BOOKS & ELECTRONIC MEDIA
Immunization essentials: a practical field guide
Mercy Ahun
GAVI Secretariat, c/o UNICEF, United Nations, Geneva, Switzerland (email: mahun@unicef.org)
Publisher: USAID, Washington, DC, USA; 2003
ISBN: 0-97 42291-2-X; 271 pages; not for sale
Free PDF version available from: http://www.dec.org/pdf_docs/PNACU960.pdf
Free print copies can be ordered from USAID
This book, the revised version of EPI essentials, which was published in 1988 and has long been out of print, is a welcome reference tool for national and subnational immunization managers in developing countries. It provides practical information for improving the delivery of immunization services. The book is available free, either by downloading a PDF file or in print format, the latter being compact enough to fit into the bags of immunization officers in the field. The language is clear and simple for readers whose first language is not English. Colourful pictures, small boxes, tables and diagrams are used effectively to supplement and explain the text. References at the end of every section provide the reader with sources for more in-depth information. The large number of technical reviewers of the text is impressive and a wide breath of immunization expertise is represented.
Sections are included on current relevant immunization issues: The Global Alliance for Vaccines and Immunization and its support for strengthening immunization services; introduction of new vaccines and technologies; costs and financing of immunization services; and the work of national Inter-agency Coordination Committees.
The roles of different levels of the health system in immunization service delivery and the impact of reforms of the health sector are well described. Key contributors to immunization programme management are also covered; the public and private sectors, (nongovernmental organizations and for-profit providers). However, the overview of immunization essentials, which appears at the end of the first chapter, would have been better placed at the beginning of this chapter for easier reference. Inclusion of a brief description of how to use programme information for drafting annual plans of action and multi-year plans would also have improved the book.
The key areas of immunization service delivery, vaccine supply and quality, cold chain and logistics, injection safety, information management, disease surveillance and communication for the expanded programme on immunization (EPI) are well covered and in enough detail for managers. Vaccine-preventable diseases appear as the final chapter, which makes this information easily accessible for readers. A brief description of service delivery strategies is included. In the chapter on delivery of immunization services, practical tips are offered on how to increase the use of routine services, including reaching the unreached although the poor (who have been identified as a major unreached subgroup) are not mentioned.
Analysis and use of routine data is one of the challenges faced by developing countries. Immunization essentials describes a variety of approaches for using such data at various levels of the health system, including the facility level. Detailed information is provided on how to manage records and monitor and evaluate programmes; and practical tips are given on how to manage challenges such as drop-outs and inconsistent data. The chapters on vaccine supply and cold chain outline how to order supplies and manage stocks. Practical suggestions are offered on how to reduce vaccine wastage, a relevant area that needs to be addressed with the introduction of newer, more expensive vaccines.
Although disease surveillance and immunization service delivery are often located in different departments in ministries of health, the inclusion of disease surveillance in this manual is a useful reminder to managers about the link between service provision and its impact on disease prevalence. The descriptions of the different types of surveillance and of laboratory services as well as how to handle outbreaks at the local level offer useful insights on preventing disease outbreaks.
The print version of the manual has a wire binding, which makes it easier to fold the book in the field without destroying it. Health workers on long, supervisory field trips will find it a compulsory companion. The fact that this book is free ensures that cost is not a barrier to its availability in developing countries. Overall, the book is well written and I would recommend its use to national, provincial, and district directors of health services as well as other public health officers in the field who are involved in immunization activities. It is a welcome addition to the immunization literature available to developing countries. 