Module 6: Recovery

World Health Organization

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Module 6: Recovery
• After a measles outbreak, it is important to
focus on strengthening essential primary
health care services – including immunization
service delivery, assessing needs and gaps in
the health system and improving quality of
services.
• It is an opportunity to build leadership and
ownership at all levels.
• It is an opportunity to tailor immunization
services to respond to the identified needs.
• In some cases, measles outbreaks have
resulted in the suspension or disruption of
some services. Recovery should include
reactivation of services as soon as possible.

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Module 6: Recovery
At the end of this module, you will be able
to:
• identify opportunities to strengthen
health and immunization systems to
reduce the morbidity and mortality
from measles and improve the health
status of the affected population;
• coordinate the recovery;
• identify factors that contributed to and
are affected by the outbreak; and
Photo: © WHO/
• work with appropriate programmes to Asad Zaidi
address gaps identified.

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Module 6: Recovery
Coordination of the recovery

• For large-scale outbreaks a recovery group should be

established to identify key lessons learned and work with the
appropriate entities to develop recovery and improvement plans.

• For more local outbreaks a district or regional team can use

Steps 1 and 2 (outlined in the upcoming slides) to identify
factors that contributed to the outbreak and address those gaps.

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Module 6: Recovery
Recovery planning

A recovery plan should identify what information is known and

what information is needed to:
• define the lessons learned from the outbreak, the outbreak
investigation/RI assessment and ORI;
• share lessons learned with the responsible immunization and
surveillance authorities;
• identify any additional information gaps; and
• work together to develop plans to incorporate lessons learned
into appropriate plans.

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Module 6: Recovery

Recovery planning Possible partners:

‐ IPC
‐ Nutrition
Planning should also include
‐ Vulnerable
other programmes where
population groups
weaknesses were identified (nomad, refugees,
and could be strengthened to other)
reduce the impact of future ‐ Immunization
outbreaks. ‐ Surveillance

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Module 6: Recovery
Step 1: Identify factors contributing to and affected by the outbreak
The following are some examples of how using information from the
outbreak investigation reports, root cause analysis and other sources,
can identify gaps in:
• IPC – Was there nosocomial transmission of measles?
• Nutrition and case management – Higher than expected case
fatality ratios? Are there underlying nutritional deficits? Was
treatment timely and appropriate?
• Immunization – Missed opportunities? Were there zero-dose
communities? Were low-coverage areas identified for
prioritization? Gaps in supplies and/or staff? Were there demand
side gaps?

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Module 6: Recovery
Step 1: Identify factors contributing to and affected by the outbreak
(continued)
• High-risk populations – Did the outbreak occur/affect
disproportionally among IDPs, refugees, nomads, etc.? Do these
populations have equitable access to immunization? Barriers?
• Outbreak preparedness– Did the risk assessment accurately
identify high-risk areas? Were opportunities to act missed?
• Surveillance – Was the outbreak detected in a timely fashion?
• ORI implementation – Did the ORI achieve high coverage? Were
AEFI reported? Were there any severe AEFI? Was risk
communication effective?
• Border protection – Were early cases imported?

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Module 6: Recovery
Step 2: Work with appropriate programmes to address
gaps identified

• Work together to identify and tailor strategies to

address identified barriers and gaps (see Annexes
10 and 11 in the WHO Measles Outbreak Guide).
• Assure that those strategies are included in
appropriate plans (e.g. immunization annual plans,
district plans, facility microplans). See Annex 12 for
immunization specific strategies).
• Plans should include budgets and indicators to
monitor recovery.

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Module 6: Recovery
Step 2: Work with appropriate programmes to address
gaps identified

• To the extent possible, planning should be funded

by local resources.
• Following an outbreak, particularly a large,
disruptive one, it may be possible to identify local
resources.
• Advocacy messages should be developed to
highlight the risk of future outbreaks.

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Key messages

• Recovery after a measles outbreak response is an opportunity to

assess the successes and challenges of the response and to identify
areas within the immunization programme, the health system and
other partner agencies to strategize improvements.
• Recovery planning should start as soon as possible after the outbreak
interventions.
• Build on partnerships that were developed during the outbreak
response and work together to tailor strategies to overcome gaps now
and in the future.

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Reference documents
WHO Recovery Toolkit
https://apps.who.int/iris/bitstream/handle/10665/205944/WHO_HIS_SDS_2016.2_eng.pdf?sequence=
1&isAllowed=y

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 Thank you.

World Health Organization

Geneva, Switzerland
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