Comparing Resources
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| Resource | Typhoid Conjugate Vaccine (TCV) Costing Tool | Cost-Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV) | WHO Manual for Estimating the Economic Burden of Seasonal Influenza | Economics of reaching zero-dose children | Achieving immunization agenda 2030 coverage targets for 14 pathogens: Projected product and immunization delivery costs for 194 Countries, 2021–2030 | Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization | IA2030 scorecard for Impact Goal Indicator 1.1 number of future deaths averted through immunzation | Ne laisser personne de côté : Directives pour la planification et la mise en œuvre de la vaccination de rattrapage | 2024-0222 GVIRF Webinar: New TB Vaccines for Adults and Adolescents, Progress, Prospects, and Perspectives, February 22, 2024 - ANNOUNCEMENT | Modeling the impact of vaccination for the immunization Agenda 2030: Deaths averted due to vaccination against 14 pathogens in 194 countries from 2021 to 2030 | Country-led Assessment for Prioritization in Immunization (CAPACITI) decision-support tool | Pertussis vaccines: WHO position paper, August 2015-Recommendations. | Demographic Health Survey (DHS), Multiple Indicators Cluster Survey (MICS) | Data at WHO | Economic costs of Rotavirus disease and the value of vaccines | Establishing and strengthening immunization in the second year of life: Practices for immunization beyond infancy | Guidance to support programmes and partners to assess and address behavioural and social drivers (BeSD) of vaccination | Guidance for the implementation and evaluation of strategies to increase vaccine demand and uptake | VIEW-hub by IVAC | The ROTA Council | HPV Information Centre | Leave no one behind: guidance for planning and implementing catch-up vaccination | Immunization Agenda 2030: A Global Strategy to Leave No One Behind | WHO recommendations for routine immunization - summary tables | Missed Opportunities for Vaccination (MOV) Strategy | WHO position papers | Guidance on an adapted evidence to recommendation process for National Immunization Technical Advisory Groups | Global NITAG Network | Comparison table of WHO prequalified typhoid conjugate vaccines (TCVs) | Typhoid burden of disease and potential benefits of new typhoid conjugate vaccines (TCVs) | CHOLTOOL | Guidelines for developing a national immunization strategy (NIS) | Why Gender Matters: IA2030 guide | Human-centred design for tailoring immunization programmes | Understanding the behavioural and social drivers of vaccine uptake WHO position paper – May 2022 | Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake | Summary of key characteristics of WHO Prequalified Rotavirus vaccines | Considerations for Pneumococcal Conjugate Vaccine (PCV) Product Choice | SYSVAC: Systematic Reviews on Vaccines | Gavi-supported rotavirus vaccines profiles to support country decision making | WHO vaccine reaction rates information sheets | Vaccine Detailed product profiles (DPPs) For Gavi-supported vaccines | Product menu for vaccines supplied by UNICEF for Gavi, the Vaccine Alliance | Highly Extensible Resource for Modeling Event-Driven Supply Chains (HERMES) | Service Provision Assessment (SPA) Survey | UN OneHealth Tool, CEA country contextualization templates | Malaria Vaccine Decision-Making Framework | Partnership for Influenza Vaccine Introduction (PIVI) | Criteria for inclusion of vaccinations in public programmes | Accelerating policy, deployment, and access to new and underutilized vaccines in developing countries | The Grading of Recommendations Assessment, Development and Evaluation (GRADE) | PriorityVax | Global Health Expenditure Database | Guidance on the economic evaluation of influenza vaccination | Community Health Planning and Costing Tool | Immunization Delivery Cost Catalogue (IDCC) | COSTVAC tool | Workload Indicators of Staffing Need (WISN) | Vaccine-Preventable Diseases (including pipeline vaccines) | UNICEF 2YL Costing Tool | The WHO Flutool Plus- Seasonal Influenza Immunization Costing Tool (SIICT) | List of WHO Prequalified Vaccines | Quality immunization services: a planning guide | Update of PAHO’s ProVac e-toolkit | Vaccine Impact Modelling Consortium (VIMC) | Global Health Data Exchange | Guide for Equitable Health Access through Supply Chain Design | Immunization Supply Chain Sizing Tool | Enhanced Vaccine Management Initiative Tools and Guidelines | Guide for Developing National Immunization Policies in the WHO African Region | Policy coherence as a driver of health equity | A Guide for conducting an Expanded Programme on Immunization (EPI) Review | WHO Service Availability Readiness Assessments (SARA) | The Human Resources for Health Toolkit | MLM Online Training documents | WHO guideline on health policy and system support to optimize CHW programs | Standard Competencies Framework for the Immunization Workforce - Immunization Program Competencies Initiative: Supporting the objective of the Expanded Program on Immunization | Health Resources Availability Mapping System (HERAMS) | A quick guide to inform understanding of gender-related barriers to immunisation: learning from research | Achieving immunisation outcomes through Gavi investments- Focus Area Demand | The KAP Survey Model (Knowledge, Attitudes, and Practices) | Practical Guide to Focus Group Discussion | A guide for exploring health worker/caregiver interactions on immunization | Measure the Behavioural and Social Drivers of Vaccination (BeSD) | Urban Immunization Toolkit | Immunization Equity Reference Group Papers (Gender and Immunisation, Urban populations and immunisation) | Vaccination in Acute Humanitarian Emergencies. Implementation guide | Vaccination in Acute Humanitarian Emergencies. A framework for decision making | Guide to Tailoring Immunization Programs (TIP) | Periodic Intensification of Routine Immunisation (PIRI): Lessons learned and implications for action | Immunisation in Practice (IIP)- Guidance on microplanning and partnering with communities | Reaching Every Community Planning Tools | The Reaching Every District Strategy; Reaching Every District (RED) 2017 Edition: A guide to increasing coverage and equity in all communities in the African Region | Vaccine Preventable Disease Surveillance Standards, Tools for a Surveillance Review | Data Quality Review | Data Quality Self-Assessment Tool | Health Inequality Monitoring: A Practical Application of Population Health Monitoring | Handbook on health inequality monitoring with a special focus on LMIC countries | New Vaccine Post Introduction Evaluation (PIE) Tool |
