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Linked recently had the opportunity to sit down with Gayane Sahakyan, Armenia’s Deputy General Director of the National Center for Disease Control and National Immunisation Program Manager, to discuss how Armenia’s participation in Linked activities contributes to efforts to strengthen its immunisation programme.
During initial discussions when Armenia joined the Linked Network, the country’s immunisation stakeholders noted an immunisation knowledge gap among primary health care and specialist providers who are not directly involved in delivering immunisation services. While not directly involved in immunisation, these providers can support demand generation by responding to vaccine-related questions from caregivers, addressing vaccine hesitancy and misinformation, and modeling vaccine acceptance. Additionally, the country sought to improve immunisation performance generally through improved performance management and monitoring. Addressing this knowledge gap and improving performance are key priorities as the country aims to achieve its goal of 95% DTP3 coverage of children under one year of age by 2025.
In July 2022, Linked facilitated an in-person workshop in Tbilisi, Georgia with country teams from Armenia, Azerbaijan, Georgia, Moldova, Mongolia, Ukraine, and Uzbekistan. Gayane pointed out that the workshop was the first face-to-face meeting that Armenia had with other countries in the region since the COVID-19 pandemic began. The theme of the workshop was “Strengthening Immunisation Service Delivery through Primary Health Care (PHC) Platforms,” and a key area of focus was strengthening PHC health worker capacity and performance, namely ensuring that PHC workers are available, knowledgeable, skilled, and motivated to conduct immunisation activities. The other areas of focus were strengthening coordination with other PHC services and strengthening performance management and monitoring of immunisation within PHC.
When considering the learnings from the workshop, the Armenia country delegation developed an action plan with the following objectives:
- Objective 1: Development and integration of an immunisation training course in the national curriculum of pre-diploma education
- Objective 2: Integration of the immunisation training course into the mandatory continuous professional development of narrow specialists and visiting nurses
- Objective 3: Strengthening the immunisation capacity of PHC health workers at Parents and Maternity schools, including supportive supervision
- Objective 4: Generating demand by implementing a secondary school-based training and a revision of the performance-based payment mechanism
At the time, the activities included within Objective 3 were not all part of the national operational plan, but following the workshop, the workshop delegation discussed these activities with the country’s immunisation partners to understand how they aligned with the support the partners were able to provide. With funding from the EU, through WHO, and USAID, through UNICEF, the government was able to incorporate the action plan activities into its current national operational plan.
During the workshop, Armenia also gained new knowledge from other countries about monitoring and reporting on the number of zero-dose children. At the time, Armenia did not register or report on the number of zero-dose children. Upon returning from the workshop, the country established a code for zero-dose children within the electronic immunisation registry to ensure routine reporting on coverage. This data allows interventions to be better targeted to these populations.
To further improve reporting and performance monitoring, the country is planning to introduce new indicators for immunisation and other health services. As part of this performance-based monitoring reform, Armenia also made the decision to revise their performance-based payment scheme based to give greater priority to immunisation – mandating that 50% of the score used to determine these payments is related to immunisation.
Linked’s approach of ongoing support to countries to adapt and implement action plans has further improved Armenia’s action plan and introduced accountability for its implementation. Following the workshop, Linked had routine discussions with the country’s immunisation stakeholders to follow up on action plan implementation and facilitated a virtual peer-to-peer discussion between Armenia and Moldova, during which each country provided an update on their progress with action plan implementation. Gayane remarked that these follow-up discussions encouraged prioritization of the activities within the action plans, increased their accountability for demonstrating implementation progress, and even introduced additional learnings that were added to the existing action plan.
Armenia’s journey with Linked over the past year and their integration of the learnings from these engagements into actions to strengthen their immunisation programme shows us how peer-to-peer, collaborative learning can result in actionable steps towards real change. Countries can use their Linked action plans as a tool to introduce new activities, strategies, or lessons learned into activities within their annual operational plans and even to leverage additional support for the immunisation programme. Additionally, Armenia’s experience demonstrates action plans should be seen as “living” documents, with countries continuing to integrate new learnings and iterating upon existing activities.
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