UI-FHS creates and publishes a range of documents about its work. Most resources are available for online viewing and download. Use the free Adobe Acrobat Reader program to view the PDF files on your computer.
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Peer-Reviewed Journal Articles
Linked vaccination coverage surveys plus serosurveys among Ethiopian toddlers undertaken three years apart to compare coverage and serologic evidence of protection in districts implementing the RED-QI approach
James D. Campbell, Marcela F. Pasetti, Lisa Oot, Zenaw Adam, Mesfin Tefera, Berhane Beyane, Nigisti Mulholland, Robert Steinglass, Rebecca Krey, Wilbur H Chen, William C Blackwelder, Myron M. Levine. Vaccine 39 (2021) 5802–5813, September 2021
Mark A. Travassos, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot, Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Yukun Wu, Inna Ruslanova, Jaya Goswami, Samba O. Sow, Marcela F. Pasetti, Robert Steinglass, Amha Kebede, Myron M. Levine. PLOS ONE, 11(3), March 2016
Mark A. Travassos, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot, Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Marcela F. Pasetti, Samba O. Sow, Robert Steinglass, Amha Kebede and Myron M. Levine. American Journal of Tropical Medicine and Hygiene, 2015 93:416-424, June 2015
Publications & Presentations
Through a series of four briefs, UI-FHS outlines key strategies for bridging the equity gap for immunization in Ethiopia.
This brief presents lessons learned from introducing a data review process and an Excel tool for triangulating immunization program data and vaccine supply data to improve data quality and programmatic decision making. (2021)
This brief summarizes the findings from an assessment of the effects of the TA on immunization program management and service delivery. (2021)
This infographic details how UI-FHS modified the RED QI approach to improving the health system’s capacity to plan, reach, and deliver immunization services to children in rural, remote, and pastoralist regions of Ethiopia. (2021)
In this brief, learn how the RED-QI approach helped support managers and healthcare workers (HCWs) at the regional, woreda (district), and facility-level to plan, implement, and monitor tailored health services to reach all children with routine immunization regardless of where they live. (2021)
This equity analysis centers on reviewing data from the Ethiopian District Health Information System 2 (DHIS2), the 2016 Demographic Health Survey (DHS), the 2019 mini-DHS, regional microplan data, and other project data sources. (2021)
This report describes the findings from an applied learning activity that aimed to identify promising capacity building initiatives conducted in the Ethiopian health sector. This activity, carried out through JSI’s UI-FHS Project, was used to inform recommendations for new ways of thinking and working to build the capacity of health workers at scale. These evidence-based recommendations address gaps in immunization training and overall health sector capacity building and promote better support to health workers, an essential key to making complex health systems function. (2020)
Sustaining Immunization Gains for All Communities in Ethiopia
The RED-QI approach, implemented in Ethiopia by JSI Research & Training Institute, Inc. (JSI) beginning in 2011, worked to improve the performance of the immunization system in 103 woredas (districts)—about two-thirds of which have limited infrastructure and remote communities, including nomadic populations. JSI’s bottom-up approach—working at the facility and woreda level to integrate quality improvement into the existing national immunization strategy—Reaching Every District (RED)—resulted in immunization system improvements. This report describes the methodology and findings of an inquiry on the elements of RED-QI that were sustained beyond direct technical support, and the factors that contributed to the continuation (or non-continuation) of these activities. (2020) Download the summary report; download the full report
Combined Immunization Coverage and Serology Surveys in three woredas in Ethiopia
To understand the paradox of high reported immunization coverage and frequent disease outbreaks, UI-FHS conducted combined immunization coverage and serology surveys in three program woredas at baseline in 2013, and after RED-QI program implementation in 2016. UI-FHS conducted the combined surveys to examine how estimates compared from various data sources, exploring what percentage of supposedly vaccinated children demonstrated protective levels of antibodies against tetanus and measles. (2019) Download the brief; Download the synthesis report; Download the full report
This poster presentation identified key findings that facilitate uptake and scaling of innovative QI approaches into a larger, complex health ecosystem. It was presented at the CORE Group Global Health Practitioner Conference in Maryland, USA. (2019)
Mobilizing Local Support for Immunization: Experience from Uganda and Ethiopia in engaging local stakeholders and leaders
