‫ﺑﺴﻢ ﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ‬

Al zaiem Al Azhari University

Faculty of medicine

Batch 27

Primary health care course assignment

The Role and Importance of Immunization in Primary Health Care: A Focus on the
. Sudanese Context

Course coordinator: [Link]

Student name: Arwa Elsadig

‫أروى اﻟﺼﺎدق اﺑﻜﺮ آدم‬

iD. 19220391

.Immunization is a global health success story, saving millions of lives every year
Vaccines reduce risks of getting a disease by working with your body’s natural
defenses to build protection. When you get a vaccine, your immune system
"responds.¹

Immunization in Sudan faces significant challenges, particularly in conflict-affected

regions where access to healthcare is severely limited. The complexities of
,vaccinating children, especially those classified as zero-dose or under-immunized
necessitate innovative strategies and community engagement. The following
"sections outline key aspects of immunization efforts in Sudan.²

In some studies results in southern sudan poor facilites immunization

Result of the research is The main reasons identified were negative attitudes
towards healthcare workers and immunization
,chain facilities, inadequate knowledge and information about immunization services
and nonavailability of

services, competing priorities of the caregivers, delayed opening of the immunization

sessions, insufficient cold

""vaccines at the health facility. ³

-:Important of Immunization on phc facilites

immunisation service delivery to nutrition sites and children’s outpatient departments

improved the immunisation coverage and decreased drop-out rates in the Rumbek
East and Rumbek Centre counties of South Sudan. This evidence of positive impact
should encourage the stakeholders of the Expanded Programme on Immunisation to
focus on the sustainability and scale-up of this intervention to other counties in
""South Sudan, as logistically as possible.⁴

Challenges Faced By the Sudanese EPI During the War

The budget constraints: War results in low federal spending plans for healthcare .1

management use, and the medical system is at risk of disintegration due to the

massive number of isolated individuals. The turnover of vaccines and the lack of

,stock support are essential elements of the EPI affected by the allocated budget

and now the deserved salaries of vaccinators are a significant challenge that

could lead to the collapse of all the efforts mentioned above. If EPI partners do

not intervene temporarily, a disaster will occur that will affect all children in Sudan
.(who are the victims)

The Cold Chain disruptions: The Central Cold Chain in Khartoum was unable to .2

meet the requirements due to the demands of electricity and power, which were

affected by the war. The EPI team and its partner (UNICEF) made great efforts

to maintain Central Cold Chain functioning; however, the obstacles were lack
ofsecurity and complex transportation to reach it. Most vaccines were transported

to safe places. The sub-national cold chains in the western, central, and southern

.Darfur States have also been closed and are not ideal for the storage of vaccines

Likewise, the lack of vehicles with refrigerators, the lack of the transport fleet, and

the unfortunate quality of the streets influence sufficient circulation

The health facilities interruptions: Most essential medical services need clinical .3

.equipment and infrastructure

Human resources: Due to security weaknesses and funding problems, the number .4

of medical workers in the district is rapidly declining. The lack of skilled and
prepared well-being workers to handle vaccines for the population, regardless

of adequate vaccine storage areas and transport limitations, will hinder progress

Overcrowding and hygiene challenges: These factors exacerbate the burden of .5

infectious diseases such as tuberculosis (TB), cholera, dengue fever, and hepatitis

.[

Communication deficiencies: Inadequate communication channels impede .6

effective partnership promotion and hinder observation and assessment processes

Proposed Solutions

Establishment of identification systems: Establishing a group system is essential .1

to recognize many displaced individuals, who generally have no official records

due to the war and could, therefore, be lost despite the contrary effort during

vaccination. Identification systems can be achieved by bringing in defaulters and

.motivating new people with the help of educated and displaced community leaders

Risk Communication and Community Engagement (RCCE): RCCE is an essential .2

method of building a solid healthcare system, ensuring value for all, and addressing

the needs of the population, especially underserved groups such as displaced

people, refugees, and rural communities. Some of the critical components of

the plan are the ability to engage local communities through the media, nonlegislative
associations, schools, and local legislators in safe states to promote

successful coordinated efforts and use techniques to support conventions on

disease prevention3. Financial support: Adequate government and donors funding

for the immunization

program should cover cold chain maintenance and vaccinator salaries. While
fullscale reconstruction of obliterated medical facilities remains improbable amid

ongoing conflict, establishing a partial yet robust cold chain system prioritizing

.vaccination seems a feasible interim solution

Human resource development: It is vital to recruit (through various media) and .4

prepare (through workshops and advice) volunteers and healthcare workers across

Sudan with sustainable retention and compensation systems. Human resources

.are the cornerstone of EPI’s progress

Engagement of NGOs and local governments: Encouraging the involvement of .5

global non-governmental organizations (NGOs) operating in Sudan and local

 governments in secure regions can ensure sustained support and service
""maintenance.⁵

Change of immunization delivery strategy. The primary strategy for vaccine delivery
was changed from

one involving mobile teams, which visited villages to

immunize children at or near each home, to a fixed

site strategy with limited outreach services. The fixed

site strategy provides immunization services from

health posts that are within walking distance ('-2

hours) of the community. The limited outreach services involved local immunizers
carrying vaccine on

foot, animal or bicycle to immunize in nearby villages (>2 hours walking distance).

""6

eliminating or significantly decreasing the occurrence of many once-common

diseases. Barriers to immunization are a significant factor in the rising incidence
rates of some vaccine-preventable diseases. Cost, reduced accessibility to
immunizations, increasingly complex childhood and adolescent/adult immunization
schedules, and increasing focus on the potential adverse effects of vaccines all
contribute to difficulty in meeting the 2010 immunization goals. Physicians must not
only be knowledgeable about vaccines but they must incorporate systems in their
offices to record, remind, and recall patients for vaccinations. They must also clearly
communicate vaccine benefits and risks while understanding those factors that
affect an individuals acceptance and perception of those benefits and risks7""

The creation of the adolescent vaccine platform presents both opportunities and
challenges. Many of the barriers to vaccinating adolescents are similar to those of
vaccinating younger children. However, adolescents have additional issues, such as
their rapidly changing emotional and cognitive development, which can shape their
immunization receptivity 8""""

The aims of this project were to minimize organizational barriers and increase
access to immunizations for children aged 6 months to 21 years in a multiethnic
community health center in Honolulu. The intervention consisted of opening a “walk-
in” shot clinic (WISC), run by a nurse practitioner, 2 evenings per week and Saturdays.
Between January and July 2005, 351 clients accessed the clinic, with 774
immunizations administered. Clinic satisfaction measures were excellent. Up-to-date
immunization status for all clients improved significantly. The WISC is an effective
and customer-friendly way to improve childhood and adolescent immunization rates
in a community health center setting. 9""

Despite enormous difficulties, the Sudan Expanded Programme on Immunization

(EPI) has achieved considerable success, doubling coverage of the target population
every year for four years in succession. In 1986, in an effort to improve reporting
efficiency, EPI began to experiment with using microcomputers to collate and
process immunization performance data. The resulting system, called 'EPI-Track'
provided a simple and robust tool for analysing and depicting programme
performance on a monthly basis at district, regional and national level. As it uses a
relational database, it can form the core of a much larger and more complex EPI
management information system.

EPI-Track contributed to the development of the World Health Organization's global

EPI reporting system, with which it now has total compatibility and seamless data
transfer. This provides the potential to collate, analyse and graphically depict
immunization data from district to global leve""l10"""

[Link] ² ¹

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