Name: The Polio Eradication Initiative: Monitoring Service Delivery During National Immunization Days; Assessing the Local Capacity to Strengthen Disease Surveillance.
Origin: Expanded Program on Immunizations (EPI) in Africa; Polio Eradication Initiative of WHO, USAID, BASICS.
Source: BASICS, with involvement of EPI staff in several African countries.
Basic Description: Guide for national and district immunization program managers to assist them in their polio eradication efforts and improvement of routine health services, with particular emphasis on service delivery and disease surveillance.
The guide covers five areas:
Country Applications: Checklists and guides in this document were adapted from actual examples that were developed and used by EPI managers in Zambia, Kenya, Uganda, Eritrea and Ethiopia. This tool has applicability throughout Africa and other regions where NIDs and to strengthen disease surveillance are found. Although this tool was developed based on polio eradication experience, the content could be adapted for monitoring service delivery and assessing local capacity to strengthen surveillance for other infectious disease control initiatives.
Languages Available: English.
Technical Scope: Global, regional, national, and district levels for developing and implementing strategies to improve the quality and sustainability of immunization.
Purpose: To monitor the performance of immunization program activities. Data can be also be used for program planning.
Type of Methods: Quantitative and qualitative.
Design: Descriptive, cross sectional or longitudinal.
Frequency of Administration: Yearly and/or monthly, depending on NIDs and routine immunization program needs.
Key Users of Information
Primary users: National and district level EPI managers and supervisors.
Secondary users: Local EPI staff (e.g., health facility level; health workers that monitor/provide immunization services); international organizations involved in polio eradication and routine immunization programs.
Objectives and Scope of Tool
Objective: To familiarize users with the "process monitoring" approach for planning and implementing NIDs, and encourage systematic application of this experience to the routine immunization program.
Scope: The guide recommends approaches for collecting and analyzing information to: determine the effectiveness and quality of the NID; enable management to make timely decisions for improving future NIDs; increase attention to priority issues during supervisory visits; and utilize data collected during NIDs to reinforce routine program activities and determine the priorities for future program evaluations.
Key Monitoring Needs and Evaluation Questions Tool Seeks to Address
It is suggested that the user first determine what information is needed to assess the effectiveness and quality of the NID in areas such as:
The following basic questions should be answered at the national, district, and health facility levels:
1) Was the planning adequate at all levels?
2) Are the reported data on immunization coverage reliable?
3) Were immunizations given safely and effectively?
4) Did the NIDs reach all communities, as planned?
5) Were people adequately informed about NIDs? How were people informed?
Key Indicators
Reliability of Reporting
Indicator 1: # of immunizations given and the reported coverage for children under 12 months of
age; and the reported coverage for the entire target age group (children under five years).
Indicator 2: Geographical areas reporting greater than 100% coverage.
Indicator 3: Geographical areas reporting less than 80% coverage or the level set by
management.
Indicator 4: Timeliness and completeness of reporting.
Indicator 5: Recording practices.
Vaccine Supply, Distribution, and Quality
Indicator 1: Dates OPV received at health facilities and outreach posts.
Indicator 2: OPV supply at delivery point.
Indicator 3: # of immunizations given compared with the total amount of vaccine used.
Indicator 4: Availability of ice during transport of vaccines and immunization sessions.
Indicator 5: Status and knowledge of the Vaccine Vial Monitors.
Indicator 6: Availability, knowledge, and status of cold chain monitors in health facilities with
refrigerators.
Indicator 7: Condition and capacity of refrigerators.
Immunization Delivery Strategy
Indicator 1: Attendance at immunization sessions and coverage of the target population.
Indicator 2: Immunization sites properly located.
Indicator 3: Children receiving OPV during both rounds.
Indicator 4: Mothers' travel time to the immunization site.
Indicator 5: Organization of the immunization session.
Indicator 6: Geographical coverage and coverage by catchment area.
Social Mobilization
Indicator 1: Mother's knowledge of the vaccine given, purpose of NIDs, target age group, and
dates for the next round.
Indicator 2: Mother's source of NIDs information.
Research Design
Process monitoring can provide useful qualitative and quantitative information for management, improving decision-making capabilities. The following tools and techniques are discussed and incorporated into this document:
Implementation
The checklists provided in this document are to be used by the supervisor and health workers as monitoring and supervision tools during micro-planning or assessment visits for NIDs, as well as routine monthly or quarterly supervisory visits. It is therefore important that they are available at the local or district level. Since they are to be used by program staff as part of routine activities, the only additional cost relates to reproduction of blank checklists (and possible initial translation into local language, if necessary) as well as some additional time required by the supervisors or health workers to complete and assess the checklists.
Analysis
The supervision and social mobilization tools were designed to monitor service delivery or social mobilization during NIDs. They provide an analytical approach to supervision and offer a broad perspective on the quality of services for one to five immunization sites, ten sites, or more. Using the suggested format, a supervisor can determine a score or rate for the various indicators and gain an overall picture of the area to determine where improvements are needed in immunization programs and services. The disease surveillance checklist enables district health teams to determine the level of available capacity and resources, and plan and budget disease surveillance and response strategies.
Use of these tools requires constructive monitoring. Supervisors and health workers must expend time and effort on exchanging information and observations, providing realistic and appropriate advice and feedback between levels, and conducting cooperative planning activities based on the data collected. Checklists can be manually completed and should be stored at the local and district levels. Computers are not required; although the checklists and data could be entered into a computerized system like EpiInfo. The "Report on National Immunization Days" should be clear and concise, and should be typed or, preferably, entered and printed via computer.
Reporting
The documentation outline for reporting on NIDs is designed to guide the NID coordination team in the preparation of an informative final report. The report will document the year's NIDs and can also be used as a guide for planning and implementing future NIDs. In addition, this report will fulfill donor requests for documentation on the use of funds for the Polio Eradication Initiative. The checklists should be utilized and kept at the local and district levels, with copies going to the national level, as required by the national immunization program. The "Report on National Immunization Days" may need to be shared with the NID coordinating committee, the districts, EPI and MOH staff, donor organizations, and other external contributors (such as Rotary Clubs, businesses, local leaders, churches, and NGOs).
Manuals and Guidelines
Guidelines are contained within the document. They should be used in conjunction with NIDs and routine immunization materials (developed by WHO, UNICEF) that are already in use in many countries.
References
A bibliography of BASICS reports on polio eradication and disease surveillance in various countries is attached as an appendix to this document. Related materials from WHO can be referenced and ordered from the "WHO GPV Catalogue '98", WHO/GPV/98.02 (also available on the Internet at: www.who.ch/gpv-documents).
Other
The spreadsheets and lists in the WHO publication, "Field Guide for Supplementary Activities Aimed at Achieving Polio Eradication", (WHO/EPI/GEN/95.01 Rev.1) are useful tools for monitoring the preparation for NIDs. This WHO guide should be used as a complement to the Guide reviewed here.
Contact Person
Robert Steinglass
BASICS Project
1600 Wilson Blvd.
Arlington, VA 22209
703-312-6800