Reaching Every District (RED) approach: a way to improve immunization performance.

Letters Reaching Every District (RED) approach: a way to improve immunization performance In their paper, Victora et al. 1 show that " child survival interventions are inequitably distributed within low-and middle-income countries ". Areas of greatest need were not prioritized, and expansion of these health programmes in more difficult areas has tended to be delayed or postponed. In response, we wish to share some results and propose a way forward based upon experiences with immunization programmes. Immunization programmes around the world have recognized and strived to reduce inequity for many years. While Universal Child Immunization (UCI) of 80% coverage was achieved in 1990, this merely emphasized the need to balance the inequalities within and between countries. Accordingly, several approaches were adopted. The " high risk approach " was designed in the mid-1990s to reach women in underserved areas with tetanus toxoid immunization using a campaign-style approach. 2 District level microplanning has been the cornerstone of the polio eradica-tion and measles elimination initiatives, to maximize the delivery of vaccines to all districts, especially underserved populations. District-level coverage and disease surveillance data are now routinely collected in most countries, with reporting of selected indicators to the global level since 2000. In 2002, the Reaching Every District (RED) approach was developed and introduced by WHO, the United Nations Children's Fund (UNICEF) and other partners in the GAVI Alliance to improve immunization systems in areas with low coverage. Far from being a programme, or separate initiative, the approach outlines five operational components that are specifically aimed at improving coverage in every district: re-establishment of regular outreach • services; supportive supervision: on-site • training; community links with service • delivery; monitoring and use of data for • action; better planning and management • of human and financial resources. 3 The RED approach encourages countries to use coverage data to make an analysis of the distribution of unim-munized infants, and thereby prioritize districts with poor access and utilization of immunization, while districts are encouraged to make microplans to identify local problems and adopt cor-rective solutions. Since 2003, 53 developing countries have started implementing RED to various degrees, mostly in Africa and south and southeast Asia. 4 All 53 countries belong to the groups of lower income and lower-middle income countries, as per World Bank classification. In 2005, an evaluation of 5 countries in Africa that had implemented RED found that, in 4 of the 5 countries, …