WHO IVB 04.05 (Booklet1)

AssessmentMethodology

WHO

World Health Organization

WHO/IVB/04.05

The Common Assessment Tool for Immunization Services

Immunization,Immunization,Vaccines and BiologicalsVaccines and Biologicals

Booklet 1

The Department of Immunization, Vaccines and Biologicals thanks the donors whose unspecified financial support has made the production of this document possible.

This document was jointly produced by the

Expanded Programme on Immunization

of the Department of Immunization, Vaccines and Biologicals

This document is available on the Internet at:www.who.int/vaccines-documents/

Copies may be requested from:World Health Organization

Department of Immunization, Vaccines and Biologicals

CH-1211 Geneva 27, Switzerland

Fax: +41 22 791 4227 Email: [email protected]

© World Health Organization 2002

All rights reserved. Publications of the World Health Organization can be obtained

from Marketing and Dissemination, World Health Organization, 20 Avenue Appia,

1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857;

email: [email protected]). Requests for permission to reproduce or translate

WHO publications – whether for sale or for noncommercial distribution –

should be addressed to Publications, at the above address (fax: +41 22 791 4806;

email: [email protected]).

The designations employed and the presentation of the material in this publication

do not imply the expression of any opinion whatsoever on the part of the World

Health Organization concerning the legal status of any country, territory, city or area

or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Dotted lines on maps represent approximate border lines for which there may not

yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not

imply that they are endorsed or recommended by the World Health Organization in

preference to others of a similar nature that are not mentioned. Errors and omissions

excepted, the names of proprietary products are distinguished by initial capital

letters.

The World Health Organization does not warrant that the information contained in

this publication is complete and correct and shall not be liable for any damages

incurred as a result of its use.

Contents

About this booklet 5

Forms in this booklet 6

1 The Common Assessment Tool (CAT) for Immunization Services 7

What is the CAT? 7

What is the CAT for? 7

Using the methodology for planning 7

Who is the CAT for? 7

Why do we need the new CAT? 8

2 The assessment approach 11

Principles of the methodology 11

Comparing the new methodology with earlier approaches 12

Why take a health system approach? 14

The three elements of the assessment 17

3 The assessment process 19

Overview of the process 19

Step 1 Initiating the assessment 22

Step 2 Preparing for the assessment 30

Step 3 Planning data collection 33

Step 4 Collecting data 38

Step 5 Analysing findings and developing recommendations 43

Step 6 Debriefing 48

Step 7 Planning for implementation and monitoring 49

Annex 1 Key indicators 51

Annex 2 Conducting a SWOT analysis 59

Carrying out the analysis 59

What to look for under each component of the SWOT analysis 60

Annex 3 Data Collection Guides for analysing data and developing recommendations 63

Annex 4 Incorporating the assessment recommendations into the national plan 67

Annex 4a Identifying activities needed to achieve targets and objectives 71

Annex 4b Estimating costs and funding sources 75

Annex 4c Summarizing projected costs of the immunization programme over the five year period 79

Common Assessment Tool for Immunization ServicesBooklet 1 – Assessment Methodology 3

Annex 5 Assessing capacity building 83

Definition of capacity building (CB) 83

Capacity building must maintain and develop existing abilities 84

Capacity building indicators 84

Annex 6 Financial Sustainability Diagnostic Tool (FSDT) 87

Introduction to the FSDT 87

Objectives of the FSDT 87

Methodology of the FSDT 88

Acronyms 89

Annex 7 New Vaccine Discussion Guide 103

Annex 8 Glossary and abbreviations 105

Common Assessment Tool for Immunization Services4 Booklet 1 – Assessment Methodology

About this booklet

This booklet gives you the information you need to carry out an assessment of immunization services.

It includes:

• details of why it’s important to take account of health system functions when carrying out an assessment

• detailed instructions for carrying out an assessment using the CommonAssessment Tool (CAT)

• detailed instructions for analysing the data you collect

• detailed instructions for making recommendations on how immunizationservices can be improved given the opportunities and constraints in thehealth system as a whole.


Forms in this booklet

The following photocopiable forms can be found in this booklet on the pages shown.

MS Word versions of the forms are also on the CD enclosed in the folder. The MS Word versions can be modified and adapted for the country being visited.

Form title Form reference Page

Summary of SWOT analysis Form 1.1 61

Data Collection GuideImmunization services Form 1.2 64

Data Collection GuideHealth system Form 1.3 65

Summary tableImmunization services activities Form 1.4 72

Summary tableHealth system activities Form 1.5 73

Estimated costs and funding sourcesImmunization services Form 1.6 76

Estimated costs and funding sourcesHealth system Form 1.7 77

Summary of projected costs (five year period)Immunization services Form 1.8 80

Summary of projected costs (five year period)Health system Form 1.9 81

Financial Sustainability Diagnostic Tool (FSDT) Form FSDT 90 – 102


The Common Assessment Tool (CAT) for Immunization Services

What is the CAT?

The CAT describes the methodology for assessing immunization services in the wider context of thehealth system.

What is the CAT for?

Using the CAT should increase your knowledge of the current and potential capacity of the health systemand the individual, programme, and system competencies that are necessary to improve performance.Assessments carried out using the CAT can also provide the information needed to develop or updatenational plans and prepare proposals for securing the support of development partners.

Using the methodology for planning

You can use the methodology in this booklet when you are planning an immunization programme to:

• increase the accessibility and use of routine immunization services, especially for people who are not currently reached

• improve the quality of immunization services

• introduce new vaccines and new technologies

• support increased financing for immunization services

• support health system development.

Who is the CAT for?

The guidelines are primarily for national level staff members who are responsible for planning,implementing, and evaluating immunization services. However, development partners collaborating withnational governments can also use them.

You can also adapt them for local health workers and sub-national staff to use to assess day-to-dayoperations and resource management in their areas of responsibility.


Development partners are public and private, national andmultinational organizations that offer technical, management, andfinancial support to developing countries.

1Chapter

... take full account of health systems

... acknowledge changes in the external environment and their effects on the health system

... assess whether existing services are ready for the introduction of new vaccines and technologies

... meet more challenging disease control goals

Health sector structure, the location of authority and responsibility, and the mix of public and private participation are changing significantly in many countries. The methodology proposed in these guidelines examines the health system and the external environment in which immunization services operate, as well as the services themselves.

Health systems exist in a wider external environment which is subject to many different types of change including epidemiological change, change in the macro-economic situation and policies, and change in the role of the public sector.

These changes often cause changes in many aspects of health systems, including the structure of the health system, the location of authority and responsibility, and the mix of public and private participation in the health system.

a Changes to healthcare mean changes to the way we approach assessments.

It is important to assess existing services to see if they are ready to introduce and sustain new vaccines and technologies.

If we are to eradicate polio and other vaccine-preventable diseases, new strategies, or improvements to current strategies, will be needed. So we need to assess the capacity of the health system to help determine if new disease control strategies can be implemented.

Why do we need the new CAT?

National and international experts have been carrying out assessments of immunization services for manyyears and these assessments have usually provided valuable information that useful recommendationscould be derived from. However, changes in the healthcare environment mean that we now need a newapproach to assessments.

The table below shows the main reasons why these new guidelines are needed.

The new guidelines ...


... provide a common assessment tool

... make sure new investments are sustainable and benefit the whole system

... introduce a new approach to fieldwork

Health sector officials, managers of services, development partners, and non-governmental organizations (NGOs) have asked for a common assessment tool to identify where improvements are needed. They want agreement on the improvements needed so that they can plan individual and joint inputs to immunization services.

The assessment needs to consider activities which benefit the whole health system because investments in outcome-orientated programmes usually have consequences for the whole system.

Your solutions and recommendations should be sustainable, and not those which benefit immunization services in the short term while having a negative impact on other services.

a Solutions and recommendations should benefit the whole health system, not just immunizations services

In the past, many assessments of immunization services focused on gathering quantitative data, with people going into the field with set questions to answer, tables to fill in and boxes to tick. When they met workers at the sub-national and service delivery levels, they questioned them to collect the data they needed to fill in the gaps.

However, it is more productive to look for the ‘issues behind the facts’ – to identify causes and trace them back to their source. This means you may have to talk with people and probe for answers and information.

Instead of questionnaires to fill in, we have provided Data Collection Guides to remind you of the key information you need to collect. You can adapt these and add any other information you need to get to the bottom of a particular issue.



The assessment approach

Principles of the methodology

The assessment methodology described in this booklet is based on the five principles below.

1 Focus on performance

Performance is the measure of quality, efficiency, and the impact of immunization services.

2 Focus on the service delivery level and trace problems you find there back to their origin

Initially, you will investigate performance problems at the service delivery level and track those that donot have local causes through the system until you find their origin.

3 Involve people who know what the problems are, and who will take part in implementing solutions

Change can only take place if the people who know what the problems are, and who will make therecommendations, are engaged in identifying and solving the problems.

4 Apply a health system perspective to immunization services

The health system and the external environment strongly influence who is immunized and howimmunizations are provided, so the assessment methodology examines both the health system and itsenvironment. Immunization is just one of the services the health system provides, so you should notconsider it as operating on its own. The strengths and weaknesses of immunization services will haveimplications for the health system, and changes to one will affect the other.


Immunization services don’t operate on their own – changes to the health system will affect immunization services.

Questions to ask when you are assessing performance

• Is the target population being immunized?

• Are children returning for second and third doses?

• Are health workers using safe practices?

If the answer to any of these questions is ‘no’, what is impeding performance?

2Chapter

5 Use in-depth inquiries and analysis to identify strengths, weaknesses, opportunities, and threats

Use the Discussion Guides in the other booklets as a guide to making inquiries and probing forinformation about internal strengths and weaknesses, and external opportunities and threats. The information people give you should help you find real problems, real causes of the problems, and practical solutions.

Comparing the new methodology with earlier approaches

From a quantitative approach to a qualitative approach

In the past, the focus of assessments of immunization services was on gathering quantitative data withteams using set questions and lists to gather information. However, we now recognise that we need amore qualitative approach which aims to find more than just facts and figures.

New tools for gathering information

Instead of questionnaires, we have prepared Data Collection Guides for gathering information. These givepeople at the sub-national and service delivery levels more opportunity to talk about what they considerthe key issues to be, and what their possible solutions are.


Find real problems, real causes of the problems, and real solutions to the problems.

Adapt the Data Collection Guides for each site you assess

• You may have to adapt the Data Collection Guides for each site so thatyou can talk to different people at each level about the same problem.

ImmunizationServices

Thehealthsystem

The externalenvironment

Stewardship

Human resource development

Finance

Service delivery

Immunization service delivery

Disease surveillance

Logistics

Vaccine supply and training

Advocacy and communications

Multi-level problem analysis

The flowchart below gives an example of how a problem identified at service delivery level can be tracedback to its causes at other levels in the health system.


• Facility does not meet national coverage targets

• Immunizations cancelled due to staff shortages

• Not enough trained staff in place

• Staff leaving because they are not promoted within the system

• Teams are not promoted according to scale

• No training programmes in place

• No effort to attain national standards for staffing levels

• No master training plan in place

A circular process

• The new process is circular and so needs to be repeated every three to five years so that the implementation of recommendations and changes can be monitored and assessed.

A health system approach

The World Health Organization defines a health system as the activities and organizations whose primarypurpose is to promote, restore, and maintain health.

Health systems have four main functions:

• Stewardship

• Human resource development

• Finance

• Service provision.

Functions of a health system in relation to immunization services

Why take a health system approach?

There are three main reasons why you need to take a health system approach when you are assessingimmunization services.

1 Immunization services are part of the health system

Immunization services are becoming increasingly integrated with other health services operating in thehealth system, so they cannot be viewed as operating on their own.

This means that the strengths and weaknesses of different parts of the health system affect theperformance of the immunization programme. Changes to immunization services can affect other services and other aspects of the health system both negatively and positively.

Improvements to immunization services will also be affected by health system functions, so ifimprovements are to be successful, you need to take these into account.

2 Funding can be focused on health system development

As well as accessing new funds for improving immunization services, there will be opportunities toimprove the health system as a whole, and to create synergies between its parts.


Immunization services are part of the health system – they don’t operate on their own.

Stewardship

Finance

Human resourcedevelopment

Service delivery

3 Sustainability depends on the health system

One of the main outcomes of an assessment is a set of recommendations for change.

Any change aimed at strengthening immunization services must be sustainable, whether it is based onroutine activities or on the introduction of new vaccines. A health system approach makes it easier toassess how sustainable a recommendation for change is.

Defining the levels in the health system

The health system in each country operates on three main levels:

National level Responsible for policy-making and standard-setting. This is usually thetop level of government in a country. However, in some large countriespolicy-making and other ‘central’ functions can be at state level.

Sub-national level Responsible for providing management support to the service deliverylevel in accordance with policies and guidelines issued by the nationallevel.

Many countries have two sub-national levels:

• regions, states, or provinces

• districts.

Service delivery level Responsible for providing health services including:

• health facilities

• health centres

• health posts, dispensaries

• hospitals

• private practitioners.


What makes a change sustainable?

For a long-term change to be sustainable, it must be able to:

• secure necessary inputs effectively

• secure necessary support effectively

• provide a continuing stream of activities and outputs that are valued by its stakeholders as long as they are needed.

What makes a health system sustainable?

A health service is sustainable when it is operated by a system with the long-term ability tomobilize and allocate sufficient resources (including manpower, technology, information,and finance) for activities that meet individual or public health needs and demands.

How the three levels in the health system operate


National level

Service delivery level

• Sets policies and standards for health systems

Sub-national level

• Manages the implementation of policies and standards for health services

• Provides health services

The three elements of the assessment

This assessment methodology is based on collecting and analysing data about immunization services, thehealth system, and the external environment.

You will need to collect data for each of these at the national, sub-national, and service delivery levels.Before you can make any recommendations, you will need to analyse the data separately by level andthen link the data for each level in a final analysis of service components and system functions.

1 Immunization services

Immunization service delivery The strategies and activities involved in immunization delivery.

Disease surveillance Monitoring disease incidence, laboratory testing, record keeping, andreporting.

Logistics Transport, cold chain, waste disposal, and delivery of vaccines and other equipment to the place where they will be used.

Vaccine supply and quality Forecasting vaccine needs, procuring vaccines, vaccine utilizationmonitoring and safety.

Advocacy and communications Social mobilization, advocacy, immunization education and promotion.

2 Health system

Stewardship Management of the public’s health, and of the individuals andorganizations that provide health services. Stewardship includes:

• policy-making and standard-setting

• planning

• information management

• coordination among public and private health providers

• cooperation with development partners and sectors and withstakeholders outside the health system

• monitoring

• advocacy

• evaluation

• regulation and legislation

• quality assurance

• infrastructure development and logistics

• programme design and evaluation.

