, 338 km 2 q 2012 census Population: Ø Total estimate = 11, 689, 696 Ø Population growth rate estimated at 2. 75% Ø Life Expectancy was 58. 44 yrs Ø Age structure: • • • 0 -14 yrs: 42. 6% (4, 974, 609) 15 -24 yrs: 19. 2% (2, 243, 542) 25 -54 yrs: 32% (3, 740, 308) 55 -64 yrs: 3. 8% (447, 754) > 65 years : 2. 4% (283, 483)

Country administrative structures RWANDA As Country RRC HQ Provinces = 4 + Kigali City Districts = 30 (Coordination level) Sectors=416 (Implementation level) RRC Branch RRC LC Cells= 2184 Implementation community RRC LC Villages=14841 (Implementation community) Model village (10 volunteers per village)

Rationale for introduction of Rubella vaccine & Measles 2 nd Dose in Rwanda 1. Increasing burden of rubella from febrile-rash illness surveillance; Risk of Congenital Rubella syndrome as public health problem 2. Consultative discussion by EPI, MOH and partners on a program for sustaining the future purchase of MR vaccine 3. Opportunity to introduce measles 2 nd dose and MR vaccines after the catch up SIAs Ø Advantage of GAVI support to support MR introduction campaign and vaccine supply for measles 2 nd dose lasting 5 yrs Ø Eliminate burden of measles affecting young adolescents Ø Preparation for MCV 2 introduction

MR vaccine Introduction Campaign Objectives 1. To give an opportunity to provide 2 nd catch up dose of measles and a unique dose of rubella vaccine 2. To achieve at least 95% coverage among 9 -15 years old children in every district during the campaign with MR and HPV vaccines • Integrated & targeted CRS and Cervical cancer prevention 3. To set stage for expansion of the scope of diseases covered by EPI as MR vaccines will available to all infants <1 year of age in the routine EPI following MR campaign

Strategy for MR vaccine Introduction in Rwanda 1. Comprehensive vaccination o Measles and rubella (MR) catch-up campaign o Linkages and expansion of current routine EPI schedule o Linkages for introduction of measles 2 nd routine dose. 2. Establish Surveillance • Integration of Rubella surveillance with case-based measles surveillance- Retrospective review of CRS ongoing • Planning to establish sentinel site for CRS surveillance • Adverse Event Following Immunization (AEFI) surveillance • Launch communication for RCV introduction • Supervision, monitoring, evaluation & reporting

Major Communication Activities for MR SIAs in Rwanda Advocacy: • Involved all the line ministries, and development partners e. g UNICEF, WHO, UNFPA, Red Cross etc. • Involved district Mayors, Secretary of the Sectors • Meeting with the Sector secretary, CHWs & teachers at HC level Mass Communication: • Engaged print and electronic media; emphasizing national and community radios • Engaged mobile telephone companies to send bulk SMS • Developed and distributed IEC (posters, banners, leaflets) • Dissemination MR campaign message in the Umuganda; a month gathering of the community members in their sectors

Major Communication Activities for MR SIAs Cont’d Inter-personal Communication: • MR campaign messaging in the Umuganda; informed agent leading a community dialogue in a monthly gathering of the community members in their sectors • House -o-House Social Mobilization by Rwanda Red Cross volunteers in selected high-risk, Urbanized and high-population districts

Rwanda Red Cross Project for Houseto-House Canvassing for MR SIAs Project Goal To contribute to reductions in morbidity and mortality due to Measles and Rubella diseases through increases in MR vaccine utilization and coverage. Specific Project Objectives 1. Train at least 1, 700 community volunteers in social mobilization for MR vaccination 2. Conduct house and school visits to at least 90 percent of households and the schools in 4 selected districts before the March 2013 MR vaccination campaign 3. Assist all vaccination teams in 4 selected districts to reach at least 95% of all children <15 yrs with MR vaccines 4. To determine the major information sources on MR vaccination

Rwanda Red Cross Project Districts for House-to-House Canvassing GASABO 15 sectors 73 cells 486 villages KICUKIRO 10 sectors 39 cells 332 villages GISAGARA 13 sectors 59 cells 524 villages NYARUGENGE 10 sectors 47 cells 357 villages 48 sectors; 218 cells ; 1699 villages

