The RED strategy
"Reaching every district" (RED) is a strategy to achieve the goal of 80% immunization coverage in all districts and 90% nationally in the WHO member states. RED aims to fully immunize every infant with all vaccines included in the national immunization schedule of countries. In order to achieve this goal, the strategy focuses on building national capacity from district level upward to maximize access to all vaccines, old and new.
RED addresses common obstacles to increasing immunization coverage such as poor quality district planning, low quality and unreliable service, inadequate monitoring and supervision of health workers.
The five RED operational components:
1. Re-establishing outreach services
In many countries a large proportion of the population only have access to immunization though outreach sessions. Outreach is any delivery strategy that requires health facility staff to leave their facility to deliver immunization. Ideally a minimum of four contacts per year are required to fully immunize an infant. For some communities, access can only be provided irregularly, and may require mobile teams to provide outreach, which will involve resources beyond the health facility and district level. Outreach sessions, especially mobile teams, present opportunities to provide other interventions along with immunization.
2. Supportive supervision
Supportive supervision implies providing on site training to health workers at the time of a supervisory visit, or at regular district meetings. To be supportive, supervisors should make regular schedules for visits, help to solve problems locally and follow up regularly with supply and resource issues. Supervisors will themselves need training to adapt their own approaches to supervision.
3. Linking services with communities
Involving the community with the planning and delivery of the service will encourage community ownership and improve attendance. Identifying community volunteers providing them with a role, such as follow up of defaulters, and holding regular meetings is an important step towards building a link with the community.
4. Monitoring and use of data for action
Monitoring and use of data for action implies not only the timely collection of data at district level, but the use of the data to solve problems. Some simple tools, including wall charts that display access and utilization need little training, but are very useful to take action according to monthly progress. Not only do districts collect coverage data, but also a large amount of other information, including logistics, supply, surveillance, all of which should be used to improve the immunization system. Some qualitative data may not be available in regular reports and may need to collected though supervisory visits.
5. Planning and management of resources
The district micro-plan is the key to the RED strategy. The micro-plan should be based upon a local situation analysis which involves every health facility and through them the community that they serve. At the national level, there is a responsibility to ensure the needed financial and human resources are available to the district, while the district must ensure the resources are efficiently used, through regular monitoring and adjusting the micro plan. Continuing to fund the RED strategy for more than the first year of implementation is vital for sustainability of coverage increase.
RED Information Sheet
Information sheet - English
- Letter published in WHO health bulletin outlining the RED strategy and progress update
Produced by WHO and UNICEF, the 'Reaching Every District' (RED) micro-planning guide is a useful set of tools for health workers dealing with immunization. Research has shown that the RED strategy results in significantly more children being immunized, and this guide aims to enable many more health workers to employ the approach.
AFRO RED Guide
The RED strategy has played a key role in successfully strengthening African immunization systems to sustainably and equitably increase immunization coverage rates to meet established targets since the early 2000's. RED has contributed to increasing DTP3 coverage in Africa from 57% to 80% between 2000-2014. This practical guide provides details on each of the five RED components and also contains templates for planning resources at district level.
Reaching Every District (RED) - A guide to increasing coverage and equity in all communities in the African Region
Atteindre Chaque District - Guide pour augmenter la couverture et l'équité dans toutes les communautés de la Région africaine
- In-depth evalutaion of the RED approach in the African Region (2007)
- RED strategy implementation in the African Region - Evaluation Report (2005)