Human resource development Human resource development includes:

• employing and assigning staff

• training

• supervision of staff.

Finance Finance includes:

• budgeting

• identifying funding sources

• collecting and allocating revenues

• tracking expenditures.

Service provision Service provision includes:

• delivery of preventative and curative health services.


• Immunization services • Health system • External environment

3 External environment

Trends Trends include:

• geographic

• political

• economic

• social and technological, for example, macro-economic reforms

• increased pressure for economic self-sufficiency

• decentralization.

Expectations and needs Stakeholders include:of stakeholders • the public

• politicians

• the education sector and other sectors

• development partners

• competitors and collaborators, for example, private practitioners orthe education sector.


The assessment process

Overview of the process

There are seven steps in the assessment process. These are illustrated on the chart on the next page andare described in detail in the rest of this chapter.


3Chapter

1 Initiating the assessmentStep

2 Preparing for the assessmentStep

3 Planning data collectionStep

4 Collecting dataStep

5 Analysing findingsand developing recommendations

Step

6 DebriefingStep

7 Planning for implementationand monitoring

Step

Step

Initiating the assessment

4 to 6 calendar monthsbefore the assessment begins

Task 1.1Decide that an assessment is needed

Task 1.2Appoint an Assessment Secretariat Task 1.3Prepare Terms of Reference

Task 1.4Identify members of the Assessment Team

Task 1.5Identify members of the Planning Team

Task 1.6Prepare an assessment schedule

Task 1.7Plan support for the assessment

Task 1.8Identify funding sources and mechanisms for all assessment activities

Ministry of Health Planning Team All Assessment Team members

Comprehensive Terms of Reference outlining the reasons for the assessment

Team members identified

Planning datacollection

2 to 3 calendar days

Task 3.1Explain assessment objectives

Task 3.2Brief the team on critical issues for country immunization operations and health system

Task 3.3Provide an overview of the assessment methodology

Task 3.4Reach a consensus on whichcritical issues to pursue

Task 3.5Adapt data collection materials

Task 3.6Reach a consensus on sub-national areas for assessment

Task 3.7Review the data collection process

Task 3.8Prepare sub-teams for data collection

Task 3.9Review special issues

Objectives and methodology understood Information from Planning Team reviewed

Preparing forthe assessment

1 to 2 person months

Task 2.1Collect, compile, and review available information on immunization operations, the health system, and theexternal environment

Task 2.2Identify critical issues for immunization and the health system by conducting a SWOT analysis

Task 2.3Compile key materials for Assessment Team members

Task 2.4Prepare to brief the entire Assessment Team

Task 2.5If appropriate, select sub-national areas for visits

Critical issues forimmunization and the health system identified

Gaps in information uncovered

Time

Tasks

Who

Outcomes

1 Step2 Step3Overview of theassessmentprocess


National, Sub-Nationaland Service DeliverySub-Teams

All Assessment Team members with technical staff from key stakeholders

All Assessment Team members

Collecting data

5 calendar days

Task 4.1Visit the national, sub-national and service delivery level facilities

Task 4.2Collect data from the national, service delivery and sub-national level facilities

Task 4.3Debrief staff from the national, service delivery and sub-national level facilities

Data collected from all levels

Staff at each level debriefed on findings and preliminary conclusions

Analysing findingsand developingrecommendations

3 calendar days

Task 5.1Analyse information bysub-national area

Task 5.2Analyse information by technical area

Task 5.3Prepare the main conclusionsof the assessment Task 5.4Develop main recommendations of the assessment

Task 5.5Compile information andprepare the first draft of the Assessment Report

Task 5.6Prepare for debriefing

Findings reviewed

Recommendations agreed

Priorities for actions set

Debriefing report prepared

Debriefing

1 to 2 calendar days

All Assessment Team members with technicalstaff from key stakeholders

1 to 2 calendar days todevelop first draft

Task 6.1Debriefing

Task 6.2Complete the final draft of theAssessment Report

Debriefing report delivered

Planning forimplementationand monitoring

Task 7.1Incorporate recommendations into a draft multi-year national plan

Task 7.2Prepare a draft budget and financing plan

Task 7.3Plan howimplementationwill be monitored

Implementation of therecommendations planned

Step4 Step5 Step6 Step7


What happens during Step 1?

The Ministry of Health (MOH) decides that an assessment is needed and liaises with the InteragencyCoordinating Committee (ICC) to decide the dates for the assessment and who should take part in it.They outline their expectations in a Terms of Reference document.

Tasks for Step 1

Task 1.1 Decide that an assessment is needed

Task 1.2 Appoint an Assessment Secretariat

Task 1.3 Prepare Terms of Reference

Task 1.4 Identify members of the Assessment Team

Task 1.5 Identify members of the Planning Team

Task 1.6 Prepare an assessment schedule

Task 1.7 Plan support for the assessment

Task 1.8 Identify funding sources and mechanisms for all assessment activities

Task 1.1 Decide that an assessment is needed

The Ministry of Health and the national ICC decide if an assessment is needed and when it is needed.

This decision should be made four to six months before the assessment to make sure there is enough timeto prepare for the assessment and to translate the assessment booklets if necessary. The MOH may ask forthe help of a technical partner such as WHO or UNICEF in the preparation phase and in other phases.

Task 1.2 Appoint an Assessment Secretariat

The MOH may decide to appoint an Assessment Secretariat to arrange the logistics for the assessment.

A secretariat is a team of two or three people, often including staff from the immunization programme,WHO or UNICEF, and other key partners. The secretariat supports the Planning Team’s activities before theAssessment Team arrives, and provides support during the preparation, data collection, analysis, andrecommendation steps.

Task 1.3 Prepare Terms of Reference

The reasons for conducting an assessment will be different for each country but they should be explicitlystated in a Terms of Reference document.

This document should tell stakeholders, such as MOH officials and development partners, what thepurpose of the assessment is and how it will be conducted. The Terms of Reference should not be morethan three pages long.


Initiating the assessment1Step

Task 1.4 Identify members of the Assessment Team

Who should be on an Assessment Team?

Most Assessment Team members will need knowledge and experience of immunization programmes. Team members can include:

• planning or health system specialists who have extensive knowledge of how health systems work indifferent contexts

• finance staff

although they can contribute to a broader view of the health system, these staff need to be assigned to a teamwith people who have experience of immunization programmes

• maternal and child health staff

although they can contribute to a broader view of the health system, these staff need to be assigned to a teamwith people who have experience of immunization programmes

• national, sub-national and service delivery health managers from within the country and neighbouringcountries

their participation can be very helpful, and can have a long-lasting impact on the improvement of services intheir country

• international experts

they should be assigned to sub-teams with national team members who know the country and its health system,and, if necessary, its language.

What skills do Assessment Team members need?

All members of the Assessment Team need to have critical thinking and communication skills that willhelp them to discuss the situation with people at each level and find the ‘issues behind the facts’.

The leader of the Assessment Team should have experience in:

• immunization programmes

• team leadership

• using this methodology.

How many team members should there be?

The number of team members will vary depending on the purpose of the assessment, the size of thecountry, and the number and location of data collection sites.


A successful team has a balance of national and international representation so that different knowledge, experience, and perspectives can be considered.

No matter how many people there are on the Assessment Team, you will need to assign some members to the national team and some to the sub-national teams.

Suggested team sizes

National Sub-Team

Number of members At least five.

Comments Individual team members may go to:

• different offices in the Ministry of Health

• partner agencies

• NGOs

• private associations

• other ministries, for example, planning and finance

• health facilities in the capital area.

Booklet 3 includes a Guide for Data Collection which national team membersshould use for this.

Sub-National and Service Delivery Sub-Teams

Number of members At least two for each district or sub-national level.

Comments After initially visiting the sub-national office, the team should divide again forvisits to health facilities. For example, in a country with regions and districts, thewhole sub-team of four would divide into teams of two to visit the selecteddistricts and health facilities within the districts.

Teams should visit public and private sector health facilities and meet withrelevant sub-national level officers, politicians and members of the communityand their leaders.

Is a full-time commitment needed?

Participating in the assessment means you will have to work full-time in preparation, data collection,analysis, making recommendations, and reporting activities. Some Assessment Team members may also beneeded at the end of the assessment to:

• finalise cost estimates for alternative strategies

• incorporate assessment recommendations into the multi-year plan of action for immunization

• complete writing the Assessment Reportsee Step 6.

Task 1.5 Identify members of the Planning Team

The Planning Team prepare for the assessment before the sub-teams go out into the field. Planning Team members need:

• data collection skills

• analysis skills

• knowledge of the immunization programme and health system in the country

• access to key data and other key documents.

As well as this, at least one member of the Planning Team will need to be familiar with health systemassessment procedures and tools.

More information

There is a summary of Planning Team tasks on pages 30-32 of this booklet, and there are Data CollectionGuides and Discussion Guides for the Planning Team in Booklet 2.


Task 1.6 Prepare an assessment schedule

An ideal schedule for a two-week assessment in a country that begins its working week on Monday would be like this:


How long will the Planning Team’s work take?

The Planning Team will take between four and six weeks to prepare for the assessment. They may also continue to take part in the assessment as members of the sub-teams.

Suggested assessment schedule

Day Step Activity Notes

Week 1Wednesday Step 3 planning

Thursday planning

Friday planning

Saturday planning, free day or travel

Sunday travel

Week 2Monday Step 4 data collection

Tuesday data collection

Wednesday data collection

Thursday data collection

Friday data collection

Saturday travel

Sunday Step 5 sub-teams analyse

Week 3Monday analysis and recommendations

Tuesday analysis and recommendations

Wednesday Step 6 debrief

Thursday Step 7 planning for implementation

Friday planning for implementation


The length of an assessment depends on its purpose and the size and nature of the geographical areabeing assessed.

If the work of the Planning Team is not included, an assessment using this methodology can becompleted in between two and three weeks, including travel. You will probably spend between 60% and70% of that time on fieldwork which can be split up so that:

• 25% of the time is for the team to plan for data collection – see Step 3, pages 33-37

• 50% of the time is for data collection, including interim analyses and meetings with stakeholders – see Step 4, pages 38-42

• 25% of the time is for analysis, developing recommendations, and briefing government authorities and other major stakeholders – see Steps 5 and 6, pages 43-48.

Schedule the assessment so that data collection starts on the first day of the working week, if possible.

Task 1.7 Plan support for the assessment

It is the job of the Assessment Secretariat to plan support for the assessment. This may include:

• helping to obtain government agreements for the assessment

• making sure information about the assessment is given to development partners

• coordinating invitations for Planning and Assessment Team members

• arranging for salaries, consultant fees, and daily wages for team members

• making hotel reservations

• coordinating transport

• reserving meeting space for Steps 3, 5, 6 and 7

• providing secretarial support and business equipment

• making sure there are adequate supplies of items like stationery

• making sure sub-national and service delivery sites are told about visits.


How many booklets are needed for the assessment?

Use the table to work out how many copies of each booklet you will need.

Booklet 1 Assessment Methodology

One copy for each member of the Assessment Team =

One copy for each member of the Planning Team =

15 extra copies = 15

Total number of Booklet 1 needed =

Booklet 2 Planning Team Assessment Instructions


One copy for each member of the Planning Team =



Booklet 3 National Sub-Team Assessment Instructions


One copy for each member of the National Sub-Team =



Booklet 4 Sub-National Sub-Team Assessment Instructions


One copy for each of the sub-national levels to be visited =



Booklet 5 Service Delivery Sub-Team Assessment Instructions


One copy for each service delivery level to be visited =



As well as this, every sub-national team should have:

• multiple copies of the Data Collection Guides

• one set of Data Collection Guides for each sub-national office and each health facility they visit

• enough copies of the Assessment Summary sheets to allow them to give a written summary to every level they visit.

What other documents will be needed?

Each sub-national team will also need a set of relevant documents. These may include:

• the national plan for the health system

• the national plan for immunization operations

• the health system budget

• the immunization budget

• national immunization policies

• operational guidelines

• reports of reviews and evaluations assessments of immunization operations conducted in the last three years.

What supplies will be needed?

The list below gives you details of the supplies the team will need.

• Notepads

each Assessment Team member will need a notepad to record the information they receive during field visits

• Flip chart paper

if this is expensive or difficult to find in the country, you can use newsprint instead. Newsprint is the paper newspapers are printed on. You can buy it from newspaper publishers for a small fee

• Index cards

approximately 4" x 6", but not smaller. If index cards are not available, you can use A4 notebook paper cut in half instead

• Masking tape or adhesive clay

for example, Blu-Tac

• Paper, pens, and pencils

• Thick felt-tip marker pens


Task 1.8 Identify funding sources and mechanisms for all assessment activities

Development partners and internal sources may provide sources of funds.

What should be included in the budget for the assessment?

The budget may include:

• salaries and daily wages for Planning and Assessment Team members

• travel and hotels

• secretarial support

• communication costs

• hire of meeting rooms

• photocopying and printing costs

• supplies and equipment

• translation costs.



The Planning Team is responsible for:

• collecting, compiling, reviewing, and collating material on immunization operations, the healthsystem, and the external environment

• carrying out a SWOT analysis to identify critical issues for immunization services and the health systemand their internal strengths and weaknesses and any external opportunities and threats they may face

• uncovering gaps in information

• identifying issues related to data quality.

Tasks for Step 2

Task 2.1 Collect, compile, and review available information on immunization operations, the health system, and the external environment

Task 2.2 Identify critical issues for immunization and the health system by conducting a SWOT analysis

Task 2.3 Compile key materials for the Assessment Team members

Task 2.4 Prepare to brief the entire Assessment Team

Task 2.5 If appropriate, select sub-national areas for visits

Task 2.1 Collect, compile, and review available information on immunization operations,

the health system, and the external environment

The Planning Team do not need to carry out any primary data collection, but do identify possible criticalissues using the data that is available.

You will need to work with the national immunization manager and members of the assessment to:

• review the Planning Team guidelines in Booklet 2

• consult with MOH staff and partners to find the most reliable sources of information

these could be people or documents with relevant information

• prepare a time schedule for Planning Team activities

• review information available at the national level.

More information

There are more details about the information the Planning Team needs to gather in Booklet 2 along withtools to help summarise the information.


Preparing for the assessment2Step

Task 2.2 Identify critical issues for immunization and the health system by conducting

a SWOT analysis

You will need to carry out a SWOT analysis to identify the strengths and weaknesses of immunizationservices and the health system, and the external opportunities and threats they face.

More information

There is more information about carrying out a SWOT analysis in Annex 2, pages 59-61.

After you have carried out the SWOT analysis, you will need to prepare a summary of critical issues whichshould include:

• any conclusions based on the SWOT analysis

• the possible implications of these conclusions on immunization services and the health system

• a brief description of any further assessment you think may be needed

• suggestions for where the Assessment Team could gather more information on the administrative level or levels.