Major Activities of Rwanda Red Cross Project for H 2 H Canvassing for MR SIAs Pre-Campaign Ø Developed a guide for H 2 H Canvassing (including recording and reporting tools) Ø Training of Red Cross volunteers as MR Promotional Agents Ø Conducted H 2 H visits for mobilization of community and registration targeted children in the 4 selected districts During the Campaign Days Ø Red Cross Volunteers supported vaccination teams at all established service delivery points, Post Campaign Ø Red Cross volunteers conducted H 2 H visits in purposefully selected households to trace for a) b) c) d) MR SIAs defaulters, Evaluate the community coverage of MR vaccination, Determine the most reliable sources of information and Detect any bad (adverse) events following immunizations

Rwanda Red Cross H 2 H Canvassing Project achievements (1) • Recruited, trained and deployed 3, 400 volunteers (two per village) in 4 districts. • 213, 159 households visited (70, 4 % of households in the four districts) prior to the MR SIAs with 386, 322 children aged 9 months to 14 years were pre-registered.

Rwanda Red Cross H 2 H Canvassing Project achievements (2) • Sensitisation/dialogue sessions were conducted in all registered Kindergarten, Primary and secondary schools in order to reinforce the uptake of MR and HPV vaccines.

Rwanda Red Cross H 2 H Canvassing Project achievements (3) • Rwanda Red Cross procured 25, 000 leaflets and 2, 000 Tshirts to be used as identification and visibility materials for volunteers deployed to conduct the house to house canvassing for the integrated Measles/Rubella vaccination week

Rwanda Red Cross H 2 H Canvassing Project achievements (4) v RRC Volunteers support Crowd control at the posts v Holding children during vaccinations v Provision of Vitamin A and recording of children to be vaccinated

Rwanda Red Cross H 2 H Canvassing Project achievements (5) Red Cross Volunteers supported provision of Vitamin A

Rwanda Red Cross H 2 H Canvassing Project achievements (6) Red Cross Volunteers recording of children to be vaccinated

Rwanda Red Cross H 2 H Canvassing Project Outcomes (1)

Rwanda Red Cross H 2 H Canvassing Project Outcomes (2) Household sources of Information on MR SIAs in Rwanda; March 2013 30% 28% 25% 20% 15% 10% 8% 4% 5% 3% 2% s he r Ot s bo ur igh ad er Ne Le da ca l an Lo ug TV Um Ho dio us He e Vi al sit th W or ke rs 0% Ra Post Campaign H 2 H visits showed: Ø 12, 112 of the 12, 220 (99%) children assessed reported to have received MR vaccines Ø 10, 686 of 12, 220 (89%) children evaluated had written proof (MR Card) of vaccination Ø No major AEFI detected

Rwanda Red Cross H 2 H Canvassing Project Outcomes (3) Post Campaign H 2 H visits Cont’d: Ø 108 children found to have missed the MR SIA dose Ø Reasons for vaccination failure were tallied as: a) b) c) d) e) f) Child was sick (31%), Lack of time (18%), Wrong ideas or misconceptions on MR vaccine (5%), Not knowing the place/site for vaccination (3%), Place for vaccination too far (2%) and Not knowing the need (1%).

Conclusions • H 2 H canvassing by Red Cross Volunteers reaches an additional 25% of households with information on SIAs • Vaccination site support by Red Cross volunteers improves the vaccination experience of HWs, parents & children • Three out of the 27 districts in Rwanda did not attain 95% MR coverage

Recommendations 1. Support Periodic H 2 H canvassing for Ø Tracing routine MR and MCV-2 vaccination defaulters as a strategy to sustain the highest possible coverage Ø Establishing a community surveillance system for febrile. Rash illness Ø Exploring community surveillance for CRS 2. The three districts that did not attain 95% MR coverage should be evaluated in-depth to inform targeted and additional support to raise coverage 3. Support training of Rwanda Red Cross Branch staff in Measles/Rubella elimination