To reduce the increasing number of zero dose children in the Eastern Cape Province, the National Department of Health, planned a four-day Zero Dose training program for the province, fully funded by the WHO Regional Office for Africa, from 26-29 September 2023. The training took place in collaboration with United Nations (UN) partners, WHO South Africa and UNICEF. The training was designed to benefit senior program managers at the provincial, district, and sub-district levels, as well as facility staff responsible for disseminating knowledge to their constituencies. The training primarily focused on critically evaluating the status of zero dose children and developing micro plans to reach them, with a particular emphasis on the components of the Expanded Program on Immunization (EPI).

Immunization is a global health and development success story, saving millions of lives every year and is a key component of primary health care and an indisputable human right. It’s also one of the best health investments. Vaccines are also critical to the prevention and control of infectious diseases and outbreaks thereof. While the Expanded Program on Immunization (EPI program) responsible for vaccines in South Africa in its schedule covers for eleven vaccine preventable diseases (VPDs), there are still children who do not have access to a single vaccine. These are called zero dose children.

The number of zero dose children has been increasing globally and South Africa is one of the priority countries for high zero dose children. Over the past 5 years, a total number of zero dose children in South Africa accumulated to almost 700,000 (682,967). In 2022 alone, South Africa recorded 147,674 and 19,127(15%) was from the Eastern Cape. The increasing immunity gaps due to the increasing zero dose children has contributed to the recent multiple vaccine preventable disease outbreaks which the country has battled, and this warrants urgent interventions to decrease morbidity and mortality due to VPDs.

The training focused on the all the components of EPI but mainly on critically reviewing where the zero dose children are, and developing micro plans aimed at reaching these children. Other topics covered included:

• Global and national strategic and guiding documents which are aligned to zero dose reduction.
• Demand creation and community mobilization
• Reach Every district strategy (RED)
• Supportive supervision
• Vaccine Preventable Disease Surveillance (VPDs) including Environmental surveillance (ES)
• Data management (using data for action) including the use of technology such (ODK app) for supportive supervision.

The way forward from the training was: 

• Cascading the training to professional nurses through integration in existing trainings
• The province will coordinate the crafting of micro plans at facility level using RED Strategy guiding principles which when following the bottom-up approach will inform the subdistrict, then district micro plans.
• Monthly Review of process indicators, performance indicators and quality indicators.
• Data monitoring and reporting on nerve Centre program on weekly intervals which follow-development of action plans to close gaps.
• Demand Creation to reduce zero dose was highlighted as a critical area of focus.