This brief outlines JSI’s experience in Uganda and Ethiopia to strengthen subnational level teamwork between the health personnel typically responsible for immunization and the non-health stakeholders who are in a position to support it. (2019)
Building the Capacity of Subnational Health Managers as a Critical Component of Decentralized Health Systems: Emerging Findings from Ethiopia
This presentation covered how the adapted “Standard Competencies Framework for the Immunization Workforce” (WHO 2018) was used in Ethiopia to identify skill gaps of Regional Health Bureau (RHB) staff and develop targeted plans of technical assistance to address them. It was presented at the 6th Global Symposium on Health Systems Research (HSR2020). (2018)
On the Move: The Challenges of Providing Routine Immunization Services to Nomadic Populations in Ethiopia
This poster presentation summarized findings on how microplanning improved immunization services for nomadic populations and overall immunization performance in study regions. It was presented at the Fifth Global Symposium on Health Systems Research in Liverpool, England. (2018)
Mid-Program Review in Afar and Somali Regions
A Mid-Program Review was conducted in 2017 to improve the operationalization of RED-QI in pastoralist contexts, examine contextual factors that influence implementation, and assess factors that might hinder or facilitate sustainability. (2018) Download the brief; Download the full report
This oral presentation summarized findings from qualitative research on the experience of quality improvement teams using PDSA cycles. It was presented at the IHI 1st Africa Forum on Quality and Safety in Healthcare in Durban, South Africa. (2018)
This brief focuses on key findings from operational research conducted on Plan-Do-Study-Act (PDSA) cycles, highlighting how the RED-QI approach encouraged greater facility-community linkages through engagement in PDSA cycles. (2018)
This policy brief summarizes the key findings from a costing study that aimed to better understand the resources that will be required by the Expanded Program on Immunization to reach all populations with equity and quality. (2017)
Tools & Guidelines
Primary Health Care Unit Reaching Every District (PHCU RED) Guidelines
In collaboration with the Ethiopian Ministry of Health and EPI partners, JSI is excited to announce two news guidelines for implementation of the Reaching Every District (RED) strategy in Ethiopia. In 2018, Ethiopia introduced an adapted version of the RED approach with guidance specific to implementation in Ethiopia. As a complement to the Ethiopian RED Guide, these guidelines provide staff in the primary health care unit (PHCU), which includes both health centers (HC) and health posts (HP), with the essential information to carry out their RED implementation tasks. As the focus of the RED approach is on strengthening district level service delivery, these guides are intended to provide step-by-step guidance for health managers at the HC level, and health workers at the HP level, to implement the five main operational components of RED: 1) planning and management of resources, 2) reaching all eligible populations, 3) engaging communities, 4) supportive supervision, and 5) monitoring and use of data for action. Through implementation of these sub-district guidelines, the Ethiopian Ministry of Health hopes to build a stronger routine immunization system and improve the quality and reach of immunization services across the country. Download the PHCU RED Guide here (includes both Health Center & Health Post Guides). Download the Health Post Guide here.
To accompany the PHCU Guidelines, we have developed an orientation video (in Amharic) to support introduction and distribution of the guide. Watch the short orientation video:
Immunization Job Aids
To reinforce good health worker practices and help overcome challenges like high staff turnover, UI-FHS developed a series of job aids to help health workers manage some key functions of the routine immunization system. These job aids address five common challenges with providing immunization services at the health facility level in Ethiopia, and they underwent two rounds of pre-testing to ensure they were practical, user-friendly, and context-appropriate. Download:
Vaccine management – poster in English (front-opening refrigerator); poster in English (top-opening refrigerator); poster in Amharic (front-opening refrigerator); poster in Amharic (top-opening refrigerator)
The Immunization Data Triangulation Tool (IDTT) is an Excel tool that triangulates immunization program and supply chain data for improved decision-making and action.
This guidance document is intended to help woreda and Primary Health Care Unit (PHCU) officers review their immunization performance and provides instructions on how to monitor and update their EPI microplan regularly.
This quick guide is used to provide basic information about vaccine-preventable diseases and their vaccines so that Expanded Programme on Immunization (EPI) program managers may apply this knowledge of key epidemiologic and clinical features of each vaccine-preventable disease to make decisions for their EPI program.