Task 2.3 Compile key materials for the Assessment Team members

You should now prepare an assessment library of any documents the Assessment Team will need toconsult during the assessment process.


Special studies

The government may ask for an in-depth study of a particular aspect of immunization services such as financing, the cold chain, vaccine procurement, laboratory capacity, or health worker communication skills. In these cases, you will need to gather specific data which isbeyond the scope of these guidelines. However, national or international experts should be able to give you advice.

Introducing new vaccines

If a new vaccine or other innovation is being assessed before being introduced, the Assessment Team will need specific information on the requirements and guidance for its introduction. This information is available from WHO or UNICEF.

What types of documents should be included in the assessment library?

Consider including:

• national plans

• budgets

• policy documents

• standards

• guidelines for the health system and immunization services.

There is a list of suggested documents in Booklet 2.

Task 2.4 Prepare to brief the entire Assessment Team

You now need to brief the full Assessment Team on your findings and give them copies of the completedforms and Data Collection Guides.

This briefing should highlight:

• the basic characteristics of the national immunization programme and the health system

• your preliminary conclusions about critical issues for immunization services and the health system, andthe external opportunities and threats that seem to be present

• any areas where there are gaps in the information or where the quality of the data may be in question

• your recommendations about issues that need further analysis.

Task 2.5 If appropriate, select sub-national areas for visits

The MOH and ICC may ask you for advice on which sub-national areas to select for data collection. There is more information about this in Task 3.6, page 36.


Keep the presentation short – no more than 30 minutes – so that there’s timefor discussions and questions from the Assessment Team.


During Step 3 all members of the Assessment Team get together for the first time to:

• learn what the objectives of the assessment are

• review the information on immunization operations and the health system that the Planning Teamgathered during Step 2

• familiarise themselves with the methodology.

Tasks for Step 3

Task 3.1 Explain the assessment objectives

Task 3.2 Brief the Assessment Team on critical issues for country immunization operations and the health system

Task 3.3 Provide an overview of the assessment methodology

Task 3.4 Reach a consensus on which critical issues to pursue

Task 3.5 Adapt data collection materials

Task 3.6 Reach a consensus on sub-national areas for assessment

Task 3.7 Review the data collection process

Task 3.8 Prepare sub-teams for data collection

Task 3.9 Review special issues

How long will Step 3 take?

You will need between two and three days to:

• learn what the objectives of the assessment are

• review the information

• familiarise yourselves with the assessment methodology

• make adaptations to the Data Collection Guides and other tools, if appropriate.


Planning data collection3Step

Task 3.1 Explain the assessment objectives

The National Immunization Manager and the Team Leader will present the Terms of Reference and clearly explain:

• why the assessment is needed

• what questions it will try to answer

• how they will use the findings and conclusions from the assessment.


Suggested planning schedule

Day Activity

Day 1 Welcome and introductions

Explanation of the Terms of Reference and assessment objectivescarried out by Immunization Manager and Team Leader

Briefing on critical issues for country immunization operations and the health systemcarried out by Planning Team

Overview of the assessment methodology, including a briefing on the use of the SWOT techniquecarried out by Planning Team and Team Leader

Day 2 Identification of critical issues for sub-teams to follow upcarried out by technical work group

Adaptation of data collection materialscarried out by technical work group

Selection of first level of sub-national areas, if the Planning Team have not already done thiscarried out by technical work group

Day 3 Study of data collection processcarried out by group work and exercises

Preparation of sub-teams for data collectioncarried out by sub-team

Travel preparationscarried out by sub-teams with support from the Secretariat

Task 3.2 Brief the Assessment Team on critical issues for country immunization

operations and the health system

Members of the Planning Team will brief you on their findings on critical issues for immunizationoperations, the health system, and the external environment.

Task 3.3 Provide an overview of the assessment methodology

You now need to review the assessment methodology with the Planning Team to make sure everyoneunderstands the principles of the assessment, the health system approach, and how to carry out a SWOTanalysis.

Task 3.4 Reach a consensus on which critical issues to pursue

You now need to divide the whole Assessment Team into six technical work groups according to eachmember’s expertise and interests. Each work group should represent the health system and each of the fiveimmunization services components.

Once you have formed work groups, each group should:

• review any information provided by the Planning Team that applies to their technical area

• review the critical issues presented

• assess how adequate and reliable the data is

• identify gaps in the information and possible problem areas.

You should then present your findings to the whole Assessment Team which will decide:

• the strengths the data suggests

• the weaknesses the data suggests

• the issues that seem to be most important

• how these issues can be investigated further.


The five immunization services components

• Immunization service delivery • Vaccine supply and quality

• Disease surveillance • Advocacy and communications

• Logistics

You may need to form some additional groups depending on the objectivesof the assessment, for example, if you are introducing a new vaccine orintervention, you may want to form an additional group for this.

Task 3.5 Adapt data collection materials

Each technical group now needs to review the Data Collection Guides and Discussion Guides in Booklets 3, 4 and 5 and focus on the sections that relate to their technical area. Each technical groupshould consider the adaptations they need to make to the Data Collection Guides, taking into account the critical issues they agreed to investigate and the characteristics of the country.

After each group has done this, they should present the adaptations they are suggesting to the fullAssessment Team and reach consensus.

Task 3.6 Reach a consensus on sub-national areas for assessment

You will need to select sub-national areas for assessment, if the Planning Team has not already done this.

Consider the objectives of the Terms of Reference and identify immunization services and health systemcriteria to help you select sub-national areas for assessment. Also, think about things like the size of theAssessment Team, the location of sub-national areas and the transport available.

Examples of criteria to use when you are selecting sub-national areas

Area for assessment Criteria

Immunization operations Access to immunization services indicated by BCG or DPT1 coverage

Drop-out rateindicated by BCG-measles and/or DPT1-measles and/or DPT1-DPT3

Quality of disease surveillanceindicated by AFP rate or completeness and timeliness of routine reporting

Progress towards disease controlindicated by incidence of a disease in the area compared to the national average

Health system Extent to which health sector reforms have been introduced

Number of hospitals, health centres, and health posts

Adequacy of staffing – the number and capability of staff

Funding level

Public/private mix

External support

External environment Percentage of urban vs. rural population

Special populations in area

Social-economic factors, for example, literacy, poverty level, and theinfrastructure

Extent of decentralization


Adapt the Data Collection Guides taking account of any critical issues.

Task 3.7 Review the data collection process

The Planning Team, Assessment Secretariat and the Team Leader now use group work exercises, role play,and other suitable techniques to make sure all members of the Assessment Team are familiar with datacollection methods.

Task 3.8 Prepare sub-teams for data collection

You will now be allocated to a sub-team depending on your expertise. Sub-teams should meet separatelyto decide how to conduct the assessment. This should include studying the Data Collection Guides andDiscussion Guides, so that you do not have to refer to them much when you are in the field.

You should also review the Assessment Summary Sheets in Booklets 3, 4 and 5 which you will fill in andleave with unit staff after each visit.

Task 3.9 Review special issues

If the Planning Team has identified special issues, the full Assessment Team must decide how they willinvestigate them and make any adaptations to the Data Collection Guides. There is more informationabout this in Annexes 5, 6 and 7, pages 83-103.


An alternative method

An alternative method for making sure Assessment Team members are familiar with data collection methods is to organize a hands-on practice session in a health facilitythat will not be used as part of the assessment.

This will give you the opportunity to use the guidelines and debrief one another, and to compare techniques and calibrate interpretations of what you have seen and heard.

If you decide to do this, you may need to set aside an extra day for the practice session.

Special issues that may have been identified for the assessment include things like:

• assessing the capacity of the health system to add a new vaccine to the routine schedule

• identifying challenges in the introduction of auto-disable syringes

• capacity building

• financing sustainability.

National level

Sub-national level


1

1 Visit national level offices

2 Visit sub-national level offices to identify health and service delivery facilities

3 Visit health and service delivery facilities and collect data

4 Debrief health and service delivery staff

5 Visit sub-national level offices to follow up questions from health and service delivery facilities

6 Debrief sub-national level staff

7 Debrief national level staff

2

3

5

4

7

6


During Step 4 sub-teams visit the national level and the sub-national areas selected during Step 3 tocollect the data and select second level sub-national areas and service delivery level facilities for datacollection.

Timeline showing the sequence of what happens during Step 4


Collecting data4Step

More information

• Booklets 3, 4 and 5 include guidance about the data the sub-teams need to collect.

Tasks for Step 4

Task 4.1 Visit the national, sub-national, and service delivery level facilities

Task 4.2 Collect data from the national, service delivery, and sub-national level facilities

Task 4.3 Debrief staff from the national, service delivery, and sub-national level facilities

Before you start Step 4, make sure all members of the team are familiar with SWOT methodology and theDiscussion Guides for the sub-national and service delivery level.

Task 4.1 Visit the national, sub-national, and service delivery level facilities

Visit the sub-national offices to identify health and service delivery facilities

When you arrive at a sub-national office, you will need to meet with relevant staff members to:

• brief them on the assessment objectives and methods

• obtain basic information

• find out if you need to pay a courtesy call to local leaders

• ask for knowledgeable members of staff to join the sub-team.

Staff members you may need to meet with include the Medical Officer and the Health Management Team.

After you have briefed staff about the purpose of the assessment, you will need to ask them to help youidentify second level sub-national areas such as districts or facilities for the assessment. You can do this by applying the criteria in Step 3, pages 33-37, or by asking a few basic questions.

Examples of questions that may help you to select second level sub-national areas

• What was the area’s immunization coverage last year for DPT3, TT2+ and measles?

• Has immunization coverage in the area risen, fallen, or remained stable over the last three years? Are there any places with more noticeable changes?

• Which areas have the highest performance for immunization services and health services? Which are the lowest performing areas?

• Which areas have the most health resources? Which have the least?

• Is private provision of healthcare an important factor in this area? Where is it more prevalent? Where is it less prevalent?

The number of sub-national levels you will need to visit will depend on the structure of the government.If the country has more than one sub-national level – both regions and districts, for example – you willneed to agree which areas to include with staff at the sub-national level.

When you are choosing second level sub-national areas think about the distance you will need to travel tothem and the available transport. Include both high and low performing areas.

Considerations for selecting health facilities

When you are selecting health facilities try to:

• include facilities in both urban and rural locations

• only visit facilities with comparatively high populations in their catchment areas

• include facilities with comparatively high numbers of people who are not currently reached

• select peripheral facilities such as health centres for most of the visits

• include private facilities (both profit and non-profit) if a large percentage of them offer immunization in the area


• include facilities offering both fixed and outreach sessions

• include underserved areas, for example, those where services are less frequent, where there are nopermanent health workers, or those that are not covered by outreach sessions.

Visit health and service delivery facilities

Before you begin collecting data:

• meet with the director of the facility and any other facility staff who can contribute to the assessment

• explain the objectives of the assessment to staff members.

Task 4.2 Collect data from the national, service delivery, and sub-national level facilities

Collect data from health and service delivery facilities

The ten steps below give you information about the best way to do this:

1 Talk to staff members about the facility’s immunization services and other services.

2 Observe health workers when they are preparing and giving immunizations. If possible, go to outreach sessions with health workers.

3 Talk to clients to find out about their opinions and concerns about the services offered by thefacilities.

4 Talk to people in communities who do not use, or who do not have access to, the services to find outwhat they think the barriers preventing them from using the services are.

5 Meet with relevant community leaders to find out their opinion on immunization services in the area.

6 Use the Discussion Guide in Booklet 3 for ideas on how to initiate discussions, and how to find the‘issues behind the facts’.

7 Use the Data Collection Guides in Booklet 5 to record your findings. You don’t need to fill out everyline in the Data Collection Guides – only the information that will help you to clarify critical issues.

8 Use the SWOT technique described in Annex 2, pages 59-61, to identify the strengths and weaknessesof immunization services and the health system, as well as any external opportunities and threats thatmay have an impact on services. Summarize your conclusions on the forms provided.

9 Summarize what you think the critical issues for immunization services and the health system mightbe. This summary should include:

• any conclusions you have made based on the SWOT analysis

• possible implications these conclusions have for immunization services and the health system

• a brief summary of draft recommendations including suggestions on the administrative level or levels.

10 Meet with other sub-team members to:

• compare interpretations of what you have found and observed

• discuss problems implementing the assessment methodology

• modify planned visits, if appropriate.


Before you leave the health facility, give a completed Assessment Summary sheet to the staff. This willserve as a reminder of the discussions and will also be a benchmark for any future assessments.

Repeat tasks 4.2 and 4.3 until you have visited all the health facilities or areas selected for the assessment.Use a separate Data Collection Guide and Assessment Summary for each one.

Collect data from the sub-national office

You now need to return to the sub-national office and collect data for that level. You should also followup on any questions or problems identified at the service delivery level.

Use the Discussion Guides and Data Collection Guides in Booklet 4 to help you with this.

Task 4.3 Debrief staff from the national, service delivery, and sub-national level facilities

Debrief health and service delivery staff

When you have finished collecting data, meet with health facility staff to discuss your findings andpossible solutions for the problems identified. Consider including community leaders or key communityrepresentatives in the debriefing.

Before the meeting, write your findings on the strengths and weaknesses on flip chart paper or newsprintand stick it on the wall. Make sure that you allow local staff members and partners to take part fully inthe meeting. It should take between 45 minutes and an hour.


Finding the ‘issues behind the facts’

The Discussion Guide in Booklet 3 gives you ideas to help you find ‘the issues behind the facts’.

However, you should not use the Discussion Guide as a questionnaire, and you do not need to ask allthe questions in the discussion points column.

Instead, focus on the critical issues you agreed with the rest of the Assessment Team during Step 1.

You will have more success gathering the information if you try to establish an open dialogue withhealth staff and their stakeholders.

Local problems – local solutions

Local problems, such as immunization session scheduling, can often be solved at the local level.

You should discuss both the problem and the possible solution with health facility staff before leavingthe health facility.

You can then report the outcome of the discussion to people at the next level.

Share findings with those who are most concerned with them, and with those who can help to solve them.

Suggested debriefing meeting agenda

Review and discussion of findings Describe the strengths and weaknesses you have observed inimmunization services and health system functions. Ask staff ifthey agree with the findings, and invite them to make suggestionsor add information that will help you understand the situation.

Consensus on recommendations Ask staff what recommendations they suggest for solving problemsidentified.

Discuss suggested responsibilities for implementingrecommendations. For example, health facility staff can agree tocheck all their vaccines and remove any whose expiry date haspassed, but they probably cannot solve a vaccine supply problemwithout involving other levels.

Conclusions Review what health facility staff have suggested they will dothemselves, and what you have agreed to bring to the attention ofstaff at the next levels.

