Title: Immunisation delivery at various sites
Course: Level 3 - Immunization > Section: Plan and monitor an immunisation program

In Ethiopia, the three common immunisation service delivery sites are fixed-site service, outreach service, and mobile service. To increase the immunisation coverage of your catchment area, you should use a combination of these three approaches.

Fixed Site Services

This kind of service is the time when you provide immunisation service at your health post on a regular day fixed after discussion with the community even though the ideal assumption is immunisation should be routinely available on a daily basis.

To give effective immunisation service at a fixed site, you need to be ready in aspects including:

- Prepare a waiting area for children and caregivers.
- Make the workplace in the shade to protect vaccines from light.
- Avoid workplace from becoming crowded.
- Determine the number of vaccines needed for the specific session.
- Assemble all necessary material including vaccines, water and soap, auto-disable syringe, swab with antiseptics, metal file to open ampoules, stationery, safety boxes, etc.
- Decide what vaccine to give a child and whether to give TT to the mother.
- Record all you have done on EPI registration book and immunisation card.

Outreach Services

Immunisation service delivery at an outreach site requires careful planning of the dates, times, and sites of regular outreach sessions with the goal of covering the target population within the target period. It is very important to work with the community in selecting the most suitable sites and the most appropriate days for outreach immunisation sessions. The site should be readily accessible, such as a school or kebele office, or in the shade of a large tree. Monitoring and evaluation of the outreach service, with community input, is essential for its success. Regular meetings should be organised to discuss ways of increasing the immunisation coverage locally, for example by changing the location to a more convenient site, or adding new outreach sites. Prior to your departure to the outreach site, you need to pack all necessary materials essential to give the service.

When you arrive, inspect the site to ensure that it has been arranged correctly to provide a proper workflow and that all surfaces have been adequately cleaned. When you leave the outreach site, you should collect all the safety boxes and any other waste, and take them back to your Health Post, where you can dispose of them in a safe way. Do not leave any waste at the site. You started your work in a clean area and it is important to abandon the site as clean as when you began. Make sure that you thank all the community volunteers who helped you deliver a successful immunisation session that day.

Mobile Services

In countries like Ethiopia, where the pastoral community has a significant number in the total population, mobile immunisation service is likely to be the most appropriate approach. The fundamental difference with other ways of delivering immunisation is that it requires a mobile team to travel from place to place, carrying all the immunisation equipment and maintaining absolute cold chain conditions for several days. Decisions about where to conduct the immunisations should be agreed with local government officials, community leaders and other stakeholders.

Once the area is identified, you should use all possible ways to get information on the eligible target population in the area, so you can estimate what resources you will need for the number of sessions planned during this trip. Make sure that news reaches every community well in advance of the dates when your mobile service will be coming, and advertise where local people should go to meet you and your team.