Table 3.

Reaching Every District (RED) components with associated description mapped to ARISE-SI advance preparation findings and activities

Reaching Every District (RED)		ARISE-SI
Component	Description	Advance preparation findings	Activities
1. PLANNING AND MANAGEMENT OF RESOURCES: better management of human and financial resources.	At the district and facility levels, planning should identify what resources are needed to reach all target populations in a way that can be managed well and thus maintained. Good planning involves: (a) understanding the district/health facility catchment area (situational analysis); (b) prioritizing problems and designing microplans that address key gaps; (c) as part of microplanning, developing a budget that realistically reflects the human, material and financial resources available; and (d) regularly revising, updating and costing microplans to address changing needs.	• Integrated care and services: drugs draw people; lack of interest may prevent people from coming. • Record Keeping and Management: use of registers for tracking waiting times, home visits, follow-up calls, Child Health Cards. • Roles: VHT can go to homes; know roads, residents, who are immunized, provide health education. • Scheduling: waiting time important issue to mothers; reliability of schedule is important. • Staffing: HU staffing does not align with UNEPI standards; however HUs agreed that they are often able to provide services with the staff that they have. • Supplies: Child Health Cards, vaccine and gas stock-outs common across HUs. • Education and Training: VHT eager to learn; training needs include HMIS, RI-TA and QI training. • Cold Chain: Lack of affordable fuel for transport; motorcycles are in disrepair; difficult passage on roads; lack of adequate gas cylinders.	• Complete initial assessment of current state. • Agree on importance of children having Child Health Cards. • Re-allocate PHC funds to hire local taxi. • Purchase gas cylinders. • Change HU and outreach schedules to accommodate child care-givers needs. • Increase staffing on RI days. • Maximize VHT capacity for RI. • Incorporate VHT into HU QI Team. • Child Health Card used as documentation, communication. • Cross-train staff in RI. • Develop better understanding of VHT assignment and HU service area.
2. REACHING TARGET POPULATIONS — improving access to immunization services by all.	“Reaching the target populations” is a process to improve access and use of immunization and other health services in a cost-effective manner through a mix of service delivery strategies that meet the needs of target populations.	• HU staff seemed to know their populations well. • Families suggested the need for integrated services. • VHTs are trained to promote general and specific services. • Reliability of scheduling is very important to families.	• HU staff were able to draw maps of their service area and identify where services are delivered and where hard to reach persons lived. • Incorporated VHT into HU QI Team. • VHT increased home visits. • VHT educated about RI. • Staff taught VHT to read Child Health Cards. • Increased staffing on RI clinic days. • Opened outreaches. • HU adjusted hours of outreach clinic to accommodate mothers’ need for working in gardens. • Staff arrived on time at outreaches.
3. LINKING SERVICES WITH COMMUNITIES — partnering with communities to promote and deliver services.	This RED component encourages health staff to partner with communities in managing and implementing immunization and other health services. Through regular meetings, district health teams and health facility staff engage with communities to make sure that immunization and other health services are meeting their needs.	• HU management committee and community leaders involved. • Many HUs using mobilizers and VHTs. • HUs are beginning to train VHTs.	• Caregiver focus groups identified specific needs of each HU service area. • VHTs were included as members of HU QI Teams. • Staff and VHTs met with religious leaders. • VHTs were enlisted from communities with unreached, including Muslims.
4. SUPPORTIVE SUPERVISION — regular on-site teaching, feedback and follow-up with health staff.	Supportive supervision focuses on promoting quality services by periodically assessing and strengthening service providers’ skills, attitudes and working conditions. It includes regular on-site teaching, feedback and follow-up with health staff.	• HU staff had many questions regarding RI policy and practice.	• Coaching included focus on QI, use of data, display of data, education/instruction about technical aspects of RI practice. • Workshops focused on addressing identified technical information needs: overview of RI in Uganda, VHT Program, understanding RI rates, RI administration policies and included interactive sessions wherein HU teams educated one another on specific topic areas.
5. MONITORING FOR ACTION — using tools and providing feedback for continuous self- assessment and improvement.	District health teams and health facility staff need a continuous flow of information that tells them whether health services are of high quality and accessible to the target population, who is and is not being reached, whether resources are being used efficiently and whether strategies are meeting objectives. Monitoring health information involves observing, collecting, and examining program data. “Monitoring for Action” takes this one step further, by not only analyzing data but by using the data at all levels to direct the program in measuring progress, identifying areas needing specific interventions and making practical revisions to plans.	• Each HU has an assigned HMIS person on staff. • Used data for reporting to DHO (immunizations, drop outs, etc.) • HMIS persons understand how to collect, and display data. • Data are not used for assessment or tracking of improvements.	• Use of QI tools: fishbone, PDSA, Model for Improvement, Ladder of Improvement, operational definitions, data collection, data display, meeting skills. • Data collected and used for improvement: caregiver waiting times, # children w/ Child Health Cards, # homes visited by VHTs, # outreach sites open, # VHTs instructed on reading of Child Health Cards, etc. • VHT registries and patient registries as data sources. • Engaging VHTs in process of collecting data and understanding how it is used for improving RI services within their HU service areas. • HMIS instructing staff on role of data for improving their processes. • Regular meeting of HU QI Team, use of meeting skills to maximize productivity of staff and time.