Increasing Immunization Coverage:

A Lesson from Young Pediatrician of Way Kanan

Lampung Province, Indonesia

Achmad Rafli, MD
• Way Kanan is one of district from 15 districts
in Lampung Province
• Area: 3.921,63 km² or 11,11% from total area
of Lampung Province
• Population in 2019: 450.109 people
• Sub-districs: 14
• Villages : 227
• Primary health care : 19
Districts of Way Kanan
Immunization reports from 19 primary health care
center
• By SMS to Way Kanan District Office
• Weekly report
• Total of cases à especially diseases that
can be prevented by immunization
• Measles
• Tetanus
• Diphtheria
• Pertussis
• Acute flaccid paralysis
• Target in 2018: 100%
Obstacles for immunization program
• Location of villages
• There are a lot of cases that not reported
• Coordination
• Changing of health care provider à little transfer of
knowledge
• Evaluation of program is not routine
• Budget and regulation from government
Zainal Abidin Pagaralam (ZAPA) General Hospital
Contribution: pediatric health service
• Polyclinic
• Bedroom
• Class III
• Class II
• Class I
• High care unit
• Perinatology
• Level I
• Level 2
Immunization polyclinic at ZAPA
General Hospital
• Immunization day: Thursday
• Start from April 19, 2018
• Time: 09.00-14.00
• Collaboration with Way Kanan Health
Officeà Memorandum of Understanding
Immunization polyclinic at ZAPA General Hospital
• Type of immunization à National Program Immunization
• B Hepatitis
• BCG
• DPT
• Oral polio and IPV
• Measles rubella
• Registration first is needed

• If the child is unknown for immunization status (forget or not complete),

the pediatrician will explain and plan for immunization.
• Parents should bring BUKU KIA
Immunization polyclinic at ZAPA General Hospital
 Immunization polyclinic at ZAPA General Hospital

Immunization schedule and adverse events following

Anaphylactic Kit
immunization diagram
 Report of Immunization Data
• Periodically to Way
Kanan Health Office
• Anticipationà adverse
events following
immunization
Immunization polyclinic launching session:
April 19, 2018
UNICEF delegation visit immunization polyclinic
ZAPA General Hospital
 BASIC IMMUNIZATION COVERAGE
WAY KANAN DISTRICT
YEAR 2018
218.9 113.4 109.2 105.9 105.2 105.1 104.8 103.1 100.8 100.6 99.6 99.1 98.4 103.0
98.1 97.2 97.1
100.0 96.2 94.6 93.0
95.0
90.0
85.0
80.0
75.0
70.0
65.0
60.0
55.0
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Universal Coverage Immunization 2018

January 2018: 64,8 % (147 villages)

January-June 2018: 70 % (159 villages)

January-September 2018: 84,1 % (191 villages)

January-December 2018:100 % (227 villages)

All of villages reach UCI target à 2018

Phase II Measles Rubella National
Immunization Campaign
Commitment to Phase II Measles Rubella Immunization
Campaign: Lampung Province
Phase II Measles Rubella Immunization Campaign:
Way Kanan
• 120.323 children à 9 months old- 15
years old
• Coordination with Waykanan Health
Office and ZAPA General Hospital
• Coordination real time via WAG
• Problems
• Monitoring
• Evaluation
Workshop and introduction Phase II Measles Rubella
Immunization Campaign to 858 Health Professional
• 858 health professionals:
medical doctors, nurses,
midwives
• Safety injection
• Injection technique
• Adverse events following
immunization
Obstacles in Phase II Measles Rubella Immunization
Campaign
• Low coverage
• Evaluation
• Coordination
• Problem solving
Evaluation of Phase II MR Immunization Campaign
 MEASLES RUBELLA IMMUNIZATION COVERAGE
WAY KANAN DISTRICT
AGE 9 MONTHS-15 YEARS OLD
2018

101.4 101.4 100.8 100.1 98.8 98.4 97.4 97.2 97.1 97.0 96.9 97.1
100.0 96.7 96.0 95.9 95.8 95.8 95.8 95.3 95.1
95.0
90.0
85.0
80.0
75.0
70.0
65.0
60.0
55.0
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Adverse events following immunization
at Way Kanan: 2018

• Serious: 2 cases
• Non-serious: 37 cases
 Adverse events following immunization report(1)

Permenkes no.12 tahun 2017

Adverse events following immunization report(2)

Permenkes no.12 tahun 2017

 Serious adverse events following immunization case (1):

Coordination with adverse events following immunization committee

Lampung Province Health Office, Indonesian Pediatric Society
 Serious adverse events following immunization case (2):

Coordination with adverse events following immunization committee

Lampung Province Health Office, Indonesian Pediatric Society
 Serious adverse events following immunization case (3):

Coordination with adverse events following immunization committee

Lampung Province Health Office, Indonesian Pediatric Society
Education to parents about immunization
Way Kanan’s Awards
Way Kanan’s Awards
• Tina Q Tan, MD
• Professor of Pediatrics (Infectious Diseases)
• Chairperson of the American Academy of
Pediatrics (AAP) Section on Infectious
Diseases (SOID)
• Member of the AAP Committee on Infectious
Diseases (COID – Redbook Committee)
American Academy of Pediatric and Indonesian Pediatric Society à Way Kanan
Thank You