Operational models for delivering healthcare in insecure settings: the One Shot strategy and
intermittent preventive treatment of children for malaria plus vaccination in Central African
Republic
*Liliana Palacios, Carmen Terradillos, Dakitchè Lawoè Houedakor, Nines Lima
Médecins Sans Frontières (MSF), Barcelona, Spain
*[email protected]
Introduction
Security challenges and health system constraints led to implementation of two operational models
in MSF projects in Central African Republic (CAR). The One Shot strategy uses the model of a large
vaccination campaign to deliver minimum packages of healthcare with the aim of harm reduction in
contexts of population displacement or insecurity when the regularity or duration of access is
uncertain. In addition, MSF implemented intermittent preventive treatment of children for malaria
(IPTc) plus vaccination. We present the experience and outcomes of these interventions.
Methods
One Shot included paediatric care (vaccination, nutrition, malaria, case identification, vitamin A, and
deworming), sexual and reproductive health (SRH), and mental health (MH) delivered by teams
ready to move out when security clearance was obtained; community sensitisation was done with
MSF community health workers. IPTc involved administration of artesunate-amodiaquine (ASAQ) for
children aged 6-59 months who also received measles, pneumococcal conjugate (PCV13), and
pentavalent (DTP-HepB-Hib) vaccinations, and long-lasting insecticidal nets (LLIN). Data were
analysed from implementation of One Shot in Batangafo (January 2015 to February 2016) and IPTc
plus vaccination in Batangafo, Kabo, and Ndele health prefectures, 4-7 days/month in July, August,
October, and November 2015.
Ethics
This retrospective study met the criteria of the MSF Ethics Review Board for exemption from ethics
review.
Results
18 One Shot campaigns were completed: 3303 children vaccinated (84 already fully vaccinated); 50
unique counselling sessions provided (in 5 One Shots); 2405 children screened for malnutrition, 66
treated for severe acute malnutrition; 151 malaria cases treated; one trauma emergency assisted; 45
SRH consultations delivered (30 antenatal, 15 gynaecological); 776 children received vitamin A
supplementation and 738 albendazole (in 2 One Shots). IPTc reached 86.3% (SD 11.9) of the target
population (15,349) over three of four rounds. 40,606 LLIN were distributed (2.6 per child).
Compared with 2014, malaria consultations dropped by 9.5% (96,897 vs 88,495, respectively) and
blood transfusions for children <5 years by 6% (869 vs 823). 23,589 PCV13, 27,511 pentavalent, and
12,451 measles vaccinations were administered. The coverage of measles vaccination (unique dose)
for the target population was 81%. Overall, for measles preventive vaccination, 31,051 children were
vaccinated in 2015 compared with 1553 in 2014. Challenges included data registration, uncertainty
around dates of follow-up sessions, and lack of systematic inclusion of SRH elements.
Conclusion
One Shot enabled delivery of services to populations that otherwise would rarely have contact with
health providers. SRH was not often delivered; the inclusion of additional services was perceived to
be too difficult. Coverage of IPTc and vaccination was not fully measured; however, these strategies
enabled more than 10 times the number of children to be vaccinated than in the previous year.
These strategies adapted to the context in CAR may not be scalable or generalizable to other
situations, but it is important that such approaches are considered and adapted wherever there is
need.
Conflicts of interest
None declared.