MCHIP/Kyrgyzstan Immunisation Programme

MCHIP/Kyrgyzstan initiated a community-based, bottom-up, quality improvement approach to more effectively work with communities and marginalised populations in an effort to increase uptake and use of vaccination services. In order to strengthen partnerships between the health system and communities, organisers brought together the curative sector and community partners with the Rayon Sanitary Epidemiologic Stations (SES) by establishing an Initiative Group (IG) that was composed of 10 members from all levels of the health system, including representatives from the MoH/RCI, Health Promotion Unit (HPU), Village Health Committees (VHCs), and a United States Peace Corps Volunteer.

The IG was established near Bishkek, in the Sokuluk Rayon, with a population of about 160,000 people and the largest number of migrants. MCHIP's approach emphasised better monitoring and utilisation of data for evidence-based decision making to improve immunisation coverage and timeliness of vaccination. With technical support and training from MCHIP, IG members worked with local Rayon health officials to apply epidemiologic skills to better define the status of immunisation and resources in their Rayon. This effort included collecting data from all levels of the Rayon health structures, identifying gaps in immunisation services, and then developing an action plan to address barriers.

Linking IG capacity-building activities with the health facility level, MCHIP observed gaps in the monitoring and reporting of immunisation data. MCHIP and the RCI identified areas where the manual that had been used to guide health workers since 2011 could be improved. Having updated it, it was published by the MoH and then printed and distributed to all vaccination points nationally. All Oblast-level managers were trained on the implementation and use of the manual, and the RCI committed to supporting training sessions at the Rayon level.

MCHIP piloted software called "Computerized Information System for Immunization ("CISI") in two family medical centres (FMCs) and at the Issyk-Ata Rayon SES to refine its utility in the monitoring and use of immunisation data and to identify what systems would be needed to roll out CISI nationally. One finding from an external evaluation was that, to optimise use of the system, CISI should be revamped to not only improve the reporting of data but also to support its use for decision making.

Immunisation and Vaccines

Kyrgyzstan has experienced an increased number of vaccine refusals due to religious and other reasons. A national immunisation communication strategy was developed in 2012 under the leadership of the United Nations Children's Fund (UNICEF), which is intended to be a first step in countering anti-vaccination rumours circulating over the internet and television. According to organisers, the MoH should increase its engagement with religious and community leaders to promote vaccination services. The Deputy Minister of Health reported that there are 8,000 to 10,000 volunteers who are officially promoting religious messages house-to-house, primarily in the southern part of Kyrgyzstan. These volunteers are also spreading health messages within the context of Islam that are frequently incorrect. These volunteers are an "untapped" resource that could be trained and engaged in disseminating health messages and information, education, and communication (IEC) materials and could help mitigate vaccine refusals based on religious reasons.

"A key component to MCHIP's approach was harnessing mutual respect that cultivated information sharing and learning between different levels of the health system and community-based organizations (e.g. NTOs and VHCs), increasing transparency and leading to improved service delivery while expanding access to services for high-risk populations.

While there is political will and support for immunization programs through the MoH and RCI at national level, efforts need to continue to build on and maximize past investments in the RI system. Such investments could further develop the quality of RI services at the local level and thereby sustain the absence of polio and other VPDs, rather than reactive investments in a crisis and retrospective manner based on outbreaks of polio or other VPDs.

An integral component that determined the success of this model was active participation and engagement by all members of the IG, most notably national-level RCI support and empowerment of VHCs through training on immunization and bringing them together with the health systems, which resulted in strengthened partnerships with communities."