Debriefing sub-national level staff

Now meet with members of the Health Management Team and other staff members and stakeholders. Use this meeting to:

• report on findings at second level sub-national areas and the service delivery level

• reach agreement on the possible causes of the critical issues in these areas

• identify health system and external opportunities and threats that may affect immunization services

• agree on what second level sub-national and health facility staff can do

• agree on what the Assessment Team needs to discuss at the next level.

Before leaving the sub-national office, give staff a copy of the Assessment Summary for each health facilityvisited, and the summary for their sub-national level.

Why is the debriefing meeting important?

Debriefing sessions at the sub-national level are of great practical benefit as they allow sub-national staffto advise you on your findings, and give you feedback that can be included in the final conclusions andrecommendations.


Remember to congratulate health facility staff on any positive findings, and to explore options for solving problems which respect existing lines of authority and responsibility.


When the data has been collected, all members of the Assessment Team meet again at the national levelto review regional findings, agree on conclusions and recommendations, and to set priorities for actions.

At this stage, technical staff from key stakeholders or partner agencies may join the Assessment Team asthey can contribute to accomplishing the proposed tasks.

Tasks for Step 5

Task 5.1 Analyse information by sub-national area

Task 5.2 Analyse information by technical area

Task 5.3 Prepare the main conclusions of the assessment

Task 5.4 Develop main recommendations of the assessment

Task 5.5 Compile information and prepare the first draft of the Assessment Report

Task 5.6 Prepare for debriefing

Task 5.1 Analyse information by sub-national area

Your sub-team should spend between half a day and a day organizing notes and completing the report onthe sub-national level they visited. You will also need to analyse your findings, prepare conclusions basedon the SWOT analysis, and write preliminary recommendations.

Each sub-team should prepare a 10 to 15 minute presentation to the whole Assessment Team describing:

• their main conclusions about critical issues for immunization services and the health system in their area

• their main conclusions about immunization services and the health system in their area

• their recommendations.


Analysing findings and developing recommendations

There ...

Strategies and activities

Here ...

... is where we want to be

... is where we are now

5Step

In health planning there are three important questions to ask:

1 Where are we now? ... ‘here’the current status of the health system

2 How do we get from ‘here’ to ‘there’?strategies and activities that have to be organized, and the management support that is needed to organize them

3 Where do we want to be in the future? ... ‘there’the country’s goals and objectives

Task 5.2 Analyse information by technical area

At this stage the assessment changes from analysis by sub-national area to analysis by immunizationservices components and health system functions.

Copies of each sub-team’s reports showing findings, conclusions, and recommendations should bedistributed to the technical work groups formed in Task 3.4.

Each technical group should analyse the data and then summarise their findings on the Data CollectionGuides in Annex 3, pages 63-65. Each group should then make a ten minute presentation to the fullAssessment Team explaining their analysis. You can summarize any conclusions or recommendations on a large index card and stick it on the wall.

Immunization services work groups

Each of the five immunization services work groups should analyse its component and reach agreement on:

• progress and achievements made

• the most important conclusions for each component

• recommendations related to each conclusion

• any possible implications these recommendations may have for the health system.

Health system work group

If the health system technical group has extensive data to analyse, it may be helpful to allocate morepeople to this group and divide them into four smaller groups to analyse each function separately.

The health system work group uses the health system information gathered by each sub-team to analyseinformation on health system functions for each of the three levels. It should reach agreement on:

• progress and achievements made

• the most important conclusions for each function of the health system

• recommendations related to each conclusion

• any possible implications these recommendations may have for immunization services.


Service delivery problems may need health system solutions

Some problems may involve other parts of the health system, so it is important to consider that solutions to these problems may be system wide.

Preparing conclusions on special issues

If a special issue was included in the assessment, one of the technical work groups will need to reviewthe proposed indicators to assess this special issue and draw conclusions. It is also important to makesure that the recommendations and activities you propose in Steps 6 and 7, pages 48-50, also addressthese issues.

Examples of special issues include things like the introduction of new vaccines or AD syringes, capacitybuilding, and financing sustainability.

Task 5.3 Prepare the main conclusions of the assessment

Before beginning this task, you should remind yourself of the country’s current immunization targets,goals, and objectives.

You should then identify:

• the progress and achievements made

• your main conclusions about critical issues for immunization services and the health system in the country

• your main conclusions about immunization services and the health system in the country.

There are several methods you could use to achieve this task. But whatever method you choose, it isimportant to make sure that it:

• promotes ownership by all key stakeholders in the assessment

• allows the different sub-teams and technical groups to give their input

• helps identify priority conclusions and recommendations.


Aims for Task 5.3

The aims of this task are to report on:

• the immunization programme’s strengths and weaknesses

• its efficiency and effectiveness

• its impact on disease burden

• its capacity to adapt to new demands – both those generated by health sector reform and thosethat arise in response to the population’s need for access to vaccines.

Identifying priority conclusions and recommendations using index cards

When all the technical groups have made their presentations, you will have a large number of conclusions and recommendations.

1 Ask each technical group to summarize their report including the main achievements, conclusions,and suggested recommendations on a large index card.

2 Stick all the cards on the wall – there will probably be between 20 and 30.

3 Discuss each conclusion on the cards and consolidate them where possible by:

• moving the cards around so that you group all the cards relating to the same problem together

• comparing the health system and immunization services cards and putting together those that have a direct impact on each other

• deciding which conclusions are most important and then putting those cards together and removing the others.

Task 5.4 Develop main recommendations of the assessment

You should now come to an agreement on the main assessment recommendations. You can achieve thisby following an approach similar to the one you used to select priority conclusions andrecommendations.

You do not need to make recommendations for each of the immunization services components andhealth system functions. For example, it is possible that most of the recommendations for solvingimmunization coverage will involve the health system in the areas of planning, training, and supervisiononly.

How can you tell if the recommendations are relevant?

To check if your recommendations are relevant, answer the questions below:

• Are the strategies consistent with the country’s objectives, policies, strategies, and plans forimmunization services?

• Are they consistent with the country’s health sector development goals and the national health plan?

• Are they consistent with the universal goals of equity, public participation, and accountability?

• Are they feasible?

• Are they affordable?

• Will these recommendations be viewed as collaborative or competitive by non-governmentalorganizations, UN organizations, and other stakeholders in the country?

• Are these recommendations consistent with national and partner’s criteria for obtaining, giving, using,and accounting for financial support?

How can you identify the ways in which immunization services may provide an opportunityfor strengthening health systems?

You may find it helpful to ask:

• What are the critical health systems functions that will allow immunization services to perform better?

• How can these be improved in a sustainable way which will benefit other services and not damagethem?

• What are the critical health systems issues if new technologies or vaccines are introduced?

• How can these be improved in a sustainable way which will benefit other services and not damagethem?

• Are they coherent with health sector development priorities?


Some problems may need more study

You may not have been able to find enough information about some issues. These may need more investigation, so you should recommend this in your final report.

Preparing recommendations on special issues

If a special issue was included in the assessment, it is important to make sure that the recommendations and activities you propose address this issue.

Examples of special issues include things like the introduction of new vaccines or AD syringes, capacity building, and financing sustainability.

Task 5.5 Compile information and prepare the first draft of the Assessment Report

Once you have developed your recommendations, you should start to consolidate the information thesub-teams and Planning Team gathered into the first draft of the final Assessment Report. You will use thisfirst draft to debrief high level officials and partners during Step 6.

Suggested table of contents for the final Assessment Report

1 Objectives of the assessment

2 Assessment methodology – a brief description of the process, including the number of sitesvisited and people interviewed

3 The context – a brief discussion of the political, economic and other critical issues in theexternal environment that have an impact on health status, immunization services, and thehealth system

4 Conclusions and recommendations relating to immunization services and the health system

5 Conclusions and recommendations on the feasibility of introducing a new vaccine or anotherinnovation in the country, if applicable

6 Next steps – for example, incorporating the recommendations into the current national plan,preparing cost estimates and a financing plan, further in-depth study, or monitoring aparticular area

Annexes Country fact sheetData Collection Guides including conclusions and recommendationsCopies of each sub-national team’s reports

Task 5.6 Prepare for debriefing

You should now prepare a summary description of the assessment process, and of your conclusions andrecommendations which you will present to the government and stakeholders.



The Assessment Team, or a sub-group of its members, gives a debriefing about the assessment and theirmajor recommendations.

Tasks for Step 6

Task 6.1 Debriefing

Task 6.2 Complete the final draft of the Assessment Report

Task 6.1 Debriefing

You now need to give a debriefing based on the conclusions and recommendations compiled in Step 5 to:

• high-level national officials and policy-makersMinister of Health, local government, and finance

• ICC members

• NGOs

• other partners.

You may also need to provide an executive summary of the preliminary report. You can prepare the fullfinal report later.

Task 6.2 Complete the final draft of the Assessment Report

During Task 6.1 you will have presented your draft conclusions and recommendations but it is unlikelythat you will have finished the final draft of the report.

You should now complete this report so that it is available before the Assessment Team separates. If possible, you should submit it to the MOH no more than one month after the assessment.


Debriefing6Step

Why is the debriefing meeting important?

The debriefing gives you the opportunity to:

• make sure that proposed changes are consistent with government policies and goals

• obtain high-level political commitment for implementing the recommendations

• promote intra-sector and inter-sector support for proposed changes

• discuss resource and funding needs.

Remember to include in the report any input that senior MOH staff and key stakeholders give you during the debriefing.


The Assessment Team proposes the implementation phases and outlines the key steps for monitoring.

Tasks for Step 7

Task 7.1 Incorporate recommendations into a draft multi-year national plan

Task 7.2 Prepare a draft budget and financing plan

Task 7.3 Plan how implementation will be monitored

Task 7.1 Incorporate recommendations into a draft multi-year national plan

Selected Assessment Team members, MOH planners, immunization managers, finance staff, and technicalstaff from key partners will need to work together on this task.

Assessment recommendations need to be integrated into the national plan. This will help to make surethat they are supported by decision-makers and implemented by national and sub-national staff. The process described in Annex 4, pages 67-69, should help you with this task.

You may not be able to complete this task in the time available, but it is important to initiate it and takepart in preparing an initial draft. The immunization manager and partners should prepare a clear timelinefor completing the draft.

If you cannot complete it in time, some members of the Assessment Team could stay behind to helpfinalize it.


Completing the planning process

When you are planning for implementation, you will need to:

• contrast your findings with current goals and targets

• establish specific objectives

• select indicators to evaluate progress

• make plans to determine what priorities need to be tackled, what strategies and activities haveto be implemented, and what management support is needed.

Planning for implementationand monitoring7Step

Task 7.2 Prepare a draft budget and financing plan

Estimates of the costs of current and future activities are important for financing immunization services.Cost analysis may include the total estimated costs, programme specific costs, and recurrent, variable, non-personnel costs. See Annex 4, pages 67-69, for more information.

You will need to clearly identify the source of financing for each component of the immunizationprogramme. You can use information about estimated costs and financing information to identifyfinancing gaps. You should also assess any financial gaps both with, and without, the planned changesand new activities.

You will need to estimate the cost of delivering new antigens, interventions and technologies before youcan budget or find support for their introduction.

Task 7.3 Plan how implementation will be monitored

It is essential to develop a mechanism that will help you to monitor progress and evaluate it in the threeto five years after the assessment.

Everyone who was involved in the assessment and subsequent revisions of the national plan will want to know what the impact of new strategies is on performance. If there is not currently a system formonitoring plan activities, you should encourage the MOH to develop a system that includes:

• appointing someone in the MOH to monitor the implementation of the plan

• preparing progress reports for the ICC, development partners, and other key stakeholders

• following up progress in sub-national officespeople from sub-national offices who were also on the Assessment Team can do this.


Evaluating implementation

You can evaluate implementation of the multi-year plan in two ways:

1 By assessing which activities have been implemented compared to what was proposed in the multi-year plan of action or annual work plan.

2 By assessing if the indicators show that the vaccine-preventable disease burden has beenreduced.

Key indicatorsIndicators are essential for analysing the current situation, for expressing specific targets, and for assessingif these targets are being met.

This annex shows the key indicators you will need to consider for the five immunization servicescomponents and the health system.

The tables show indicators for the three levels – national, sub-national, and service delivery.

The Discussion Guides in Booklets 3, 4 and 5 are based on these indicators.

Service delivery: Immunization services key indicator – 1


National level

Coverage level for each vaccineduring the last three years

National drop-out rate

Completeness and timeliness ofroutine coverage reporting fromthe sub-national levels

Proportion of sub-national unitsby coverage level for each vaccine(e.g. <50%, 50-79%, >80%)

Existence of a national plan forimmunization

Completion of a standardizedimmunization injection safetyassessment

Existence of a policy, plan, andbudget for injection safety

System for detecting,investigating, and reportingadverse events followingimmunization (AEFIs)

Sub-national level


Sub-national area drop-out rate

Completeness and timeliness ofroutine coverage reporting fromthe catchment area

Proportion of catchment areas bycoverage level for each vaccine

Proportion of facilities offeringvaccinations

Supervision system for injectionsafety

Distribution and maintenancesystem for supplies of safeinjections

System for detecting,investigating, and reporting AEFIs



Health facility drop-out rate

Completeness and timeliness ofroutine coverage reporting to thesub-national level

Effective outreach schedule

Use of one sterile needle and onesterile syringe for each injection

Collection of sharps in puncture-proof containers

Appropriate disposal of injectionequipment

Knowledge of what should bereported as an AEFI

1Annex

Disease surveillance: Immunization services key indicator – 2


National level

Vaccine-preventable diseaseincidence

Non-polio AFP rate

% of measles outbreaksinvestigated

% of measles cases withinformation on age andvaccination status

Completeness and timeliness ofroutine reporting

Sub-national level


Non-polio AFP rate






Non-polio AFP rate




Logistics: Immunization services key indicator – 3

National level

Existence of guidelines on:

• vaccine management

• transport management

• cold chain

• disposal and destruction

Supplies, equipment andconsumables are available wherethey are needed and in theamount needed

Cold-chain equipment operatingand in good repair

Staff monitor status and stock of supplies, equipment, andconsumables when visiting sub-national and service deliveryareas

Sub-national level

Supplies, equipment andconsumables are available wherethey are needed and in theamount needed


Staff monitor status and stock of supplies, equipment, andconsumables when visiting service delivery areas

Staff have an emergency plan forsub-national area


Good quality supplies,equipment, and consumables areavailable in the amount needed


Staff have an emergency plan forhealth facility


Vaccine supply and quality: Immunization services key indicator – 4

National level

Supply

• vaccine forecasting

• vaccine utilization and wastagemonitoring

Quality

• an assessment of qualityperformed by a fully functionalregulatory authority (NRA), orother independent assessmentof quality performed