This guide is intended for health workers, EPI focal points at the Woreda Health Office (WoHO) and Primary Health Care Unit (PHCU) levels. It provides step-by-step instructions on how to implement various quality improvement (QI) tools and methods and serves as a practical tool for supervisors to use on supportive supervision visits to the health facility level.
This step-by-step guide was created to help woreda staff plan, implement and monitor mobile services for routine immunization.
The RED-QI How-to Guide for Immunization Program Managers conveys the essential knowledge and tools needed to apply the Reaching Every District using Quality Improvement (RED-QI) approach. It is a practical resource intended for program managers at woreda health offices and primary health care units.
This Excel database allows woreda health office staff to analyze their coverage and drop-out rates to place their facility into one of four access- and utilization-related categories. Staff use the data to target routine immunization efforts and support.
This Excel template for the microplanning process can be used to plan for immunization service delivery. The microplan helps identify both gaps and resources, set targets, and guide health staff in developing appropriate strategies to reach immunization goals.
Process Based Supportive Supervision Checklists
These are checklists for immunization supportive supervision at woreda, health center, and health post levels. Woreda health offices and primary health care units can utilize these checklist as an opportunity to provide on-job training and mentoring to health facility staff. Download woreda level; Download health center level; Download health post level
The plan-do-study-act cycle is a useful quality improvement tool that helps health workers identify problems, brainstorm and test solutions, and analyze the results. This template is designed to help health extension workers solve routine immunization problems. Download the PDSA template
Blog Posts & Online Media
Data use for supply chain management: From zero to hero (by Adriana Almiñana, Amare Bayeh, Angela Montesanti Porter, Heather Scobie, Harrison Mariki, and Daniel Kinyanjui; TechNet Conference session; 2020)
Everyone Together: Leveraging Resources from the Bottom Up (by Adriana Almiñana, Tewodros Alemayehu, and Berhanu Bekele; webinar on Boost online platform; 2020)
Data Triangulation: A New Tool for the Data Revolution in Ethiopia (by Wendy Prosser and Amare Bayeh, on JSI’s “Viewpoints” blog; 2020)
Improvement through Continuous Learning: Key Takeaways from the 1st Africa Forum on Quality and Safety in Healthcare (by Adriana Almiñana and Milly Namaalwa, on JSI’s “Viewpoints” blog; 2018)
Inspiring Data Use, Action, and Innovation across the Southern Nations, Nationalities, and People’s Region in Ethiopia (by Adriana Almiñana and Diane Masket, on JSI’s “Viewpoints” blog; 2018)
Working toward Universal Immunization: John Snow, Inc (JSI) (by Molly Abbruzzese, on Bill & Melinda Gates Foundation’s “Impatient Optimists” blog; 2016)
How on Earth Can a Remote Ethiopian Health Post Function without Electricity? (by Dr. Orin Levine, on Huffington Post’s “Impact” blog; 2016)
JSI’s UI-FHS Project Joins Ethiopian Government Efforts to Shine Spotlight on Critical Region for World Immunization Week (by Adriana Almiñana, on JSI’s “Viewpoints” blog; 2015)
Learning Grant Reports
This case study examines how health extension workers at a health post in SNNP Region collect, monitor, analyze, and use their data to make informed decisions to improve routine immunization services in their community. (2015)
This case study highlights the contributions that health extension workers make to routine immunization services in Hintalo Wajerate Woreda of Tigray Region. (2014)
This case study conducted in Hintalo Wajerate Woreda of Tigray Region highlights the implementation of peer learning methods and the impact of the peer learning process on woreda health staff and communities. (2013)
This desk review, explored the health landscape in Ethiopia and aided in preparation of the strategy for implementation of the project. It summarizes the Expanded Program on Immunization (EPI) and maternal, neonatal, and child health (MNCH) strategies implemented over the past decade in Ethiopia, and it examines EPI performance and progress. (2012)
Rapid Assessment Report
The rapid assessment report highlights key programmatic and community/cultural issues and existing assets and promising practices in each of UI-FHS’s three learning woredas. This information was used to design woreda-specific quality improvement approaches to strengthen and sustain high levels of routine immunization performance. (2012) Download the brief; Download the full report