At the heart of quality immunization service delivery is a competent workforce enabled to always provide regular and safe vaccinations to all members of the community. In some countries, equipping immunization workers with the knowledge and skills they need to do a better job is not always possible. Iraq is one of those countries where COVID-19 created an additional workload on immunization workers who had to engage in the introduction of COVID-19 vaccines and assist in the pandemic response. The immunization workforce had already been encountering difficulties, including shortages in staff and undertraining.  

Iraq’s Ministry of Health is taking action to empower immunization workers in the face growing challenges. With support from EMPHNET, it is maximizing the Expanded Program on Immunization (EPI) staff’s workforce development. A more recent collaboration between Iraq MoH and EMPHNET has increased the focused on enhancing performance through supportive supervision and improving knowledge of injection safety and waste management.

Large-scale Training Workshops Focus on Immunization Safety

Health care facilities are ideal settings for health hazards, as invasive procedures and exposure to inappropriately disposed and potentially infectious wastes can become a source of disease transmission. These hazards exist and threaten life and health. But they could be prevented through the application of proper infection prevention control (IPC) measures.

With a focus on injection safety and medical waste management, the Iraq MoH is working to institutionalize high-standard IPC measures. It is to achieve this goal through conducting relevant training and ensuring the surveillance of adverse effects following immunization (AEFI). Between December 2023 and January 2024, the Ministry conducted ToT workshops targeting EPI managers and AEFI technical officers from all directorates of health. 

These TOTs were followed by large-scale training workshops held at the provincial level. These workshops targeted EPI focal points and the AEFI technical officers in all districts. Workshop participants learned about the local problem of unsafe injection practices, their role in the spread of bloodborne infections, and ways to improve injection safety. They also learned about the different types of waste generated at health facilities, especially during immunization sessions, and were provided with information on handling, storage, and disposal requirements.  As part of this training, participants engaged in hands-on sessions to learn how to report AEFI cases using the DHIS2 platform.

*Provincial-level Training on Immunization and Injection Safety and Waste Management

These training workshops were effectively implemented based on the feedback from the participants. These large-scale workshops are expected to reflect on the performance of participants in creating a safe environment at immunization posts for providers and patients.

Supportive Supervision Focus on Areas for Improvement at the Frontlines

Unlike traditional instruction, supportive supervision (SS) enables health experts to provide mentorship to less experienced colleagues in an informal setting. This learning method is gaining popularity in the health sector, particularly in capacity building for immunization workers at the frontlines. SS is offered through regular supportive visits, carried out at intervals, and where topics discussed are based on a checklist created by the supervisors.

With support from EMPHNET, the MoH is employing SS to motivate health workers toward better performance. Initial steps have been taken to facilitate SS throughout the country. The ministry created a team of trainers who received TOTs on supportive supervision: they learned how to plan and conduct supportive visits, create supportive checklists, conduct on-the-job training, and report on problems identified. The TOTs’ participants were EPI provincial managers and cold chain technical officers in all directorates of health. Subsequent district-level training workshops followed and were facilitated by these participants.

These workshops are continuation of a ten-year collaboration between EMPHNET and the Ministry of Health in EPI workforce development that is country-tailored and serves priority areas. Previous collaborations focused on supportive supervision, immunization in practice, cross-program learning, and continuous professional development for staff at the national, the subnational, and the district level.