From 30 October to 10 November 2017, WHO and the National Department of Health of South Africa organised a comprehensive immunisation and in-depth vaccine-preventable disease (VPD) surveillance review, data quality verification and effective vaccine management assessment (EVMA). External partner organisations supporting the review included: UNICEF, CDC, and NESI/University of Antwerp. Local partners participating in the review included: SAVIC/SMU, National Institute of Communicable Diseases and Sanofi Pasteur.
WHO recommends that periodic EPI programme reviews are conducted in member countries every 3 to 5 years to assess the strengths and weaknesses of the immunisation system and VPD surveillance system at all levels, with the aim to provide evidence for the strategic directions and priority activities for the immunisation programme.
The last nationwide in-depth surveillance review in South Africa was conducted in 2009. The country has not yet conducted a nationwide EVMA or EPI data quality review. There are verbal reports of a comprehensive EPI review done more than 20 years ago; however, there are no official reports available. A number of assessments of the EPI programme and surveillance system have been conducted at district level.
The specific objectives of the review, which took place in all 9 provinces of South Africa, included:
- To conduct a comprehensive assessment of the organisation and implementation of the EPI programme in South Africa;
- To assess the organisation and the implementation of VPD surveillance (with focus on acute flaccid paralysis, measles and neonatal tetanus) at all levels in South Africa;
- To conduct an effective vaccine management assessment focusing on the core indicators;
- To conduct an immunisation data quality review through verification of routine immunisation data reporting;
- To assess the knowledge, perceptions and contribution of communities and community healthcare workers on the immunisation and vaccine-preventable disease surveillance systems in South Africa.
The review period included a desk review, training, field work including data collection and data entry, report writing and debriefing to SA-NDoH. Ten teams (1 national and 9 provincial teams) collected data through key informant interviews, document reviews and observation of immunisation practices. In addition the roles of private health facilities and community health workers in immunisation service delivery were assessed.
South Africa has a fully government funded immunisation programme which currently provides 11 antigens in various combinations. The programme is supported by a national laboratory that serves as a national and regional reference laboratory. The review team found a high level of commitment by healthcare workers at all levels. Policies and guidelines are aligned with the regional and global goals and policies. However, performance gaps in programme components indicate discrepancies between policy and implementation. Detailed recommendations have been drafted.
NESI staff actively participated in the entire review process, and was Field Team Lead for Free State Province.