Increasing the quality, safety, and efficiency of Vietnam’s immunization program

Every child in the world deserves the best protection that modern science offers—and often the best protection comes in the form of vaccines and the immunization programs that deliver them.

With PATH’s help Vietnam is increasing the quality, safety, and efficiency of its national immunization program. The overall approach consists of testing system improvements in a single province, identifying the best practices, and encouraging other provinces to adopt them.

Keeping current

One best practice is regularly offering refresher training to update the skills and knowledge of vaccinators. PATH has provided extensive technical training to 63 province- and district-level health managers in Ha Tinh and Thanh Hoa. We also helped them master interactive training techniques. Equipped with their new skills, the managers conduct three-day trainings for hundreds of other health workers—the district- and commune-level staff who provide care to the provinces’ combined population of five million people.

This “training of trainers” means that vaccinators receive the information that is critical to effective immunization. They learn about new vaccines, latest techniques in vaccine management—that is, keeping vaccine at the right temperature to ensure its potency—and safe injection practices, such as disposing of needles appropriately.

Supervision that supports

Another best practice is improving the performance of health staff through more constructive supervision. Traditionally in Vietnam, supervising staff meant traveling infrequently to commune health centers and, once there, looking for mistakes. This approach encouraged staff to hide problems, not solve them. We helped managers in Ha Tinh learn “supportive supervision”—to use collegial problem-solving, on-the-job training, routine coaching, and standard checklists to evaluate staff and support their improvement.

Maintaining vaccine quality

Because vaccines are temperature sensitive, PATH conducted quality-control studies in two provinces. We found that vaccine vial monitors (VVMs)—labels that change color when exposed to too much heat or light—were effectively helping health workers discard vaccine that had been compromised by Vietnam’s tropical heat. But freezing of vaccine because of unreliable cooling systems turned out to be a greater problem than expected. To mitigate it, we worked with the national immunization program to improve training and instructions for monitoring the temperature of refrigerators.

Health workers were also having difficulty understanding the English-language expiration dates printed on vaccine vials, resulting in incorrect use of expired vaccine—which might not protect the child—or premature disposal of vaccine. We created a simple translation sheet designed as stickers to be attached to vaccine carriers. More than 12,000 of the stickers have been distributed nationwide.

A birth dose against chronic liver disease

Thanks to a pilot project in Thanh Hoa province, future generations of Vietnamese people will be protected from the chronic liver disease that results from hepatitis B.

In Vietnam, the number of mothers who pass hepatitis B to their newborns during delivery is high, and people who are first infected with hepatitis B as infants are much more likely to become chronic carriers of the infection, which can cause liver cancer later in life. Fortunately, it is possible to prevent mother-to-child transmission of hepatitis B—with a “birth dose” of vaccine given within one to three days of delivery.

The challenge is to reach newborns—and to reach them so soon. Many mothers give birth at home. Others give birth in small, local health centers that often lack refrigerators for storing the vaccine.

PATH and the national immunization program decided to try what has proven successful in other countries. Because hepatitis B vaccine is not highly heat-sensitive—it can be kept at tropical room temperatures for up to one month—we tried keeping single-dose vials of vaccine out of the cold chain for up to two weeks at a time. Staff from local health centers pick up the number of vials needed from district health centers twice a month. Babies born in the local centers are vaccinated there. When women give birth at home, they get word to local health staff, and vaccinators then visit the home the next day. The approach reaches 99 percent of infants within the three-day window.

A final step toward protection

Strong immunization programs depend on ongoing training and education for immunization staff, ongoing system improvements, and ever-increasing engagement of families and communities.

In addition to the system improvements described above, PATH and the national immunization program have developed television broadcasts, radio spots, and printed educational materials to help families realize the importance of immunization—and of getting their children all of the vaccinations they need. These media help ensure that the quality services offered will be used—the final step in getting children protected.

Photo: Philippe Blanc.