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Application of the Canalisation Strategy in the Expanded Immunisation Programme

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The strategy of "canalisation" (or channelling) was designed by staff of the Ministry of Health of Colombia and the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO). It was based on fieldwork in the Huila area in 1981. Since then it has been widely applied for the improvement of outcomes of regular vaccination programmes developed by the Expanded Programme on Immunisation (EPI) in Colombia.

The canalisation/channelling is based on the establishment of bonds between members of the community and health institutions by means of support and collaboration with community leaders. The objective is to channel the intended population towards health institutions or the personnel in charge of vaccination. The aim of its application is to develop vaccination programmes with the active participation of health personnel and the communities being vaccinated.
Communication Strategies
The "canalisation" or channelling process is based on knowledge of community needs and interpersonal communication between the community and health institutions with the support of community leaders and education about the importance of vaccination.

The process aims to establish good relations with the community. The purpose is to better understand the community, gain the confidence of its members, and identify leaders who will support fieldwork. The community leader must be a well-known person, who knows the community, and counts on its member's approval.

The development of this strategy includes the following phases:
  • Identification of the intended population and promotion of vaccination:

    In order to have complete and up to date information on the characteristics of the zone and the state of vaccination of the community, each one of the houses of the community is visited and the information obtained is added to the census forms. The visits are also used to give information and promote the upcoming vaccination session. This task is carried out by both a community leader and a health agent (health promoter, nurse, health assistant, vaccinator, medical doctor, etc.).

    With the purpose of knowing the needs and characteristics of the population, a sketch or map is produced. On this map each one of the houses that exist in the area, the ways or streets around where most of the members of the population circulate, the main institutions, and the main health organisations (centres, posts or hospital) are identified.

    In order to create this map the whole area is covered and the houses and other main locations are recorded in detail. On this map the work areas are delineated, each one of which corresponds to a group of neighbouring houses that the health official and the leader can visit daily.

    When arriving at each house, the health official is introduced to the family by the leader. Then the census form is filled in and the family receives an explanation of several issues such as what a vaccination is, what diseases are prevented by vaccines and why it is important that pregnant women and children below four years of age are vaccinated with the corresponding doses. The visit is also used for informing the family on other health programmes.

    In cases where pregnant women or children below four years of age are found to have not completed their vaccination scheme, an appointment is set for them to attend the vaccination post the next day at a convenient hour for them.


  • Planning:

    During the planning phase the materials and the human and financial resources for the vaccination session are prepared. The location of the vaccination post is defined according to two criteria: 1. that it is central and that no house is very far from the site, and 2. that it can be easily and quickly accessed by people and there are not impediments for any neighbour arriving at the site. The vaccination site can be a house, a school or any building, as long as it fulfilled the requirements above.

    The health official calculates the number of people to vaccinate and the vaccines and syringes that are needed to carry out the daily vaccination.


  • Vaccination session:

    For the development of the session, the health official goes to the health institution in order to gather the syringes and vaccines, and take them to the vaccination post. The leader, meanwhile, visits the families where a need for vaccination was identified during the previous visit, to guide and accompany them to the vaccination site. The health official carries out the vaccination and simultaneously educates people about the vaccines given and those that are scheduled for the future.

    Each vaccine applied is registered in the daily vaccination registry and a Vaccination Card is issued for each child. When finishing the day it is verified if all the children and mothers that had been identified were taken care of. If not, the leader goes again to the houses of the people who did not attend to remind them of their vaccination appointment. A key task of the leader's job is to find out the reasons for which these people did not attend.

    This process is to be repeated for each work area pointed out in the map and repeated again from the first round to set appointments for the application of the new doses.


  • Evaluation:

    Permanent assessment of the availability and use of materials, the process, and the results is a fundamental part of this strategy. The data obtained is used as continual feedback within the process and to improve the process in the future.


  • Training:

    Before undertaking fieldwork, people involved in the process are trained in their responsibilities, the basic definitions of the diseases, and the handling of vaccination materials. Some of the basic communication points that must be contained in the vaccination message that is to be transmitted to the visited families include: * Vaccines protect children against the following diseases: Polio, Diptheria, Pertussis, Tetanus, Measles, and Tuberculosis.
    * Vaccines are free: there is no cost for families. All hospitals, health centres or vaccination sites will vaccinate children.
    * To the communities that do not count on these resources, vaccination sites are located in a school, family house, or another place readily accessible.
    * Vaccination is the best way to protect children against many infectious diseases.
    * Children do not suffer from diseases against which they have been vaccinated.
    * It is better and less expensive to prevent than to cure. From the time they are born until they are four years old, children are prone to get sick very easily if they are not vaccinated.
    * Unvaccinated children are a risk factor for the community; an epidemic in the infant population can be avoided if children are vaccinated.
Development Issues
Immunisation and Vaccines, Children, Health.
Key Points
The application of the "canalisation" strategy was key in the success of the National Vaccination Crusades carried out in the 80's in Colombia with the objective of increasing the vaccination coverage of children.

The application of the "canalisation" strategy facilitates the control of the vaccination processes. When detailed information of each of the child is known - their name, address, age, sex, number of vaccines given and dose of each one that has been applied - it is possible to guarantee that children really complete their vaccination scheme. In this way, children that had previously begun their vaccination process can complete it and if a child doesn't complete the whole scheme it is possible to detect him later and to apply the remaining doses.
Partners

Ministry of Health of Colombia, Pan American Health Organisation (PAHO)/World Health Organisation (WHO).

Sources

Expanded Programme of Immunisation. Strategy of Canalization. Ministry of Health, Colombia. National Plan for the Survival and Infantile Development. (Programa Ampliado de Inmunizaciones. Estrategia de Canalizaci