• manufacturer viable or vaccinesprocured from prequalifiedsources

Source and finance

• system for selection of sources

• sustainable financingmechanism

Sub-national level

Supply




Supply



Quality

• vaccine stored and handledproperly

• quality and expiry date ofvaccine checked before use

Advocacy and communications: Immunization services key indicator – 5

National level

Active support of routineimmunizations:

• by political leaders

• by development partners

Active public promotion ofimmunizations

Sub-national level

Active support of routineimmunizations by political leadersand other influential people andgroups in the area

Active public promotion ofimmunizations by units


Knowledge of public, includingparents, about immunizations

Active attempts to reach theunreached, defaulters, and non-users

Health staff communicateeffectively with clients

Community involvement inplanning and monitoring ofhealth services


Stewardship: Health system key indicator – 1

National level

Policy-making and standard-setting

National health policies:

• address the needs of theunserved and under-served

• assure equity of access tohealth services

• address health interventionsthat are priorities for thecountry

As well as governing the publicsector, policies and regulationsgovern the activities of multi- and bilateral agencies, non-governmental organizations, andthe private health sector

Sub-national level


Sub-national policies and plans:

• address the needs of theunserved and under-served

• assure equity of access to health services

• address health interventionsthat are priorities for thecountry and the area



The health facility’s schedule:

• addresses the needs of theunserved and under-served

• assures equity of access

• includes health interventionsthat are priorities for thecountry and the area

Planning

Existence of a multi-year nationalhealth plan and budget as well asa plan and budget for the currentyear

Adaptability of staff to changeplans and adjust budgets basedon current events such as sectorreforms

Planning

Existence of a plan for each unitin the sub-national level and abudget for the current year

Planning

Existence of a health facility planand a budget for the current year

Information management

Staff at all levels receive timelyinformation on new policies andguidelines

Staff at all levels receive reportson national progress towardsmeeting disease reduction andother health goals

Staff use information to plan andto make adjustments in strategies

National statistics are submittedto WHO regional and globaloffices on time


Staff receive timely informationon new policies and guidelines

Staff receive reports on nationalprogress towards meeting diseasereduction and other health goals

Staff get feedback on reportssubmitted



Staff receive timely informationon new policies and guidelines

Staff receive reports on nationalprogress towards meeting diseasereduction and other health goals

Staff get feedback on reportssubmitted



Stewardship: Health system key indicator – 1 continued

National level

Coordination amonghealthcare providers

Staff coordinate planning,implementation, and monitoringamong representatives of privateand public healthcare providers

Staff keep all representatives ofhealthcare providers informed ofnew policies, guidelines, andchanges in public healthadministration

Sub-national level








Cooperation

Staff coordinate support providedby partners

Staff keep partners and othersinformed of activities andchanges

Cooperation

Staff coordinate support providedby partners

Staff keep partners and othersinformed of activities andchanges

Cooperation

Staff coordinate support providedby partners (not usually applicableat the service delivery level)

Evaluation

Staff periodically evaluateprogress towards theachievement of national goalsand objectives, and the impact of strategies on the health of the nation

Evaluation

Staff periodically evaluateprogress towards theachievement of the sub-nationallevel goals and objectives

Evaluation

Staff periodically evaluateprogress towards theachievement of the unit’s goalsand objectives


Human resource development: Health system key indicator – 2

National level

Staffing

Personnel in all locations meetnational staffing levels andstandards

There are enough staff with theappropriate skills to meet theneeds in all locations

Staff receive adequate salaries ona regular basis

Working conditions are adequate

Staff job performance is regularlyevaluated and feedback isprovided

Sub-national level

Staffing







Staffing






Training

All staff have the knowledge andskills they need to do their jobs

Training


Training


Supervision

Guidelines for supervisors ofhealth workers and otherpersonnel in the system havebeen issued

Supervisors are able to providethe administrative and technicalsupport needed

Supervision

Staff provide supervision and theadministrative and technicalsupport needed at the servicedelivery level

Supervision

Staff receive the supervision andtechnical and administrativesupport they need


Finance: Health system key indicator – 3

National level

Budgets are consistent with plans

Available funding meets theneeds of the healthcare systemand immunization servicesdescribed in the national planand budget

Funds approved are allocated

Funds allocated are spentaccording to plan

Generally accepted accountingpractices are followed

Sub-national level

Budgets are consistent with plans

Available funding meets theneeds of the healthcare systemand immunization servicesdescribed in the national planand budget

Funds approved are allocated

Funds allocated are spentaccording to plan

Generally accepted accountingpractices are followed


Staff members are aware of thecost of services, sources offinancing, and the need forefficiency in the use of resources


Conducting a SWOT analysisSWOT stands for strengths, weaknesses, opportunities, and threats*. When you are assessingimmunization services, you will need to use a SWOT analysis to study the strengths and weaknesses ofimmunization services and the health system at each level. You will also need to identify opportunitiesand threats from outside immunization services and the health system that may have an effect on them.

Carrying out the analysis

1 Make lists of the internal strengths and weaknesses of immunization services and the health system,and the external opportunities and threats they face. Enter them in the appropriate quadrants of theSummary SWOT analysis.

2 Compare, discuss, and analyse the possible implications of the items in the list.

3 Formulate strategies and recommendations based on the analysis.


SWeaknessesStrengthsW

OpportunitiesO

ThreatsT

Study the internal strengths and weaknesses of immunization services and the health system at each level.

Identify opportunities and threats from outside immunization services and thehealth system that may havean effect on them.

Discussion and analysis are just as important as listing the strengths,weaknesses, opportunities, and threats.

* John M. Bryson, Strategic Planning for Public and Nonprofit Organizations: A guide to strengthening and sustainingorganizational achievement. Revised edition. 1995. San Francisco, Jossey-Bass Publishers.

2Annex

What to look for under each component of the SWOT analysis

Strengths

Factors that contribute to good system performance and that can be built on to achieve new objectives.

Examples of internal strengths might include an effective cold chain, or public acceptance of the need for immunization.

Weaknesses

Factors in the system that hinder the achievement of objectives.

Examples of weaknesses include frequent occurrence of adverse events following immunization, or staffdissatisfaction with salaries.

Opportunities

Factors outside the health system that you can take advantage of when planning change. Usually fit into one of the following categories:

• political, economic, social, and technological trends

• stakeholders who control resources

• actual or potential collaborators or competitors.

Examples of opportunities include the appointment of a new key decision-maker who supportsimmunizations, or public demand for injection safety.

Threats

Factors outside the health system that have a negative effect on it. Examples include a general decrease ingovernment revenue, or an extensive turnover or transfer of staff.


61

Wea

knes

ses

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.1

Stre

ng

ths

Op

po

rtu

nit

ies

Thre

ats

Cou

ntry

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.

Dat

e ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.

aPh

otoc

opy

this

for

m f

or e

ach

Sum

mar

y SW

OT

anal

ysis

.

Sum

mar

y o

f SW

OT

anal

ysis

SW

eakn

ess

es

Str

en

gth

sW

Op

po

rtu

nit

ies

OTh

reatsT


Data Collection Guides for analysing data and developing recommendations

During Step 5 of the methodology, you will use the forms in this section to summarize your conclusionsand recommendations.

1 Fill in one form for each of the immunization services components.

2 Fill in one form for each of the health system functions.


3Annex

64

DA

TA C

OLL

ECTI

ON

GU

IDE

Imm

un

izat

ion

ser

vice

s

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.2

Imm

uniz

atio

n se

rvic

e de

liver

yVa

ccin

e su

pply

and

qua

lity

Cou

ntry

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Dis

ease

sur

veill

ance

Adv

ocac

y an

d co

mm

unic

atio

nsD

ate

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Logi

stic

sa

Phot

ocop

y th

is f

orm

for

eac

h im

mun

izat

ion

serv

ices

com

pone

nt. T

ick

whi

chev

er a

pplie

s.

Ach

ieve

men

ts

Co

ncl

usi

on

s–

Impl

icat

ions

for

imm

uniz

atio

n se

rvic

esC

on

clu

sio

ns

– Im

plic

atio

ns f

or h

ealth

sys

tem

Rec

om

men

dat

ion

s

65

DA

TA C

OLL

ECTI

ON

GU

IDE

Hea

lth

sys

tem

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.3

Stew

ards

hip

Serv

ice

prov

isio

nC

ount

ry ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Hum

an r

esou

rce

deve

lopm

ent

Fina

nce

Dat

e ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

aPh

otoc

opy

this

for

m f

or e

ach

heal

th s

yste

m f

unct

ion.

Tic

k w

hich

ever

app

lies.

Ach

ieve

men

ts

Co

ncl

usi

on

s–

Impl

icat

ions

for

imm

uniz

atio

n se

rvic

esPl

ease

incl

ude

info

rmat

ion

for

each

of

the

sub-

func

tions

, e.g

. pol

icy-

mak

ing,

pla

nnin

g et

cC

on

clu

sio

ns

– Im

plic

atio

ns f

or h

ealth

sys

tem

Plea

se in

clud

e in

form

atio

n fo

r ea

ch o

f th

e su

b-fu

nctio

ns,

e.g.

pol

icy-

mak

ing,

pla

nnin

g et

c

Rec

om

men

dat

ion

s


Incorporating the assessmentrecommendations into the national planAssessment recommendations need to be integrated into the national plan. This will help to make surethat they are supported by decision-makers and implemented by national and sub-national staff.

Planning is a dynamic process that does not always take place in a purely logical way. However, the stepsbelow give a useful sequence for developing a plan of action.

1 Review the goals for immunization services and the health system in the multi-year plan

• Ask if the plan’s targets and goals are achievable, or if they are too ambitious or too restricted,given the current health system and external environment.

• Ask if the plan’s targets and goals are consistent with the Assessment Team’s recommendations.

• Resolve any difficulties.

• Make the necessary adjustments to the national plan.

2 Write the interim objectives or milestones

• These must be met if goals are to be achieved.

3 Review current and planned strategies

Review the strategies that are currently in the plan and compare them to the Assessment Team’srecommendations. Choose or plan strategies that are:

• relevantthey are most likely to contribute to the achievement of interim objectives or milestones

• sustainablethey are most likely to have a lasting impact on immunization coverage and disease incidence, and contribute to health systems development

• effectivethey are most likely to have a positive impact on the health system

• feasiblegiven existing or projected financial and human resources

• acceptableto decision-makers and the public.


4Annex

There may be several ways to achieve objectives, but as planning proceeds, any practicalconstraints should become clearer and you may have to revise original strategies.

4 Identify the necessary indicators to monitor progress

Indicators are essential for analysing the current situation, for expressing specific targets, and forassessing if these targets are being met.

Also identify:

• the level each indicator should be monitored at

• the source of the information

• the frequency of collection

• the staff responsible for consolidating and analysing the information.

If you are proposing any new indicators, assess the benefits of collecting additional informationagainst the benefits of improving the quality and completeness of existing indicators.

5 Review the activities described in the national plan

Identify all necessary activities and tasks and determine if they will contribute to achieving the newobjectives and strategies, and how they will combine with them.

You will also need to:

• work out the implications for staffing, facilities, supplies, and transport budgets.

6 Estimate the cost of planned activities

Categorize the activities on the basis of whether they can be implemented:

• at minimal additional cost

• at additional cost where funds are available

• at additional cost where new funds are needed.

Often there will not be enough resources to implement all the recommendations, so decision-makersmay ask planners and finance specialists for a variety of ‘what if’ scenarios so that they can study thecost implications of different strategies and combinations of strategies.

7 Schedule activities and assign responsibility

When you have selected the activities that will reach the objectives most effectively, you will need toschedule them and assign responsibility for their implementation. You will also need to estimate howlong activities will take and then fix realistic starting and completion dates. You may find summarytables like those in Annex 4a helpful.

8 Re-estimate costs and prepare budgets for the next three to five years

Allocate funds that you know are available, or are pledged, and estimate any potential funding gaps.You may find the forms in Annex 4b helpful for this.



Incorporating the assessment recommendations into the national plan


Identifying activities needed to achieve targets and objectives

The forms on the following pages will help you to identify the activities that need to be achieved to meet established targets and specific objectives.

1 Fill in one form for each of the immunization services components and one for each of the health system functions.

2 Identify marginal costs of adding new vaccines or interventions.


4aAnnex

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Ind

icat

or

Targ

etA

chie

ved

to

Mai

n

Act

ivit

ies

Tim

elin

eO

ffic

e an

dEs

tim

ated

Sou

rce

of

dat

e/st

atu

sco

nst

rain

tle

vel

cost

fun

ds

resp

on

sib

leC

apita

lU

S$Re

curr

ent

US$

Q1

Q2

Q3

Q4

Year

1Ye

ar 2

Q1

Q2

Q3

Q4

SUM

MA

RY T

AB

LE

Imm

un

izat

ion

ser

vice

sac

tivi

ties

Imm

uniz

atio

n se

rvic

e de

liver

yVa

ccin

e su

pply

and

qua

lity

Cou

ntry

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Dis

ease

sur

veill

ance

Adv

ocac

y an

d co

mm

unic

atio

nsD

ate

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Logi

stic

sa

Phot

ocop

y th

is f

orm

for

eac

h im

mun

izat

ion

serv

ices

com

pone

nt. T

ick

whi

chev

er a

pplie

s.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.4

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Ind

icat

or

Targ

etA

chie

ved

to

Mai

n

Act

ivit

ies

Tim

elin

eO

ffic

e an

dEs

tim

ated

Sou

rce

of

dat

e/st

atu

sco

nst

rain

tle

vel

cost

fun

ds

resp

on

sib

leC

apita

lU

S$Re

curr

ent

US$

Q1

Q2

Q3

Q4

Year

1Ye

ar 2

Q1

Q2

Q3

Q4

SUM

MA

RY T

AB

LE

Hea

lth

sys

tem

acti

viti

es

Stew

ards

hip

Serv

ice

prov

isio

nC

ount

ry ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Hum

an r

esou

rce

deve

lopm

ent

Fina

nce

Dat

e ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

aPh

otoc

opy

this

for

m f

or e

ach

heal

th s

yste

m f

unct

ion.

Tic

k w

hich

ever

app

lies.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.5


Estimating costs and funding sources

The forms on the following pages will help you to identify the estimated costs and funding sources that are needed to achieve established targets and specific objectives.

1 Fill in one form for each of the immunization services components and one for each of the health system functions.

2 Identify marginal costs of adding new vaccines or interventions.


4bAnnex

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Typ

e o

f co

stD

om

esti

c so

urc

eEx

tern

al s

ou

rce

Tota

l fu

nd

ing

Sho

rtfa

llav

aila

ble

Cap

ital

cost

s

• Bu

ildin

g sp

ace

• Ve

hicl

es

• Eq

uipm

ent

• O

ther

Cap

ital

cost

s su

bto

tal

Rec

urr

ent

cost

s

• Pe

rson

nel

• Va

ccin

es

• Su

pplie

s

• Tr

ansp

ort

• Su

rvei

llanc

e an

d m

onito

ring

• Tr

aini

ng

• C

omm

unic

atio

n, in

clud

ing

heal

thpr

omot

ion,

etc

.

