Collaborative immunisation effort across WDHB district pays off 'big time'

24 October 2012
Whanganui District Health Board’s (WDHB) ability to lift last quarter’s immunisation target result from 89 percent to 94 percent is largely due to immunisation staff pulling together and working collaboratively says WDHB service and business planning portfolio manager Melissa Cragg.
Dr Cragg says it’s a credit to all concerned that Whanganui’s immunisation rates have been steady over the past 12 months with 94 percent of children having completed their immunisation programme by two years of age for the 1 July 2012 to 30 September 2012 quarter.
That this result included a 92 percent rate for Maori children and a 100 percent rate for Pacific children is a highlight for Whanganui’s immunisation community.
And Dr Cragg is equally pleased that in the same reporting period, the result for children who were up to date with immunisations by eight months of age was 90 percent across the board for European, Maori and Pacific children.
Whanganui District Health Board region's immunisation team
From left to right: Whanganui Regional Primary Health Organisation (WRPHO) B4 Schools facilitator Janine Spence, WDHB service and business planning funding portfolio manager Melissa Cragg and WRPHO immunisation coordinator Sue Hina.
Along with this, the WDHB has done exceptionally well with its HPV (cervical cancer immunisation for Year 8 girls) and Boostrix (tetanus, diphtheria and whooping cough for Year 7 students) programmes. The latest HPV report, up to the end of June 2012 shows the WDHB coverage rate to be the highest in the country with 88 percent for Maori (8 percent higher than the next highest DHB), 65 percent for New Zealand European/other (2 percent higher than the next highest DHB), 70 percent for Pacific and 73 percent for total population (7 percent higher than the next highest DHB and 3 percent more than the 70 percent national target).

In the war to fight the flu, general practices throughout the Whanganui district, have been at the forefront of influenza prevention for 2012 with the local immunisation rate sitting at 72 percent for both over 65 years and high needs members of the community.

“Given that the national average is 63 percent for high needs populations and 64 percent for over 65 years, the results demonstrate just how committed our primary care providers are in wanting to help Whanganui residents avoid the flu and its side effects,” Dr Cragg says.

In the meantime, Whanganui DHB’s decision three years ago to use the National Immunisation Register for the HPV programme rather than the School Vaccination Database has been boosted this year by the decision to add the Boostrix Year 7 and Year 11 vaccinations programme to the NIR programme. The fact that Whanganui is one of only two DHB’s in New Zealand to use the NIR for Boostrix Year 11, is also worth noting Dr Cragg says.

“While our immunisation and clinical staff have a lot to celebrate and be proud of, it’s the WDHB Immunisation Steering Group which has really driven the effort for staff to work collaboratively across the WDHB area,” Dr Cragg says.
The value of having our key immunisation stakeholders represented on the steering group can’t be underestimated. As a group, they’ve successfully pulled together a number of services which instead of working individually, now work collaboratively under the watchful eye of the steering group. The four main activities undertaken are:
  • Opportunistic Immunisations identified through the close partnership between the Emergency Department (ED), Whanganui Accident and Medical (WAM) and Wanganui Hospital Paediatric Ward staff who work hard to encourage parents to have their children immunised. Ensuring all three areas have immediate access to the NIR, that they have the same identification processes, and they support each other in terms of training and competency to give the vaccinations has been paramount. The Immunisation Coordination Team (Whanganui Regional Primary Health Organisaton) and NIR administrator have been supporting this work.
  • Location of children once they reach school age – both the Immunisation Coordination Team and the Public Health Unit are establishing processes and procedures to help them locate school children aged 5-6 years needing  immunisations and other checks (Before School Check – B4SC). 
  • Joint Initiative with Ministry of Social Development (MSD) – a series of meetings have taken place between MSD staff and the Immunisation Coordination Team following a directive that DHBs and MSD staff have to work more closely in regard to immunisation. The immunisation team has been very proactive in Whanganui agreeing to the following initiatives following discussions with MSD staff:
  1. the immunisation team provide flyers to WINZ to advertise onsite clinics at WINZ offices on the first Friday of the month, beginning November 2012.  Each clinic will run for approximately two hours from 1-3pm
  2. Immunisation Coordination Team to educate WINZ staff
  3. provision of client education at WINZ Client Seminars on ‘as required’ basis
  4. WINZ to provide a room suitable for immunisations and or B4SC checks with Immunisation Coordination Team supplying staff and other equipment
  5. review of above activities to evaluate their effectiveness three months after their commencement.
  • The new eight month target – a large piece of work between the Immunisation Coordination team, the NIR Administrator and WDHB Service and Business Planning Department to establish and improve a process around the new eight month target. The collaboration and willingness to ensure all parties are involved in the process accounts for the early achievement of this target.
Dr Cragg says the Outreach Immunisation Service’s collaborative activity which apart from extending beyond immunisation, includes a range of other stakeholders. Thanks to team members accessing families within their homes and holding clinics within the community, a more holistic approach is being taken which includes seizing on a range of health promotion and assessment opportunities.
One particular area of collaboration occurs between the Outreach Team and the WDHB Oral Health Team, where the opportunity exists for simple ‘lift the lip’ assessments to take place, oral health messages to be delivered and consent and registration to be obtained.  Often the families who require the most support and advice in regard to oral health are the same families referred to the outreach service, so collaboration is beneficial to all parties involved.

A combined increased focus on immunisation within the WDHB region and recommendations by the Ministry of Health has seen boostrix vaccinations offered to all WDHB staff who work closely with children – a boostrix vaccine which includes the vaccine for pertussis (whooping cough) which has affected several children in the WDHB district children over the past months.

The WDHB staff Boostrix programme commenced in July 2012 to immunise staff working with babies and young children against pertussis, and tetanus and diphtheria also covered by the vaccine. In all, 102 staff from Public Health, Dental, the Emergency Department, the Children’s and Maternity Wards, Waimarino, theatre (anaesthetists), and Community Health have received the vaccine which was rolled out and led collaboratively by Infection Control, Public Health Unit and Paediatric Ward staff who administered the vaccine.

Dr Cragg says it’s pleasing that the improvements made over the past months have not gone unnoticed by the Ministry of Health which has acknowledged the WDHB’s efforts and its results. “I’m particularly proud that the recent request for the WDHB to provide details about our partnership with the Ministry of Social Development is a nod to our current status as the only DHB region undertaking collaboration in this area,” Dr Cragg says.
“This information, (to be published by the Ministry as an example of how collaboration can be achieved) will be part of a report going to the Prime Minister in early 2013. 
“And following a visit by Ministry of Health Senior Advisor Stakeholder Engagement for Immunisation the WDHB has been asked to act as a sounding board for the Ministry in regard to new policy and ideas around immunisation before implementation occurs.”

Dr Cragg pays tribute to the team she says has made Whanganui district’s collaborative approach to immunisation a reality. She says there’s still work to do including identifying further opportunities and enhancing existing activities.

“Our ‘team’ includes many primary and secondary health workers within and external to the WDHB,” Dr Cragg says. “While their roles are diverse and they work for a variety of organisations, all share the same goal – to improve and maintain the immunisation status of children in the WDHB district which in turn improves the overall wellbeing of our children and their families.”