Table 1.

Use of Polio Eradication Expertise Areas in Immunization Programs in the 10 Focus Countries

Country Coverage	Policy and strategy	Planning	Management & oversight	Implementation & service delivery	Monitoring & Evaluation	Communication and community engagement	Surveillance & data analysis	Capacity building	Partnership
Angola DTP3 2013: 77% DTP3 2015: 64%	RED activities in polio high-risk districts	Annual EPI planning and review process Microplanning	ICC for immunization and mother, newborn, child health promotion	Timely and sustainable vaccine supply Filling cold chain gap at district level Technical and supervisory support during preparation and implementation of intensification of routine immunization		Defaulter tracing	Data quality assessments Integrated disease and response surveillance (polio, measles, yellow fever, neonatal tetanus)	MLM training of district management teams RED training of frontline health workers Training on vaccine management
Chad DTP3 2013: 48% DTP3 2015: 55%	RED activities in polio high-risk districts Special vaccination for island and nomads population (integrated with other interventions)	Annual EPI planning and review process Micro-planning	Monthly meetings with head of state expanded to EPI and health Hub coordination structure used for EPI, including monthly review meetings Social mobilization coordination meetings Compilation and feedback of process indicators for action	Vaccine management and monitoring Organization of immunization fixed and outreach sessions Organization of PIRI targeting special populations	Monitoring of process and outcome indicators at health facility level: stock out, micro-plans, sessions conducted, supervision, data quality, coverage, drop-out	Work with and train community committees Active defaulter tracing Registration of all children aged <2 y with immunization status for mobilization of unvaccinated children	Weekly visits to high-priority sites Integrated disease and response surveillance (polio, measles, yellow fever, neonatal tetanus)	MLM training for EPI and district managers, Immunization in practice (IIP) for health center staff Use of DVD-MT at district and regional levels
DRC DTP3 2013: 74% DTP3 2015: 81%	RED activities in polio high- risk districts Negotiation with armed forces for access (North Katanga)	Annual EPI planning and review process Microplanning in all health facilities, including all villages	Weekly meeting of Strengthening the Routine Immunization group to monitor the implementation of the plan Monthly meeting of review cut off of analysis and validation of immunization data at all levels Monthly teleconference with high- risk provincesNational Coordination Committee for Health and Epidemics		Monitoring of process and outcome indicators at health facility level: vaccine stocks, kerosene availability, sessions, supervision, coordination meetings held (HF, DS), Number of undervaccinated children Monitoring tools for polio national immunization days (NIDs) (lot quality assessments) adapted for RI	Evidence generation through high quality KAPB (Harvard Polling) Involvement of community leaders in planning Mobilisation of children and women due for vaccination Sociological evidence generation on vaccine hesitancy Promotion of family key practices	Weekly visits to high-priority sites Integrated disease and response surveillance (polio, measles, yellow fever, neonatal tetanus) Ebola surveillance and response Laboratory for polio expanded to measles, rubella, yellow fever Data management training workshop and mapping	Planning Cold chain and logistics DVD-MT Placement of consultants and STOP teams in priorities antennas	Trans-border coordination Resource mobilization through Congolese parliamentarians for wider immunization
Ethiopia DTP3 2013: 72% DTP3 2015: 86%	RED activities in polio high-risk districts Use of African Vaccination Week and supplementary immunization activities for providing services in high- risk zones	Annual EPI planning and review process Microplanning	Coordination of communication in high- risk zones			Job aids on messages for immunization (speaking book)	Integrated disease and response surveillance (polio, measles, yellow fever, neonatal tetanus)	Capacity building in RED, MLM training and IIP training on use of continuous temperature monitoring devices
Nigeria DTP3 2013: 46% DTP3 2015: 56%	Engage military escort for vaccination activities in security-deprived north- east	Annual EPI planning and review process Micro-planning Identification of high risk communities and quarterly outreach to them Inclusion of previously missed populations using geographic information system data	Polio accountability framework adapted to RI with dashboards for RI In the states with Memorandum of Understanding (MOU) for RI, regular review meeting with all stakeholders. RI services integrated with other interventions (nutrition, water sanitation hygiene [WASH], birth registration)	IPV introduction, in particular in high- risk and insecure areas Use of “hit and run” to deliver immunization in conflict-affected areas	Monitoring of process and outcome indicators: cold chain, stocks, vaccination sessions, supervision, improvement plans based on supervision	Evidence generation through high-quality KAPB (Harvard Polling) New-born tracking, defaulter tracing and mobilization for RI Birth registration Nutritional screening and referral WASH promotion Using the village community mobilizers use of new technology and innovations to enhance demand and improve coverage	Visiting the polio high- risk sites Recording children immunized by settlements—linking micro plans with coverage. RI performance report using the DVD-MT and District Health Information System 2nd generation platforms Integrated disease and response surveillance (polio, measles, yellow fever, neonatal tetanus) Lassa fever, cholera, Ebola surveillance and response	Training of health facility and local government area staff Integrated primary health care training for health workers Training of EPI managers on effective supportive supervision	Emergency operations center used for EPI and emergency response (eg, Ebola) Tripartite MOU between state with Bill & Melinda Gates Foundation/ Dangote Foundation, and USAID, enabled accelerated RI improvements, supported by WHO and UNICEF
South Sudan DTP3 2013: 45% DTP3 2015: 31%	RI re-established in conflict zones	Annual EPI planning and review process Microplanning		Support to vaccination services Use of Rapid response missions to deliver immunization in 3 conflict-affected states	Supervision			Capacity building in immunization and epidemiology
Afghanistan DTP3 2013: 70% DTP3 2015: 78%	Pilot project in districts (some high risk for polio)	Microplanning			Monitoring of sessions			Capacity building in RI
Pakistan DTP3 2013: 72% DTP3 2015: 72%	Pilot project in districts (medium risk for polio)	Microplanning	Provincial and district review meeting		Monitoring of sessions	Evidence on knowledge, attitude, practices among parents and caregivers around RI through focus group discussions Social mobilization toolkit for RI		Capacity building in RI and communication
Somalia DTP3 2013: 42% DTP3 2015: 42%	RI established in conflict zones with direct support of Global Polio Eradication Initiative partners	Annual EPI planning and review process	District review meetings	Delivery of vaccination services	Monitoring of process and outcome indicators: cold chain, stocks	Evidence generation through high-quality KAPB (Harvard Polling) Promote immunization Mobilize unvaccinated children	Data collection and analysis	MLM training for Ministry of Health and implementing partners
India DTP3 2013: 83% DTP3 2015: 87%	Mission Indradanush: planning for RI intensification in high- risk zones	Annual EPI planning and review process Microplanning, including high- risk settlements	Block, district, state review meetings Accountability framework		Monitoring of process and outcome indicators at health facility level: vaccine stocks, sessions, supervision, coordination meetings held, RI coverage, reasons of nonvaccination	Evidence generation through high-quality KAPB (Harvard Polling) Newborn tracking RI due lists and defaulter tracing Promotion of family practices	Integrated disease surveillance and response	Capacity building of district health officers and health facility staff

Abbreviations: DS, district; DTP3, 3 doses of diphtheria tetanus pertussis vaccine; DVD-MT, district vaccine and devices-management tool; EPI, Expanded Program for Immunization; HF, health Facility; ICC, Inter-Agency Coordination Committee; IIP, immunization in practice; KAPB, knowledge, attitude, practice behavior; MLM, midlevel management; NID, national immunization day; PIRI, periodic intensification of routine immunization; RED, Reaching Every District; RI, routine immunization; STOP, stop transmission of polio; WASH, water sanitation and hygiene.