• M

aint

enan

ce a

nd o

verh

eads

• O

ther

Rec

urr

ent

cost

s su

bto

tal

Tota

l

Perc

enta

ge

of

tota

l

Cen

tral

go

vern

men

tLo

cal

gove

rnm

ent

Hea

lth

insu

ranc

eO

ther

Gra

nts

Loan

sO

ther

ESTI

MA

TED

CO

STS

AN

DFU

ND

ING

SO

UR

CES

Imm

un

izat

ion

ser

vice

s

Imm

uniz

atio

n se

rvic

e de

liver

yVa

ccin

e su

pply

and

qua

lity

Cou

ntry

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Dis

ease

sur

veill

ance

Adv

ocac

y an

d co

mm

unic

atio

nsD

ate

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Logi

stic

sa

Phot

ocop

y th

is f

orm

for

eac

h im

mun

izat

ion

serv

ices

com

pone

nt. T

ick

whi

chev

er a

pplie

s.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.6

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Typ

e o

f co

stD

om

esti

c so

urc

eEx

tern

al s

ou

rce

Tota

l fu

nd

ing

Sho

rtfa

llav

aila

ble

Cap

ital

cost

s

• Bu

ildin

g sp

ace

• Ve

hicl

es

• Eq

uipm

ent

• O

ther

Cap

ital

cost

s su

bto

tal

Rec

urr

ent

cost

s

• Pe

rson

nel

• Va

ccin

es

• Su

pplie

s

• Tr

ansp

ort

• Su

rvei

llanc

e an

d m

onito

ring

• Tr

aini

ng

• C

omm

unic

atio

n, in

clud

ing

heal

thpr

omot

ion,

etc

.

• M

aint

enan

ce a

nd o

verh

eads

• O

ther

Rec

urr

ent

cost

s su

bto

tal

Tota

l

Perc

enta

ge

of

tota

l

Cen

tral

go

vern

men

tLo

cal

gove

rnm

ent

Hea

lth

insu

ranc

eO

ther

Gra

nts

Loan

sO

ther

ESTI

MA

TED

CO

STS

AN

DFU

ND

ING

SO

UR

CES

Hea

lth

sys

tem

Stew

ards

hip

Serv

ice

prov

isio

nC

ount

ry ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Hum

an r

esou

rce

deve

lopm

ent

Fina

nce

Dat

e ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

aPh

otoc

opy

this

for

m f

or e

ach

heal

th s

yste

m f

unct

ion.

Tic

k w

hich

ever

app

lies.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.7


Summarizing projected costs of the immunization programme over the five year period

The forms on the following pages will help you to summarise the projected costs of achieving establishedtargets and specific objectives.

1 Fill in one form for each of the immunization services components.

2 Fill in one form for each of the health system functions.


4cAnnex

SUM

MA

RY O

F PR

OJE

CTE

D

CO

STS

(FIV

E Y

EAR

PER

IOD

)

Imm

un

izat

ion

ser

vice

s

Imm

uniz

atio

n se

rvic

e de

liver

yVa

ccin

e su

pply

and

qua

lity

Cou

ntry

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Dis

ease

sur

veill

ance

Adv

ocac

y an

d co

mm

unic

atio

nsD

ate

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Logi

stic

sa

Phot

ocop

y th

is f

orm

for

eac

h im

mun

izat

ion

serv

ices

com

pone

nt. T

ick

whi

chev

er a

pplie

s.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.8

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Co

mp

on

ent

and

Esti

mat

edD

om

esti

c so

urc

eEx

tern

al s

ou

rce

Tota

l fu

nd

ing

Sho

rtfa

llty

pe

of

cost

cost

fo

r av

aila

ble

five

yea

r p

erio

d

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cen

tral

go

vern

men

tLo

cal

gove

rnm

ent

Hea

lth

insu

ranc

eO

ther

Gra

nts

Loan

sO

ther

Serv

ice

del

iver

y

Dis

ease

su

rvei

llan

ce

Log

isti

cs

Vac

cin

e su

pp

ly a

nd

qu

alit

y

Ad

voca

cy a

nd

co

mm

un

icat

ion

s

Hea

lth

sys

tem

m

gm

t fu

nct

ion

s

Cap

ital

co

sts

sub

tota

l

Rec

urr

ent

cost

s su

bto

tal

Gra

nd

to

tal

SUM

MA

RY O

F PR

OJE

CTE

D

CO

STS

(FIV

E Y

EAR

PER

IOD

)

Hea

lth

sys

tem

Stew

ards

hip

Serv

ice

prov

isio

nC

ount

ry ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..

Hum

an r

esou

rce

deve

lopm

ent

Fina

nce

Dat

e ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

aPh

otoc

opy

this

for

m f

or e

ach

heal

th s

yste

m f

unct

ion.

Tic

k w

hich

ever

app

lies.

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

1.9

Ob

ject

ive

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Co

mp

on

ent

and

Esti

mat

edD

om

esti

c so

urc

eEx

tern

al s

ou

rce

Tota

l fu

nd

ing

Sho

rtfa

llty

pe

of

cost

cost

fo

r av

aila

ble

five

yea

r p

erio

d

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cap

ital c

ost

Recu

rren

t co

st

Cen

tral

go

vern

men

tLo

cal

gove

rnm

ent

Hea

lth

insu

ranc

eO

ther

Gra

nts

Loan

sO

ther

Serv

ice

del

iver

y

Dis

ease

su

rvei

llan

ce

Log

isti

cs

Vac

cin

e su

pp

ly a

nd

qu

alit

y

Ad

voca

cy a

nd

co

mm

un

icat

ion

s

Hea

lth

sys

tem

m

gm

t fu

nct

ion

s

Cap

ital

co

sts

sub

tota

l

Rec

urr

ent

cost

s su

bto

tal

Gra

nd

to

tal


Assessing capacity building

Definition of capacity building (CB)

In the context of strengthening immunization services, capacity building means significantly enhancingthe ability of the national immunization programme to:

• increase and maintain access to immunization services

• decrease the burden of vaccine-preventable diseases

• expand the use of safe and cost-effective vaccines.

In capacity building, special attention is given to:

• safety and quality

• consistency with national health sector goals

• identifying funding shortfalls

• progressing towards self-reliance in identifying and generating resources

• managing knowledge so that work experience can be retained and expertise disseminated throughoutthe organization.


5Annex

How does this definition fit in with GAVI milestones?

1 By 2010 or sooner, all countries will have routine immunization coverage at 90% nationally with at least80% coverage in every district.

2 By 2002, 80% of all countries with adequate delivery systems will have introduced hepatitis B vaccine.By 2007, all countries.

3 By 2005, 50% of the poorest countries with high disease burdens and adequate delivery systems will haveintroduced Hib vaccine.

4 By 2005, the world will be certified polio-free.

5 By 2005, the vaccine efficacy and burden of disease will be known for all regions for rotavirus andpneumococcal vaccine, and mechanisms identified to make the vaccines available to the poorest countries.

Capacity building must maintain and develop existing abilities

As well as developing new abilities, the capacity building process must maintain and develop existingabilities. It must be based on a methodology which can:

• assess the current situation

• define future goals

• plot a way of reaching goals.

Any capacity building strategy must also address three levels:

• the individual

• the institutions

• the overall health system.

Capacity building indicators

Countries should identify their own indicators to measure progress in addressing each of the healthsystem functions. The GAVI Inter-Taskforce Sub-group on Capacity Building has also suggested indicatorsfor each function which are consistent with global targets.

Capacity building indicators help countries to:

• carry out needs assessments

• develop plans that address gaps

• monitor implementation.

Many capacity building indicators overlap with the critical indicators included in the CAT. The information below gives details of capacity building indicators and tells you if they are also includedin the CAT.

Finance – proposed CB indicators

CB indicators

The most recent indicators are summarized in Annex 6, section 6

CAT indicator that may overlap with the CB indicators

See Annex 6, section 6

Management – proposed CB indicators

CB indicators

Timeliness and completeness of reports, reflecting institutional capacity to monitor its performance


Completeness and timeliness of routine coverage reporting from sub-national levelssee Immunization services – immunization service delivery

Completeness and timeliness of routine surveillance reportssee Immunization services – disease surveillance

Staff at all levels receive timely information on new policies and guidelinessee Health system – stewardship

National statistics are submitted to WHO regional and global offices on timesee Health system – stewardship


CB indicators

Provision of adequate immunization supplies as reflected by lack of stock-outs


Supplies, equipment, consumables are available where they are needed and in the amount neededsee Immunization services – logistics

Staff monitor status and stock of supplies, equipment, and consumables when visiting sub-national,service delivery areassee Immunization services – logistics

Vaccine forecastingsee Immunization services – vaccine supply and quality

Vaccine utilization and wastage monitoringsee Immunization services – vaccine supply and quality

CB indicators

Number of days spent by national management team members in districts – proxy for assessingsupervision of sub-national level activities and district micro-planning


Guidelines for supervisors of health workers and other personnel in the system have been issuedsee Health system – human resource development

Supervisors are able to provide the administrative and technical support neededsee Health system – human resource development

Strengthening human and institutional resources – proposed CB indicators

CB indicators

Percentage of total staff at each level that have received training in past two years, including the specificsof those training activities


All staff have the knowledge and skills they need to do their jobssee Health system – human resource development

CB indicators

National training plan developed, funded, implemented


Existence of a multi-year national health plan and budget for the current yearsee Health system – stewardship

CB indicators

Adequacy of staffing (country to define specific levels), as defined by the rate of staff turnover at allrelevant levels


Personnel in all locations meet national staffing needs and standardssee Health system – human resource development

There are enough staff with the appropriate skills to meet needs in all locationssee Health system – human resource development


Immunization services operations/service provision – proposed CB indicators

CB indicators

Suggest using indicators included in the CAT for the five components of service delivery


All indicators overlapsee Immunization services


Financial Sustainability Diagnostic Tool (FSDT)

This annex is adapted from the "Guidelines for preparing a National Immunization Program FinancialSustainability Plan" prepared by the GAVI Financing Task Force (FTF), and includes information on theFinancial Sustainability Diagnostic Tool (FSDT), developed by the Access to Technologies Team (ATT).

Introduction to the FSDT

Countries receiving funding from GAVI through the Vaccine Fund are required to prepare financialsustainability plans at the end of the second year. The Financial Sustainability Diagnostic Tool (FSDT) isdesigned to facilitate the process of preparing Financial Sustainability Plans.

Countries could use the FSDT to diagnose their current situation in the areas defined in the FinancialSustainability Plan guidelines, and thus guide the development and implementation of the FinancialSustainability Plan.

The FSDT is a qualitative tool, based on possible key benchmarks for financial sustainability ofimmunization programmes. From the results of the assessment, countries should be able to: identify thestrengths of the current financing of immunization programmes, highlight areas for further improvement,and identify what type of capacity building is required to prepare and implement viable FinancialSustainability Plans.


6Annex

Objectives of the FSDT

This tool is intended to:

• assess the current level of financial sustainability of countries to monitor progress toward financialsustainability and better management of national immunization programmes within health sectordevelopment, using simple qualitative indicators

• assess the country capacity to formulate and implement a Financial Sustainability Plan using theframework provided by the guidelines for Financial Sustainability Plan preparation developed by the GAVI FTF

• help identify the strengths of countries current immunization programmes and highlight areas for further improvement in achieving financial sustainability, prior to submission of FinancialSustainability Plans

• provide guidance and information on technical assistance and training needed to support anddevelop current immunization financing systems, structures, staffing and strategies.

Methodology of the FSDT

The FSDT is linked to the Financial Sustainability Plan guidelines and the overall objectives of the keycomponents. The FSDT appears as an annex to the Financial Sustainability Plan guidelines.

The tool should be used as best suited to country needs. For many countries, this might mean a jointlyconducted diagnosis at the outset of the financial sustainability plan development process with externalexperts, as well as the internal core expert team. Other countries might opt to use the tool as a self-assessment tool.

The FSDT is formulated as a questionnaire, including guiding criteria and possible sources of information.All questions lead in to straight “Yes” or “No” answers. Following the completion of the FSDT, conclusionsand recommendations should be drawn, summarizing the country’s strengths, the areas susceptible toimprovement and indicating possible needs for capacity building and/or technical assistance whererequired.

The FSDT would be completed through a series of interviews with all relevant stakeholders both atnational, sub-national and operational level. These stakeholders include, amongst others, Ministry ofHealth (national immunization staff, planning department within the Ministry of Health), Ministry ofFinance (departments responsible for planning, budgeting, expense control, HIPC/PRSP), Ministry ofPlanning, ICC members and other partners. The answers should be validated where possible. Sources ofvalidation could be the national budget, minutes of meetings of the ICC, public expenditure reviews,immunization costing and financing studies.

A maximum of one week should be estimated to complete the FSDT, including the drawing up ofconclusions, recommendations and a work plan for developing the Financial Sustainability Plan.


Acronyms

EPI Expanded Programme on Immunization

FIC Fully Immunized Child

GDP Gross Domestic Product

Hep B Hepatitis B Vaccine

Hib Haemophiylus Influenzae Type B Vaccine

HIPC II/PRSP Heavily Indebted Poor Countries II / Poverty Reduction Strategy Paper

HIV/AIDS Human Immunodeficiency Virus / Auto-Immune Deficiency Syndrome

ICC Interagency Coordinating Committee

MoF Ministry of Finance

MoH Ministry of Health

NIDs National Immunization Days

NIP National Immunization Programme

SWAP Sector Wide Approach

TB Tuberculosis

VVM Vaccine Vial Monitor


90

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

1.00

Co

un

try

and

hea

lth

sys

tem

co

nte

xt

Wh

at a

re t

he

curr

ent

con

dit

ion

s an

d p

lan

ned

ch

ang

es in

th

e p

ub

lic s

ecto

r o

rgan

izat

ion

an

d f

inan

cin

g t

hat

are

like

ly t

oh

ave

an im

po

rtan

t ef

fect

on

th

e th

e fi

nan

cial

su

stai

nab

ility

of

the

imm

un

izat

ion

pro

gra

mm

e?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Fin

ance

, M

inis

try

of H

ealth

and

Lea

ding

Don

or A

genc

ies

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

1.01

Is im

mun

izat

ion

cove

rage

a m

ajor

dev

elop

men

t in

dica

tor

with

in t

he c

urre

nt h

ealth

sys

tem

?■■

Yes

■■N

o

1.02

Has

a m

ulti-

year

pla

n be

en d

evel

oped

for

the

hea

lthse

ctor

?■■

Yes

■■N

o

1.03

Doe

s th

e go

vern

men

t bu

dget

con

tain

vac

cine

and

/or

othe

r im

mun

izat

ion

line

item

s?■■

Yes

■■N

o

1.04

Hav

e po

tent

ial h

ealth

sec

tor

prog

ram

me

prio

ritie

s th

atco

uld

impa

ct f

unds

for

the

NIP

bee

n fo

rese

en in

the

budg

et a

lloca

tion

proc

ess?

