Reaching Every District (RED) - A Guide to Increasing Coverage and Equity in All Communities in the African Region

"RED encourages health workers to partner with communities for the planning, promotion, delivery and monitoring of immunization and other primary health care services. Engaging with communities results in more accommodating and user-friendly services, increases utilization and promotes accountability."

The Reaching Every District (RED) strategy has played a key role in strengthening African immunisation systems to sustainably and equitably increase immunisation coverage rates to help achieve the health, equity, and economic objectives of several global development goals. RED's 5 strategies, which provide the framework for this World Health Organization (WHO) guide, include:

1. Planning and management of resources, which, when done in a participatory manner with key programme staff and ministry units, from the beginning and with community partners, promotes ownership;
2. Reaching all eligible populations, which requires service delivery strategies that are appropriate to the needs of the people and that make additional efforts to immunise communities affected by inequities;
3. Engaging with communities, which is built on partnerships with communities through supportive and coordinated actions by District Health Management Teams (DHMTs), health facility committees, health workers, and community members;
4. Conducting supportive supervision, which "encourages open, two-way communication, and building team approaches that facilitate problem-solving"; and
5. Monitoring and using data for action, which involves everyone: managers, supervisors, health workers, local officials, and the community.

The 2017 RED guide takes into consideration a review of best practices and the emerging issues since 2008. These include various global initiatives that provide new resources and renewed focus on targets for sustainability, address inequities between communities, and work toward better integration across health programmes. In recent years, immunisation stakeholders have both narrowed and intensified their focus on closing gaps in immunisation services at the community level. Innovative strategies to reduce these pockets of local inequities are referred to as "Reaching Every Community" or "Reaching Every Child" (REC). The principles behind REC - an approach that reinforces immunisation session planning through an "equity lens" - have been woven into the strategies and tools described in this document. This includes more emphasis on community-based interventions at the sub-district level.

For example, chapter 3 describes techniques and approaches for engaging with communities. Steps include:

• Building community partnerships
• Supporting trust and friendly services
• Delivering services to disadvantaged communities
• Working with community health workers and mobilisers
• Using effective communication
• Monitoring community participation

This guide also provides tools for planning and monitoring the RED approach and addresses some operational issues concerning logistics, communication, and integration. Links to resource materials and country examples are provided at the end of each section.