Overview

The Uganda Immunization Training Program (UITP) is a project to train mid-level immunization program personnel in Uganda using materials adapted from those developed by the WHO Regional Office for Africa. The program represents a partnership between the Task Force for Child Survival and Development (TFCSD), Emory University School of Medicine, Makerere University School of Public Health (MUSPH), the Uganda Ministry of Health (MOH), Uganda National Expanded Program on Immunization (UNEPI) and the African Field Epidemiology Network (AFENET). The program proposes to train 30 national level program personnel in Year 1 and 600 mid-level personnel from district and sub-district levels in Years 2- 4.  UITP will also adopt and disseminate the WHO/AFRO prototype curricula medical/nursing/midwifery schools. UITP is funded by the Merck Foundation - the philanthropic arm of Merck pharmaceuticals.

Background

A Training Needs Assessment (TNA) conducted by the WHO Regional Office for Africa (WHO/AFRO) in 12 African countries including Uganda in 2004 showed that EPI training is insufficient, infrequent and is often conducted on an ad hoc basis. This TNA also revealed that that there is no harmony between pre and in-service training; curricula were either incomplete or outdated; reference materials and demonstration equipment were inadequate; insufficient time was allocated to pre-service EPI training; lecturers and tutors had insufficient knowledge on EPI; and, support supervision and follow up was lacking.

In 2004, the Uganda Ministry of Health commissioned another TNA. Similar issues related to EPI training were identified: inadequate pre-service training of health workers as a result of insufficient content in the existing curricula, lack of training materials and equipment, and inadequate time allocated for practical sessions. This TNA also found that although health workers were competent in some EPI priority areas like use of new vaccines (Hepatitis B/H influenzae), polio eradication, vitamin A supplementation and measles elimination, the EPI program was weak in supportive areas like management, capacity building and financing at the district level. Some of the weak areas identified were: vaccine forecasting, stock management, immunization safety, management and maintenance of cold chain equipment, surveillance, data management, advocacy and social mobilization, and monitoring and evaluation (MoH, 2004).

Following the 2 TNAs, UNEPI, with support from GAVI, UNICEF, USAID, and WHO, adopted the prototype curriculum, but tutors and lecturers at training institutions have yet to be oriented. UNEPI adopted and adapted the WHO EPI modules for in-service training, and developed some training materials. Only the materials for operational level staff (immunization in practice) were adopted, and partial training conducted. Training materials for the Mid- level Managers (MLM) module are currently undergoing adaptation; this process is expected to be concluded by the end of 2007. This process has been delayed by human and financial resource constraints at the centre (UNEPI), as well as pressing activities like the just concluded mass measles campaign. Only nine Ugandans largely from UNEPI and the national level have been trained by WHO/AFRO on the MLM module.

In light of the training needs identified through the TNA, and discussions with key EPI stakeholders in Uganda, there is need to establish a comprehensive training program that is responsive to these EPI service delivery needs.  With funding from the Merck Foundation, the Uganda Immunization Training Program (UITP) was initiated in December 2007.

Description of Proposed Training Program

The TFCSD-Emory-MUIPH-MOH-AFENET Immunization training program is hosted by Makerere University Institute of Public Health (MUIPH) and AFENET. It will provide sustainable training in vaccine management and immunization services for national and sub-national (district) level EPI managers in Uganda through pre and in-service training. The program works closely with the Ministry of Health, Uganda National Expanded Programme on Immunization (UNEPI), WHO country office and other development partners involved in immunization to achieve its objectives.

During the 1st year of the program, a training of trainers at the national level, will be conducted including UNEPI/MOH staff, MUSPH faculty members, pediatricians, and officials from UNICEF,WHO and other multilateral agencies. The trainers from the national level will conduct training of national and district staff at designated training facilities selected from MUIPH field training sites. This training will use materials adopted from WHO/AFRO mid-level management modules (MLM). Following the national level staff training, mid-level managers from the district level will be trained. These include: District Medical Officers (DMO), EPI focal persons, District Health Visitors (DHV), cold chain assistants, HSD in- charges and HSD EPI focal persons from all districts in Uganda.