■■Ye

s■■

No

– H

IV/A

IDS

– TB

– M

alar

ia–

Cur

ativ

e he

alth

care

– O

ther

s

1.05

Has

the

pot

entia

l im

pact

of

publ

ic/h

ealth

sys

tem

orga

niza

tion

on t

he f

undi

ng o

f th

e N

IP b

een

take

n in

toac

coun

t by

the

nat

iona

l im

mun

izat

ion

man

ager

inbu

dget

ing

and

fund

ing

of t

he p

rogr

amm

e?

■■Ye

s■■

No

– D

ecen

tral

izat

ion

– In

tegr

atio

n–

Con

trac

ting

with

the

priv

ate

sect

or–

Oth

ers

Fin

anci

al S

ust

ain

abili

ty

Dia

gn

ost

ic T

oo

l (FS

DT)

Cou

ntry

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

Dat

e of

ass

essm

ent

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

Ass

essm

ent

perf

orm

ed b

y. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.

Poin

ts o

f co

ntac

t. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.

91

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

1.06

Are

the

re a

ny p

lann

ed p

ublic

/hea

lth r

efor

ms

unde

r w

ayin

how

prio

ritie

s ar

e se

t w

ithin

nat

iona

l or

finan

cing

part

ner

budg

ets

that

wou

ld h

ave

impo

rtan

t im

plic

atio

nsfo

r th

e im

mun

izat

ion

prog

ram

me?

■■Ye

s■■

No

– SW

Aps

– Pu

blic

/priv

ate

part

ners

hips

– O

ther

s

1.07

Are

the

re a

ny p

lann

ed c

hang

es in

the

fin

anci

ng s

trat

egy

or f

inan

cing

mec

hani

sms

to f

und

the

heal

th s

yste

m t

hat

are

likel

y to

hav

e a

posi

tive

impa

ct o

n th

e fu

ndin

g of

the

NIP

?

■■Ye

s■■

No

– So

cial

insu

ranc

e–

Priv

ate

insu

ranc

e–

Com

mun

ity f

inan

cing

– Pa

yrol

l tax

es–

Oth

ers

1.08

Are

the

re a

ny m

acro

econ

omic

issu

es f

acin

g th

e co

untr

yth

at a

re e

xpec

ted

to p

ositi

vely

aff

ect

the

futu

re f

undi

ngof

the

NIP

?

■■Ye

s■■

No

– Ec

onom

ic g

row

th–

Deb

t re

lief

– In

flatio

n–

Oth

er

1.09

Is t

here

an

adeq

uate

rem

uner

atio

n sy

stem

in p

lace

to

ensu

re m

otiv

atio

n of

hea

lth s

taff

so

that

sal

ary,

per

diem

,an

d tr

avel

allo

wan

ces

are

paid

whe

n du

e*?

■■Ye

s■■

No

* W

hen

due:

dep

endi

ng o

nco

ntra

ctua

l agr

eem

ents

e.

g. w

eekl

y, m

onth

ly

1.10

Hav

e th

e fu

ll-tim

e na

tiona

l im

mun

izat

ion

man

ager

and

full-

time

natio

nal c

old

stor

e m

anag

er b

een

in p

lace

for

at le

ast

a ye

ar?

■■Ye

s■■

No

92

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

2.00

Fin

anci

al m

anag

emen

t

Wh

at c

on

stra

ints

do

bu

dg

etin

g, f

inan

cial

man

agem

ent,

dis

bu

rsem

ent

and

pro

cure

men

t sy

stem

s p

lace

on

th

e fi

nan

cial

sust

ain

abili

ty o

f th

e im

mu

niz

atio

n p

rog

ram

me?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lth F

inan

ce D

epar

tmen

t an

d/or

Min

istr

y of

Fin

ance

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

2.01

Are

acc

ount

ing

polic

ies

and

acco

unt

code

cla

ssifi

catio

nspu

blis

hed

and

appl

ied?

■■Ye

s■■

No

2.02

Is t

he n

atio

nal b

udge

t ap

prov

ed w

ithin

3 m

onth

s of

the

star

t of

the

fin

anci

al y

ear?

■■Ye

s■■

No

2.03

Is t

he r

eque

sted

bud

get

cons

iste

nt w

ith t

he a

lloca

ted

budg

et t

o th

e le

vel o

f at

leas

t 75

%?

■■Ye

s■■

No

2.04

Is im

mun

izat

ion

expe

nditu

re t

rack

ing

carr

ied

out

with

in3

mon

ths

afte

r cl

ose

of t

he q

uart

er?

■■Ye

s■■

No

2.05

Are

all

dono

r fu

nds

rele

ased

with

in 3

mon

ths

afte

rre

ques

t?■■

Yes

■■N

o

2.06

Are

gov

ernm

ent

fund

s re

leas

ed w

ithin

3 m

onth

s af

ter

requ

est?

■■Ye

s■■

No

2.07

Are

req

uest

ed f

unds

ava

ilabl

e at

hea

lth d

eliv

ery

leve

lw

ithin

3 m

onth

s of

due

dat

e?■■

Yes

■■N

o

93

3.00

Pro

gra

mm

e ch

arac

teri

stic

s, o

bje

ctiv

es a

nd

str

ateg

ies

Wh

at a

re t

he

pro

gra

mm

e o

bje

ctiv

es t

hat

fo

rm t

he

bas

is f

or

the

fin

anci

ng

req

uir

emen

ts o

f th

e im

mu

niz

atio

n p

rog

ram

me

ove

r th

e co

min

g f

ive

to s

even

yea

rs?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lthN

atio

nal I

mm

uniz

atio

n Pr

ogra

mm

e

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

3.01

Are

the

re s

peci

fic p

lans

to

intr

oduc

e ne

w a

ntig

ens

toth

e N

IP o

ver

the

next

5–7

yea

rs?

■■Ye

s■■

No

– H

ep B

– H

ib–

Yello

w F

ever

– O

ther

3.02

Are

the

re s

peci

fic p

lans

to

intr

oduc

e di

ffer

ent

form

ulat

ions

of

stan

dard

ant

igen

s ov

er t

he n

ext

5–7

year

s?

■■Ye

s■■

No

– Q

uadr

aval

ent

– Pe

ntav

alen

t–

Oth

er

3.03

Are

the

re a

ny p

lann

ed p

rogr

amm

e im

prov

emen

ts t

o th

eN

IP o

ver

the

next

5–7

yea

rs?

■■Ye

s■■

No

– C

old

chai

n im

prov

emen

tsan

d ex

pans

ion

– Re

duci

ng w

asta

ge–

Usi

ng a

uto

dest

ruct

or

Uni

ject

syr

inge

s

3.04

Are

the

re a

ny s

peci

fic p

lans

to

incr

ease

imm

uniz

atio

nco

vera

ge in

har

d to

rea

ch a

reas

and

/or

spec

ific

popu

latio

n su

b-gr

oups

?

■■Ye

s■■

No

3.05

Are

the

re a

ny p

endi

ng c

hang

es in

the

ran

ge o

fde

velo

pmen

t pa

rtne

rs t

hat

are

likel

y to

incr

ease

fin

anci

alpa

rtic

ipat

ion?

■■Ye

s■■

No

– D

onor

s–

Priv

ate

sect

or–

Tech

nica

l coo

pera

tion

agen

cies

– Bi

late

ral a

genc

ies

– M

ultil

ater

al a

genc

ies

– O

ther

3.06

Are

all

plan

ned

chan

ges

to t

he N

IP, t

heir

budg

etim

plic

atio

ns a

nd p

oten

tial f

undi

ng s

ourc

es a

ppro

ved

byna

tiona

l aut

horit

ies

and

part

ners

prio

r to

incl

usio

n in

the

mul

ti-ye

ar p

lan?

■■Ye

s■■

No

94

4.00

Bas

elin

e an

d c

urr

ent

pro

gra

mm

e co

sts

and

fin

anci

ng

Can

th

e co

un

try

pro

vid

e a

det

aile

d p

ictu

re o

f p

rog

ram

me

spec

ific

cu

rren

t fu

nd

ing

req

uir

emen

ts f

or

the

imm

un

izat

ion

pro

gra

mm

e?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lth N

atio

nal I

mm

uniz

atio

n Pr

ogra

mm

e, M

inis

try

of H

ealth

Pla

nnin

gD

epar

tmen

t, M

inis

try

of F

inan

ce

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

4.01

Are

the

cos

ting

and

budg

etin

g re

quire

men

ts o

f al

lim

mun

izat

ion

stra

tegi

es in

clud

ed in

the

cur

rent

NIP

?■■

Yes

■■N

o–

Rout

ine

imm

uniz

atio

n–

NID

s–

Mop

ups

4.02

Doe

s th

e cu

rren

t im

mun

izat

ion

budg

et in

clud

e a

recu

rren

t (o

pera

tiona

l) co

st b

reak

dow

n?■■

Yes

■■N

o–

Vacc

ines

– In

ject

ion

supp

lies

– Pe

rson

nel

– C

old

chai

n m

aint

enan

ce–

Tran

spor

t–

Soci

al m

obili

zatio

n–

Shor

t-te

rm t

rain

ing

– Su

rvei

llanc

e an

d m

onito

ring

4.03

Doe

s th

e cu

rren

t im

mun

izat

ion

budg

et in

clud

e a

capi

tal

cost

bre

akdo

wn?

■■Ye

s■■

No

– Tr

ansp

ort

– C

old

chai

n eq

uipm

ent

– Bu

ildin

g sp

ace

– Lo

ng-t

erm

tra

inin

g–

Oth

er

4.04

Doe

s th

e cu

rren

t im

mun

izat

ion

budg

et in

clud

e a

cost

brea

kdow

n of

imm

uniz

atio

n he

alth

sta

ff?

■■Ye

s■■

No

– Re

crui

tmen

t co

sts

– Sa

larie

s–

Perd

iem

s–

Ince

ntiv

es

4.05

Is t

he t

otal

cur

rent

fun

ding

for

the

NIP

know

n by

fund

ing

sour

ce?

■■Ye

s■■

No

– N

atio

nal g

over

nmen

t–

Sub-

natio

nal g

over

nmen

t–

Lend

ers

– D

onor

s–

Oth

er

95

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

4.06

Is t

here

an

annu

al r

evie

w o

f th

e im

mun

izat

ion

prog

ram

me

fund

ing

and

expe

nditu

res

by t

hose

resp

onsi

ble

for

the

plan

ning

, bu

dget

ing

and

reso

urce

mob

iliza

tion

proc

ess

with

in t

he h

ealth

sec

tor?

■■Ye

s■■

No

– M

oH–

MoF

– IC

C–

Oth

er

4.07

Is t

he im

mun

izat

ion

budg

et f

orm

ulat

ed u

sing

rec

ent

cost

ing

data

and

/or

form

ulas

?■■

Yes

■■N

o–

Tran

spor

t op

erat

ing

cost

s–

Vacc

ines

– In

ject

ion

supp

lies

96

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

5.00

Futu

re r

eso

urc

e re

qu

irem

ents

an

d p

rog

ram

me

fin

anci

ng

Giv

en r

eso

urc

e re

qu

irem

ents

an

d f

un

din

g p

rob

abili

ties

, wh

at is

th

e lik

elih

oo

d o

f th

e fu

nd

ing

gap

bei

ng

fill

ed?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lth N

atio

nal I

mm

uniz

atio

n Pr

ogra

mm

e, M

inis

try

of H

ealth

Pla

nnin

gD

epar

tmen

t, M

inis

try

of F

inan

ce,

ICC

part

ners

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

5.01

Hav

e co

stin

g an

d bu

dget

ing

calc

ulat

ions

bee

n m

ade

for

impr

ovin

g im

mun

izat

ion

stra

tegi

es o

f th

e N

IP o

ver

the

next

5 y

ears

?

■■Ye

s■■

No

– Ro

utin

e im

mun

izat

ion

– N

IDs

– M

op u

ps

5.02

Has

a 5

yea

r im

mun

izat

ion

budg

et b

een

deve

lope

din

clud

ing

a re

curr

ent

(ope

ratio

nal)

cost

bre

akdo

wn?

■■Ye

s■■

No

– Va

ccin

es–

Inje

ctio

n su

pplie

s–

Pers

onne

l–

Col

d ch

ain

mai

nten

ance

– Tr

ansp

ort

– So

cial

mob

iliza

tion

– Sh

ort-

term

tra

inin

g–

Surv

eilla

nce

and

mon

itorin

g

5.03

Has

a b

reak

dow

n of

the

imm

uniz

atio

n pr

ogra

mm

eca

pita

l cos

t re

quire

men

ts b

een

calc

ulat

ed f

or t

he n

ext

5 ye

ars?

■■Ye

s■■

No

– Tr

ansp

ort

– C

old

chai

n eq

uipm

ent

– Bu

ildin

g sp

ace

– Lo

ng-t

erm

tra

inin

g–

Oth

er

5.04

Hav

e co

stin

g an

d bu

dget

ing

calc

ulat

ions

bee

n m

ade

for

impr

ovin

g th

e ef

ficie

ncy

of t

he N

IP o

ver

the

next

5 y

ears

?■■

Yes

■■N

o–

Col

d ch

ain

impr

ovem

ents

and

expa

nsio

n–

Redu

cing

was

tage

– U

sing

aut

o de

stru

ct o

r U

nije

ctsy

ringe

s–

Oth

er

97

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

5.05

Hav

e co

stin

g an

d bu

dget

ing

calc

ulat

ions

bee

n m

ade

for

addi

ng n

ew a

ntig

ens

to t

he N

IP o

ver

the

next

5 y

ears

?■■

Yes

■■N

o–

Hep

B–

Hib

– Ye

llow

Fev

er–

Oth

er

5.06

Hav

e co

stin

g an

d bu

dget

ing

estim

ates

bee

n m

ade

for

incr

easi

ng im

mun

izat

ion

cove

rage

of

popu

latio

n gr

oups

or

geog

raph

ic a

reas

tha

t ar

e be

low

the

nat

iona

l ave

rage

?

