From 9-26 May 2016, WHO/AFRO and the Ministry of Health & Social Services of Namibia (MoHSS) organised a comprehensive review of the Namibian National Immunisation Programme, integrating assessments of vaccine-preventable disease surveillance, data quality, and post-introduction evaluation of four vaccines. This was one of the first integrated reviews to be held in the African region, following a similar review in Tanzania. The broad objectives of the review included: 1) to assess progress since the last comprehensive EPI (2010) and surveillance (2013) reviews, 2) to assess the quality of programme data, and 3) to evaluate the introduction of four new vaccines: PCV, rotavirus vaccine and hepatitis B birth dose which were introduced during 2014; and inactivated polio vaccine (IPV) which was introduced in November 2015.
The review period included a desk review, training, field work, data entry, report writing and debriefing to the MoHSS. During the desk review, purposive sampling was used to select eight regions for field work based on programme performance over the previous three years. This resulted in four regions with strong performance in routine immunisation coverage and surveillance, as well as four regions with weak immunisation coverage and surveillance performance. Using the same criteria, two districts in each of the eight regions were then selected to evaluate strong- and weak-performing districts. This criteria was again applied to select 2-3 health facilities in each district, resulting in a total of 8 regions, 13 districts (some regions contained a single district) and 36 health facilities visited as part of the review.
The review highlighted a number of strengths and challenges for the national immunisation and surveillance programmes. The government is committed to sustainable immunisation financing, currently procuring 100% of all vaccines as well as funding operational costs at all levels. Evaluation teams found that immunisation sessions were offered daily and free of charge at all government-owned facilities by qualified nurses. Since 2014, four new vaccines have been introduced. Namibia also successfully completed the switch from trivalent to bivalent oral polio vaccine in April 2016. Challenges were observed in the area of staffing, supportive supervision and data capturing. Detailed recommendations have been drafted.
Partners participating in the review included NESI, WHO/HQ, WHO Namibia, WHO Rwanda, UNICEF, US Centers for Disease Control and Prevention (CDC), Sabin Vaccine Institute, and PATH. NESI staff actively participated in the entire review process, and served as Field Team Lead for the Oshana region, as well as Topic lead for Service Delivery.