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Introduction: The immunisation program for Mberengwa district has been experiencing a decline in coverage and high dropout rates despite it having adopted the Reaching Every District strategy in 2004. This study investigates reasons for this program failure. Methods and Materials: The Logic Model Conceptual Framework was used to evaluate the program. Data were collected using questionnaires from health workers, key informants and a separate questionnaire used to collect data from mothers of children under five years old. Focus group discussions were conducted with women in the community. A checklist was used to assess program resource availability. Data were analysed using EPI info statistical software. Qualitative data were analysed thematically Results: Forty six health workers and 56 mothers were interviewed. Ten health workers had been trained in Reaching Every District. Less than half knew the tool that is used to monitor program progress. None of the health centres had zoned catchment area maps for offering the different EPI services. Program resources were reported to be inadequate. None of the facilities were conducting regular EPI meetings with the community. Main barriers to immunisation were religious objectors, unavailability of vaccines and unavailability of outreach services Discussion: Resources put into the program were inadequate. Health workers were not conversant with the operations of the strategy. Community involvement in the program was poor .Efforts to improve program performance should be aimed at training health workers in Reaching Every District, revitalising strong links with the community and re-establishing Expanded Program on Immunisation outreach services.

Introduction: The outpatient surveillance system in Kwekwe district reported 86 AEFI cases in 2009. No surveillance forms were completed for these cases. This study was therefore conducted to identify reasons for this anomaly. Methods: Interviewer administered questionnaires were used to collect data on knowledge, usefulness and system attributes from health workers and caregivers of under-fives who were found at 18/33 health facilities in the district. Results: None of 61 nurses interviewed could correctly define an AEFI. AEFI notification and investigation forms were available at 6/18 health facilities. None of the health facilities had AEFI case definitions displayed. Reasons for failure to notify cases included lack of training on the system 56(91.8%), unavailability of stationary 43(70.5%) and mothers not knowledgeable on AEFIs 21(34.6%). The surveillance system was found to be acceptable. Conclusion: Lack of knowledge on AEFI surveillance procedures was the main challenge. As a result, 150(45%) nurses were trained in AEFI surveillance and surveillance forms were distributed to all health facilities.

Background The cornerstone of the health system in Zimbabwe, the district health system has been under the responsibility of the district health executive since 1984. Preliminary information obtained from some provincial health managers in Midlands Province suggested a poor performance by most district health executives. We therefore investigated the reasons for this poor performance. Methods A descriptive cross sectional study was conducted. Structured interviewer administered questionnaires were used to obtain information from district health managers of five randomly selected districts in the province. Checklists were used to assess resource availability, staffing levels and proxy indicators to effective district health executive function. Data were analysed using Epi Info statistical package. Results Thirty district health managers were interviewed. Almost half of the participants could not list at least five functions of district health executives. Twenty nine managers reported having inadequate management skills requiring training. District health executives failed to meet their targets on expected activities in the year 2010 such as conducting monthly district health executive meetings, conducting quarterly supervision to health centres and submitting quarterly district health reports to the provincial level. Conclusion Poor knowledge on expected functions could have resulted in poor performance. Without adequate management training district health managers are likely to underperform their duties. DHE guidelines were therefore distributed to all districts. Management trainings were conducted to all district health executives throughout the country from November 2011.

Background AFP is a rare syndrome and serves as a proxy for poliomyelitis. The main objective of AFP surveillance is to detect circulating wild polio virus and provide data for developing effective prevention and control strategies as well planning and decision making. Bikita district failed to detect a case for the past two years. Findings A total of 31 health workers from 14 health centres were interviewed. Health worker knowledge on AFP was low in Bikita. The system was acceptable, flexible, and representative but not stable and not sensitive since it missed1 AFP case. The system was not useful to the district since data collected was not locally used in anyway. The cost of running the system was high. The district had no adequate resources to run the system. Reasons for not reporting cases was that the mothers were not bringing children with AFP and ignorance of health workers on syndromes captured under AFP. Conclusion Health worker’s knowledge on AFP was low and all interviewed workers needed training surveillance. The system was found to be flexible but unacceptable. Reasons for failure to detect AFP cases could be, no cases reporting to the centres, lack of knowledge on health workers hence failure to recognise symptoms, high staff turnover.