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Monitoring & Evaluation for Routine Immunization: Data For Action. Using information to improve routine immunization services. Presentation 2 Objectives. Be familiar with the role of information in routine immunization

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Monitoring evaluation for routine immunization data for action

Monitoring & Evaluation for Routine Immunization: Data For Action

Using information to improve routine immunization services


Presentation 2 objectives
Presentation 2 Objectives Action

  • Be familiar with the role of information in routine immunization

  • Be able to use, modify or develop tools for monitoring or improving data quality and use at health facility / district level

  • Be aware of resources available for vaccination information in routine immunization


Overview of m e framework for ri
Overview of M&E framework for RI Action

Goals

* WHO / UNICEF Global Immunization Vision and Strategy

** Millennium Development Goal 4


How monitoring works for ri
How monitoring works for RI Action

  • RI staff at all levels routinely monitor system performance and use this information to drive decision-making

  • Monitoring indicators include

    • Doses administered, coverage, dropout

  • Monitoring tools include

    • Monitoring charts, tables, monthly summary forms

  • Internal monitoring activities include

    • Supervision visits

    • Rapid community assessments


How evaluation works for ri
How evaluation works for RI Action

  • Internal evaluation activities include

    • Annual reporting of ~40 EPI indicators to WHO/UNICEF including doses administered and immunization coverage

    • Data quality self-assessments

    • Lot quality assurance surveys

  • External evaluation activities include

    • External immunization coverage surveys

    • Data quality audits


How data for action works for epi
How Data for Action works for EPI Action

  • RI staff are expected to monitor their system AND use this information for action

  • Use of RI information to improve coverage is often the weakest part of RI

  • Supervisors (& you) should observe and ask staff if they know how to both calculate and use monitoring indicators, tools and activities


Common ri indicators
Common RI Indicators Action

  • Service performance

    • Defined as number of children receiving one of the later vaccines

      • Coverage with DTP3 (DTP = DPT = DTC)

      • Coverage with measles

      • Percentage of children never reached

  • Access

    • Defined as availability/start of services (number of children who received one of the earliest vaccines)

      • Coverage with BCG or DTP1

  • Utilization

    • Defined as continued use of services

      • “Dropout rate” e.g. the number of children who received an early vaccination (DTP1) compared to the number of children who received a later vaccination (DTP3)


How to calculate coverage
How to calculate coverage Action

  • Coverage formula

    ________number of doses given_______ X 100

    estimated number of age-eligible children

    in catchment area

  • Sources of error for coverage

    • Number of doses given

    • Estimated number of age-eligible children in the catchment area


How to calculate dropout
How to calculate dropout Action

Dropout definition: Child begins but does not complete immunization schedule

Drop-out rate formula

[ ( # Beginning – # Ending ) / # Beginning ] X 100

  • Usually, series begins with DTP1 or BCG

    and ends with DTP3 or measles

    = [( DTP1 – measles ) / DTP1] X 100

    = [( DTP1 – DTP3 ) / DTP1] X 100

    = [( BCG – measles ) / BCG] X 100

    = [( BCG – DTP3 ) / BCG] X 100


Visualization of never reached versus drop outs
Visualization of Never-reached versus Drop-outs Action

Never-reached

Never-reached

Drop-outs

Drop-outs



Tool 1 monitoring chart
Tool 1: Monitoring chart Action

  • Used at multiple levels to visually track monthly performance

  • Charts include:

    • Number of doses administered per month

    • Cumulative number of doses administered in year

    • Coverage rate

    • Difference in number of doses administered between 2 vaccines (dropout)

    • Monthly target and cumulative target population

  • Good charts are:

    • Up to date

    • Properly filled


Completing an immunization monitoring chart
Completing an Immunization Monitoring Chart Action

  • Enter monthly objectives on the y-axis (target population ÷ 12)

  • Diagonal line represents regular progress over a 12 month period ending with 100% coverage

  • Every month

    • Enter the antigen total for the month

    • Calculate the cumulative total for the antigen

    • Mark the cumulative total on the chart with a dot

    • Calculate the cumulative number of drop outs

    • Calculate the cumulative drop out rate


Practice how to fill in a monitoring chart
Practice: How to fill in a monitoring chart Action

  • Zorgho, 2003

  • Target population < 1 = 12,897


Zorgho Action

2003

12897

1075

12897

11822

10748

9673

8598

7523

6449

5374

4299

3224

2150

1075

0


Zorgho Action

2003

12897

1075

12897

11822

10748

9673

8598

7523

6449

5374

4299

3224

2150

1075

0

836

836

909

1745

818

2563

525

525

631

1156

539

1695


Zorgho Action

2003

12897

11822

10748

9673

8598

7523

6449

5374

4299

3224

DTP1

2150

1075

DTP3

0

836

836

909

1745

818

2563

525

525

631

1156

539

1695

311

589

868

37

34

34


Tool immunization summary form
Tool: Immunization summary form Action

  • Facility summary form

    • Summary of doses administered at facility

    • Data summarized from session tally sheets

  • District summary form

    • Summary of doses administered across all facilities in district

    • Data summarized from facility summary sheets

  • Sent monthly by each level

  • Used nationally as source of information on number of doses administered


Illustrative flow of immunization summary information
Illustrative flow of immunization summary information Action

National

Department of

Epidemiology

EPI program

Consolidated monthly

Surveillance report

Weekly reports

Consolidated monthly

reports, vaccination

Case reports

District

Monthly reports

Case reports

Weekly reports

Health Center

consolidates

Tally sheets

Patient registers

Case reports

Health Center

Health posts

Outreach sites



Tool defaulter tracking system
Tool: Defaulter Tracking System Action

  • Method to identify children who did not return for vaccination (drop outs)

  • Multiple tools used as “tracking system”

    • Ledger of children’s names who dropped out

    • Tickler box or blanket

      • Copy of vaccination card is kept with the month when child is expected to return

      • At end of month, remaining cards used to identify and then find children who did not return



Tool: Prioritize your locations by severity of problems (I)

What proportion of the children have ACCESS to immunization services? (what is DTP1 coverage?)

HIGH coverage with DTP1 (>80%)

Low coverage with DTP1 (<80%)

What proportion of children COMPLETE the immunization schedule (what are the DTP1 - DTP3 drop-out rates?)

Drop-out rate <10%

Drop-out rate >10%

Drop-out rate <10%

Drop-out rate >10%

Categorize the problem

  • Dropout rates are low = good utilization

  • Coverage is high = good access

  • Category 1 (no problem)

  • Dropout rates are high = poor utilization

  • Coverage is low= poor access

  • Problem Category 4

  • Dropout rates are high= poor utilization

  • Coverage is high = good access

  • Problem Category 2

  • Dropout rates are low = good utilization

  • Coverage is low= good access

  • Problem Category 3

Source: Increasing immunization coverage at the health facility level, WHO 2001


Tool prioritize your locations by severity of problems ii
Tool: Prioritize (I)your locations by severity of problems (II)


Tool rapid community assessment
Tool: Rapid community assessment (I)

  • Monitoring tool used by supervisors to rapidly understand whether vaccination services are reaching the community and identify barriers to vaccination

  • Not a survey and does not generate coverage rates

  • Useful to use in places where administrative vaccination coverage is reportedly high

    • A rapid assessment should not find many unvaccinated children

  • General method

    • Select ~20 households and assess vaccination status and reasons for no vaccination

    • Should be conducted in parts of a catchment area where low coverage is expected


Thanks

Thanks (I)

Questions?


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