Losing the immunisation gap in Ethiopia: a formative evaluation of ‘The Fifth Child Project’
According to the 2011 Ethiopia Demographic Health Survey, 41.7% of children 12-23 months old in Benishangul Gumuz Regional State received the third dose of the pentavalent vaccine; approximately 13% were completely unimmunized, thus susceptible to vaccine-preventable diseases. Intervention overviewTo address low coverage and support Ethiopia's Health Extension Program, in 2013, the International Rescue Committee began implementing the 'Fifth Child Project'a multipronged community engagement strategy to improve timely utilization of maternal and child health services, with emphasis on immunization, across Assosa and Bambasi woredas.The intervention focuses on promoting systematic use of quality immunization data for local level decision-making, particularly around defaulter follow-up through the introduction of a defaulter tracing tool.It also applies an overarching community engagement approach by equipping existing cadres of Health Extension Workers and Health Development Army members with improved interpersonal communication skills for effective and tailored counselling sessions and leveraging them to conduct timely home visits targeted at defaulters.At the household level, it integrates the use of a colour-coded calendar known as Enat Mastawesha.The calendar serves as a planning tool for caregivers to keep track of upcoming for peri-natal appointments and serves as a job-aide for health workers.Essential systems support is also provided to ensure that immunization services meet basic policy standards (e.g.cold chain functionality, support for outreach sessions).