■■Ye

s■■

No

– O

utre

ach

cost

s–

Staf

f in

cent

ives

– Pe

rdie

ms

– O

ther

5.07

Hav

e co

stin

g an

d bu

dget

ing

estim

ates

for

hea

lth s

taff

been

mad

e in

line

with

incr

easi

ng c

over

age

targ

ets

over

the

next

5 y

ears

?

■■Ye

s■■

No

– Re

crui

tmen

t co

sts

– Sa

larie

s–

Perd

iem

s–

Ince

ntiv

es

5.08

Is t

he t

otal

fun

ding

req

uire

men

t fo

r th

e im

mun

izat

ion

prog

ram

me

by f

undi

ng s

ourc

e kn

own

for

the

next

5 y

ears

?■■

Yes

■■N

o–

Nat

iona

l gov

ernm

ent

– Su

b-na

tiona

l gov

ernm

ent

– Le

nder

s–

Don

ors

– O

ther

5.09

Are

gov

ernm

ent

fund

s fo

r th

e im

mun

izat

ion

prog

ram

me

pred

icta

ble

for

up t

o 5

year

s?■■

Yes

■■N

o

5.10

Are

don

or f

unds

for

the

imm

uniz

atio

n pr

ogra

mm

epr

edic

tabl

e fo

r up

to

5 ye

ars?

■■Ye

s■■

No

5.11

Is t

here

an

estim

ate

for

the

pote

ntia

l fun

ding

gap

for

imm

uniz

atio

n fo

r th

e ne

xt 5

yea

rs?

■■Ye

s■■

No

98

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

5.12

Is t

here

any

indi

catio

n of

cha

nges

in f

undi

ng p

riorit

ies

ofna

tiona

l or

exte

rnal

fun

ding

par

tner

s th

at a

re li

kely

to

have

pos

itive

aff

ect

on t

he f

undi

ng o

f th

e im

mun

izat

ion

prog

ram

me?

■■Ye

s■■

No

5.13

Are

new

sou

rces

and

mec

hani

sms

of in

tern

al a

ndex

tern

al f

undi

ng b

eing

con

side

red

for

futu

re f

undi

ng o

fth

e im

mun

izat

ion

prog

ram

me?

■■Ye

s■■

No

– H

IPC

II/P

RSP

– N

ew d

onor

s–

Vacc

ine

inde

pend

ence

initi

ativ

e–

Revo

lvin

g fu

nds

– H

ealth

insu

ranc

e–

Oth

er

99

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

6.00

Sust

ain

able

fin

anci

ng

str

ateg

ic p

lan

an

d in

dic

ato

rs

Wh

at a

re t

he

mai

n is

sues

an

d p

rob

lem

s im

ped

ing

fin

anci

al s

ust

ain

abili

ty, a

ctio

ns

that

will

be

take

n t

o a

dd

ress

th

e is

sues

and

pro

ble

ms,

an

d t

he

ind

icat

ors

an

d t

arg

ets

that

will

be

use

d t

o m

on

ito

r an

d e

valu

ate

the

acti

on

s?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lth N

atio

nal I

mm

uniz

atio

n Pr

ogra

mm

e, M

inis

try

of H

ealth

Pla

nnin

gD

epar

tmen

t, M

inis

try

of F

inan

ce,

ICC

part

ners

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

6.01

Has

a f

orm

al p

lan

been

dev

elop

ed a

nd e

ndor

sed

by t

heM

oF d

etai

ling

an in

crea

se in

the

gov

ernm

ent’s

sha

re o

ffu

ndin

g fo

r th

e N

IP?

■■Ye

s■■

No

6.02

Are

the

re a

ny c

ontin

genc

y pl

ans

or im

mun

izat

ion

rese

rve

mec

hani

sms

in p

lace

to

deal

with

pos

sibl

ere

sour

ce c

onst

rain

ts?

■■Ye

s■■

No

– Pr

iorit

izat

ion

of a

ctiv

ities

– Li

mite

d in

trod

uctio

n of

new

ant

igen

s–

Oth

er

6.03

Has

a lo

ng-t

erm

(5–

10 y

ears

) ca

pita

l fin

anci

ng p

lan

incl

udin

g al

l fun

ding

sou

rces

for

the

NIP

been

dev

elop

edan

d en

dors

ed b

y th

e IC

C?

■■Ye

s■■

No

6.04

Has

a f

orm

al p

lan

for

the

purc

hase

of

vacc

ines

and

AD

syrin

ges

been

dev

elop

ed a

nd e

ndor

sed

by t

he IC

C f

orth

e pe

riod

of p

ost

vacc

ine

fund

sup

port

?

■■Ye

s■■

No

6.05

Has

a f

orm

al p

lan

been

dev

elop

ed a

nd e

ndor

sed

by t

heIC

Cad

dres

sing

pos

sibl

e fu

ndin

g sh

ortf

alls

as

a re

sult

ofco

mpl

etio

n of

the

pol

io e

radi

catio

n pr

ogra

mm

e*?

■■Ye

s■■

No

* Po

lio f

unds

are

oft

en u

sed

tosi

mul

tane

ousl

y st

reng

then

the

rout

ine

prog

ram

me

6.06

Has

a m

ulti-

year

pla

n fo

r re

sour

ce m

obili

zatio

n be

ende

velo

ped

and

endo

rsed

by

the

ICC

?■■

Yes

■■N

o

100

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

6.07

Doe

s th

e m

ulti-

year

pla

n in

clud

e co

st s

avin

g m

easu

res

toop

timiz

e th

e us

e of

vac

cine

s an

d im

mun

izat

ion-

rel

ated

supp

lies?

■■Ye

s■■

No

– Re

duci

ng w

asta

ge–

Usi

ng V

VM

– Ra

tiona

lizin

g se

ssio

ns–

Stoc

k co

ntro

l–

Prev

entiv

e m

aint

enan

ce–

Oth

er

6.08

Doe

s th

e m

ulti-

year

pla

n in

clud

e in

dica

tors

to

mea

sure

the

effic

ient

use

of

reso

urce

s?■■

Yes

■■N

o–

Cos

t pe

r FI

C–

Oth

er

6.09

Wer

e at

leas

t 75

% o

f th

e re

com

men

datio

ns o

f th

e la

stna

tiona

l rev

iew

of

the

NIP

on e

ffic

ienc

y an

d fin

anci

ngim

plem

ente

d?

■■Ye

s■■

No

6.10

Are

the

re s

elec

ted

indi

cato

rs t

o m

onito

r pr

ogre

ss m

ade

in t

erm

s of

sus

tain

able

fin

anci

ng?

■■Ye

s■■

No

– %

incr

ease

in n

atio

nal

expe

nditu

re o

n N

IP a

s a

shar

e of

GD

P af

ter

adju

stm

ent

for

debt

ser

vice

over

the

nex

t 5

year

spr

ogra

mm

e sp

ecifi

c co

sts

– D

epre

ciat

ion

sche

dule

for

repl

acin

g ca

pita

l ite

ms

– %

incr

ease

in s

ecur

edfu

ndin

g fo

r th

e N

IP–

%de

crea

se in

the

NIP

fund

ing

gap

– O

ther

101

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

7.00

Stak

eho

lder

co

mm

ents

Is t

he

Fin

anci

al S

ust

ain

abili

ty P

lan

co

nsi

sten

t w

ith

th

e IC

C m

emb

ers’

per

spec

tive

s?

Co

ntr

ibu

tors

to

th

is s

ecti

on

sh

ou

ld in

clu

de:

Min

istr

y of

Hea

lth –

Fin

ance

and

/or

Plan

ning

Dep

artm

ent,

Min

istr

y of

Fin

ance

, ot

her

ICC

par

tner

s

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

7.01

Are

the

maj

or s

take

hold

ers

of t

he N

IP r

epre

sent

ed in

the

ICC

?■■

Yes

■■N

o–

MoF

, M

oP,

MoH

– D

onor

s–

Dev

elop

men

t ba

nks

– In

tern

atio

nal a

genc

ies

– O

ther

7.02

Has

the

cur

rent

imm

uniz

atio

n w

ork

plan

bee

n ap

prov

edby

the

ICC

?■■

Yes

■■N

o

7.03

Is t

he IC

Cop

erat

iona

l, w

ith a

leas

t 2

mee

tings

a y

ear

for

whi

ch m

eetin

g no

tes

are

avai

labl

e an

d Te

rms

ofRe

fere

nce

exis

t?

■■Ye

s■■

No

7.04

Are

the

rol

es a

nd r

espo

nsib

ilitie

s of

the

ICC

and

indi

vidu

al m

embe

rs,

in t

he p

lann

ed im

plem

enta

tion

ofth

e Fi

nanc

ial S

usta

inab

ility

Pla

n, a

ppro

pria

te a

nd w

ell

defin

ed?

■■Ye

s■■

No

– M

onito

r N

IPpr

ogre

ss–

App

rove

ann

ual w

ork

plan

s–

App

rove

mul

ti-ye

ar p

lan

– A

dvoc

acy

for

fund

ing

– A

ddre

ssin

g fin

anci

alsu

stai

nabi

lity

of t

he N

IP–

Oth

er

7.05

Is t

he t

rack

ing

of r

esou

rces

for

the

NIP

org

aniz

ed b

y bo

thIC

Cm

embe

rs,

as w

ell a

s st

aff

from

the

MoH

and

MoF

?■■

Yes

■■N

o

102

Ther

e is

an

MS

Wo

rd v

ersi

on

of

this

fo

rm o

n t

he

CD

. If

you

nee

d t

o, y

ou

can

ed

it o

r am

end

it f

or

the

cou

ntr

y yo

u a

re a

sses

sin

g.

aLo

ok

for

Form

FSD

T

Qu

esti

on

sA

nsw

ers

Gu

idin

g c

rite

ria

Rem

arks

7.06

Are

the

fun

ding

prio

ritie

s of

ICC

mem

ber

inst

itutio

nsco

nsis

tent

with

the

Fin

anci

al S

usta

inab

ility

Pla

n?■■

Yes

■■N

o

7.07

Is t

here

a c

ompr

ehen

sive

list

of

actio

ns t

o be

tak

en b

yth

e go

vern

men

t an

d by

ICC

mem

bers

to

mov

e to

war

dth

e ac

hiev

emen

t of

the

FS?

■■Ye

s■■

No

7.08

Are

dia

gnos

es o

f fin

anci

al s

usta

inab

ility

issu

es a

nd t

hest

rate

gies

to

addr

ess

cons

trai

nts

and

oppo

rtun

ities

inth

e Fi

nanc

ial S

usta

inab

ility

Pla

n co

nsid

ered

by

the

ICC

to

be a

ppro

pria

te a

nd r

ealis

tic?

■■Ye

s■■

No

New Vaccine Discussion Guide

Use this Data Collection Guide if you have been asked to assess the feasibility of introducing a newvaccine into the national immunization programme. Talk with epidemiologists and health managers inthe Ministry of Health to get information from a national perspective.

Checklists for new vaccine introduction, guidelines for new vaccine disease burden assessment, andguidelines for planning the introduction of new vaccines are available from WHO and UNICEF.

To further assess the capacity of the system to introduce and sustain the new vaccine, you will also needto consider data on the immunization services components and the health system.


7Annex

? Question: What is known about the disease?

Discussion points

Ask clinicians whether they have ever seen the disease and whether they thinkit’s an important public health problem.

? Question: What are the disease burden estimates?

Discussion points

Ask for a copy of any disease burden studies for this disease that have beenmade in the country.

? Question: Do staff members believe it to be important to public health?

Discussion points

Ask managers what they know about the disease – is it a public healthproblem?

? Question: What is known about the new vaccine? Is it seen as beneficial?

Discussion points

Ask epidemiologists what they think the benefits and shortcomings of the newvaccine are.


Glossary and abbreviations

Several definitions have been adapted from WHO’s Health Promotion Glossary and Family PlanningManagement Terms, Management Sciences for Health, 1996.

Advocacy

individual and social actions designed to gain political commitment, social acceptance, and organizationaland system support for a particular health goal or programme

Capacity

the ability of individuals, organizations, and systems to perform effectively and efficiently. Also, theirpotential to perform

Communication

informing the public about health concerns and keeping important health issues on the public agenda.Includes health promotion, health education, and social mobilization

Components

the five parts of the immunization services. These are:

• immunization service delivery

• disease surveillance

• logistics

• vaccine supply and quality

• advocacy and communications

Development partners

private and public, national and multinational organizations that offer technical, management, andfinancial support to developing countries

Disease surveillance

monitoring disease incidence, record keeping, reporting, and laboratory testing

Equity

fairness – all people have an equal opportunity to develop and maintain their health

External environment

the political, economic, social, and technological forces, trends, and stakeholders that have an impact on services


8Annex

Functions

the actions a system is intended to perform. In this assessment methodology, the health system functionsexamined are:

• stewardship

• human resource development

• finance

• service provision

Immunization service delivery

the strategies and activities involved in providing vaccinations to clients

Indicator

a quantitative or qualitative statement that provides a basis for measuring progress towards objectives

Innovation

a new vaccine or technology introduced or considered for introduction into immunization operations, for example, injection equipment

Logistics

• the delivery of vaccines and other equipment in good condition to the place of use

• transport

• maintenance of the cold chain

• communications

• vaccine management

• waste disposal

Stakeholder

any person, group, or organization with an interest in an activity or service. Stakeholders include clients,health workers, the public, politicians, and development partners

Stewardship

the careful and responsible management of the public’s health, and of the individuals and organizationsthat provide health services

SWOT analysis

strengths, weaknesses, opportunities, and threats – an analysis technique that involves specifying thestrengths and weaknesses of an organization’s performance and the external opportunities and threatsthat may have an impact on it

Sustainability

the ability of an organization to:

• provide quality services to its clients

• increase or maintain demand for services

• expand services to reach people who are not currently reached

• generate financial resources


Vaccine supply and quality

stock management, wastage monitoring, and the procurement of vaccines from manufacturers

Abbreviations

AEFI Adverse events following immunization

CB Capacity building

EPI Expanded Programme on Immunization

FIC Fully Immunized Child

FSDT Financial Sustainability Diagnostic Tool

GAVI Global Alliance for Vaccines and Immunization

GDP Gross Domestic Product

Hep B Hepatitis B vaccine

Hib Haemophilus Influenzae Type B vaccine

HIPC/PRSP Heavily indebted poor countries II/Poverty reduction strategy paper

HIV/AIDS Human Immunodeficiency Virus / Auto-Immune Deficiency Syndrome

ICC Interagency Coordinating Committee

MoF Ministry of Finance

MOH Ministry of Health

NGO Non-governmental organization

NIDs National immunization days

NIP National immunization programme

NRA National Regulatory Authority

SWAPS Sector Wide Approach Processes

SWOT Strengths, Weaknesses, Opportunities, Threats

TB Tuberculosis

VVM Vaccine vial monitor



Documents

WHO IVB 04.05 (Booklet1)