Table 4 Summary of Key activities and actions resulting from the gap analysis on immunisation services in Ghana through the BNA approach

Capacity Building

• Conduct EPI Training Needs Assessment in all the districts

• Train regional , district and sub-district teams and health Staff (specific numbers and duration of training were provided by regions/districts) on the following:

❖ Microplanning and mapping of existing static and outreach points

❖ management and strategies to increase immunisation practice and coverages

❖ logistics and cold chain management

❖ Data management and reporting into national data system

❖ EPI Coverage Survey

❖ Identification and management of adverse events following immunisation (AEFI’s)

❖ interpersonal communication and customer care

• Strengthen service delivery within the second year of life to increase second dose of measles immunization at 18 months

• Prioritize EPI activities and incorporate in the Integrated Regional Budget

• Orient newly posted lower level and community health delivery staff (e.g. Community Health Officers) on EPI protocols

• Build capacity of regional and district teams on proposal writing and grant applications to improve fund raising activities

Procurement and logistics

• Procure vehicles, motorbikes and boats and distribute according to need

• Create centralized maintenance system for vehicles at regional and district levels

• Conduct cold chain inventory

• Procure and supply vaccine refrigerators, cold boxes, vaccine carriers & stabilizers to regions and district based on need

• Provide adequate supplies of EPI tally books, vaccine ledgers, updated policies and field guide for use at services delivery points and facilities

• Maintain quarterly distribution of vaccines and logistics from national to regional levels and monthly distribution of vaccines and logistics to districts to avert shortages

• Maintain quarterly planned preventive maintenance of cold chain equipment throughout the year at the regional level

Community Mobilization and Engagement with partners and stakeholders

• Continuous education of women on the importance of card retention for Tetanol-diphtheria (Td2+) data monitoring

• Improve communication at the community level through local radio/FM using messages and jingles in local languages

• intensify health education at all service delivery points

• conduct regular quarterly meetings with political and community leaders at district and sub-district levels

• Hold regional stakeholders meetings to mobilize support

• Regular community durbars, community advocacy meetings and radio discussions on EPI services

• Conduct community surveys at the district to assess levels of satisfaction

• Reactivate mother support groups in the communities

Monitoring and coordination

• Develop a composite monitoring and supervision plan at all levels

• Conduct half yearly monitoring and supervisory visit from national to the 10 regions

• Conduct quarterly monitoring and supervisory visit from region to districts

• Conduct bi-monthly monitoring and supervisory visit from districts to sub-districts

• Conduct annual EPI cluster survey

• Review staff postings in all districts to ensure equity in health staff distribution by regional level

• Conduct quarterly data validation meetings for district and sub-districts in the regions

• Monitor and evaluate monthly outreach services for each district (planned versus conducted) by regional level

• Develop areas for peer review and encourage peer review among districts by regional level

• Submit plans for increasing vaccination sites by districts to region annually

• Conduct quarterly EPI data quality and self-assessment at the district level

• Organize half yearly coaching and mentoring visits to regions by national level