Abstract for: The Immunization System at Community Level: the Case of Rwanda

This work-in-progress paper deals with the modeling of both planned and emergency immunization at the community level in Rwanda. We develop specific models adapted for different contextual settings to understand the health impact of interventions at community level taking into account local diversity. In previous work we developed a framework that captures the complexity of immunization systems and offers directions for sustainable redesign. An Immunization System Diagram assembles the paradigms of planned and emergency immunization in one system and emphasizes the synchronized flows of child, nurse and vaccine at the vaccination point. We obtained ethical clearance in Rwanda to collect immunization system related data in all health care facilities, which allows us to analyze the contextual differences from primary data. Currently a massive data collection for both (peri-)urban and rural settings is underway. We already observed outbreaks of vaccine preventable diseases in hard-to-reach communities, where access to medicines is an issue. We build the community model for two or three local settings in Stella. We plan to have completed at least a partial validation (with some key stakeholders) of the model before the conference and if feasible, a validation workshop in Rwanda.