Background

An Integrated Campaign of Mono Oral Polio Vaccine Type 2 (mOPV2) and Vitamin A Supplementation

An integrated campaign that addressed an outbreak of vaccine-derived poliovirus type 2 and improved vitamin A supplementation delivery during COVID-19

Background

Photo credit: UNICEF Ghana

An outbreak of VDPV2 in 11 of 16 regions of Ghana in 2019 resulted in 30 cases of acute flaccid paralysis (AFP) and spurred an urgent mass polio vaccination response. However, vaccination was suspended with the onset of the COVID-19 pandemic in March 2020. The pandemic also resulted in a reduction of uptake of other essential health and nutrition interventions. A review of public health data revealed that vitamin A coverage for children aged 6-59 months decreased significantly during this time to 28% during January-June 2020, from 48.9% in 2018 and 30.5% in 2019.

Stakeholders discussed the need for a collaborative campaign integrating mono-oral polio vaccine type 2 (mOPV2) and vitamin A supplementation in order to save resources and increase coverage of both interventions. The decision was made by the national government to jointly target approximately 4.5 million children aged 6-59 months with vitamin A supplementation by adding this intervention to the second round of Phase 3 of the mOPV campaign in eight regions. 

This study, conducted by Ghana Health Services and UNICEF Ghana, documents lessons learned from the planning to implementation phases of the campaign.

Context

Challenges

Motivation for integrated campaign planning was driven by the urgency of halting the outbreak of polio, coupled with the need to increase uptake of lifesaving health and nutrition services during the pandemic. These campaigns have synergies that make integration feasible. Logistically, the same cadre of health workers deliver both interventions to the same target beneficiaries at similar locations. From a planning standpoint, mechanisms for intersectoral collaboration exist through the Expanded Program on Immunization (EPI) Leadership and Coordination Working Group and subcommittees.

Challenges to integration included:

  • Late decision to integrate–made before the second round of Phase 3 of the mOPV campaign, leading to logistics challenges and limited time to integrate monitoring and evaluation (M&E) tools
  • Coordination difficulty due to inability to meet face-to-face during pandemic
  • Low awareness of integrated services amongst communities
  • Some confusion in communities as both interventions targeted slightly different age groups (0-59 months and 6-59 months for mOPV2 and vitamin A supplementation, respectively)

Opportunities

Factors that facilitated collaboration included:

  • Formation of working groups and subcommittees to manage logistics, social mobilization, data, and coordination
  • Leveraging scarce financial and transportation resources
  • Integration of messaging for social mobilization
  • Conducting joint training sessions for volunteers and health workers
  • Harmonization of field tools

Research Objectives

The goal of the integrated campaign was to interrupt a cVDPV2 outbreak and increase coverage of Vitamin A for children 6-59 months.

The objectives of this case study were to:

  1. Document the lessons learned from the planning to implementation stages
  2. Evaluate the effectiveness of campaign messages and strategies for social mobilization
  3. Determine the coverage of mOPV2 and vitamin A supplementation
  4. Identify the missed opportunities for immunizing the target population.  
  5. Make recommendations to improve coverage for subsequent integrated campaigns

Vitamin A supplementation was added at a late stage to the mOPV2 campaign in an attempt to adapt to the context of COVID-19 and increase coverage of both interventions.