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| Purpose | This tool estimates the costs associated with introducing and scaling up typhoid conjugate vaccines (TCVs) in national immunization programs. | This tool helps evaluate the cost-effectiveness of seasonal influenza vaccination programs to inform decision-making on vaccine investments. | This manual provides guidance on estimating the economic burden of seasonal influenza to support informed decision-making on prevention and control strategies. | This resource focuses on estimating the costs associated with reaching "zero-dose children"—those who have not received any routine vaccines. It aims to provide an understanding of the financial resources required to extend immunization services to these children, particularly in hard-to-reach areas and underserved populations. | This article presents an analysis of the costs associated with vaccine products and the delivery systems needed to achieve the coverage targets set by the Immunization Agenda 2030 (IA2030). It aims to provide insights into the financial requirements for scaling up immunization efforts to meet global health goals. | This article reviews the health impact of the Expanded Programme on Immunization (EPI) over its 50-year history. It assesses the global benefits of immunization efforts in reducing mortality and morbidity from vaccine-preventable diseases since the establishment of EPI in 1974. | The IA2030 scorecard for Impact Goal Indicator 1.1 tracks the number of future deaths averted through immunization based on annual updates of WUENIC. It provides insights into the annual progress against targets in terms of the impact of immunization on reducing mortality. | This resource presents a modeling analysis of the potential health impacts of achieving the immunization coverage targets set by the Immunization Agenda 2030 (IA2030). It aims to quantify the reduction in mortality from vaccine-preventable diseases if these targets are met. | To support national immunisation programmes to prioritise among multiple immunisation products, services, or strategies. | Provide global vaccine and immunization recommendations for diseases that have an international public health impact. | Nationally representative household survey that provides data for wide range of monitoring and impact evaluation indicators in the areas of population, health and nutrition. | To provide latest available data of relevance to health topics. | The brief provides an overview of economic costs of Rotavirus disease and the value of vaccines. | (a) Assist countries in making informed decisions about establishing or strengthening a visit or visits in the 2YL that includes vaccination and other services as part of a continuum of care for children; (b) Provide practical guidance on planning, managing, implementing, and monitoring vaccination services and improving immunization coverage during a scheduled visit in the 2YL; (c) Provide broad guidance on catch up vaccination for children older than one year, who are delayed or missing vaccine doses. | The webpage provides behavioural and social drivers (BeSD) tools and guidance to enable programmes and partners to collect, analyze and use data on BeSD to understand reasons for low uptake and to inform planning priorities, implementation, and standardized monitoring and evaluation. | Increasing and sustaining vaccination uptake is vital for vaccines to achieve their success. Achieving high vaccination coverage requires an understanding of the drivers of immunization uptake, engaging with communities to apply tailored evidence-based strategies to improve uptake and strengthen the quality of services. To determine the impact and sustainability of the interventions monitoring and evaluation is also necessary. | VIEW-hub is an open-access data visualization tool that displays data on vaccine introduction, use, coverage, access, impact, and disease burden for nine vaccines: the pneumococcal conjugate vaccine, the rotavirus vaccine, the Haemophilus influenzae type b vaccine, the inactivated polio vaccine, the human papillomavirus vaccine, the typhoid vaccine, the measles-containing vaccine (second-dose), the measles-rubella vaccine, and vaccines for COVID-19. | ROTA provides scientific and technical evidence to scientific authorities such as policymakers on rotavirus disease and vaccines. | The Centre provides an efficient web-based communication between the research field, the medical communities and the public health professionals and decision-makers on a worldwide scale. | To assist national immunization programmes to establish or refine a catch-up vaccination policy and catch-up schedule and to ay out strategies for continuously implementing catch-up vaccination as a component of routine immunization and as an integrated part of the healthcare system. | To set out an overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. | Assists to develop optimal immunization schedule on the current routine immunization recommendations. | A strategy to increase immunization coverage by making better use of existing contacts with health sector (at health centers, hospitals, outreach sites). Provides information on the missed opportunities for vaccination. | In accordance with its mandate to provide guidance to Member States on health policy matters, WHO publishes vaccine position papers providing global vaccine and immunization recommendations for diseases that have an international public health impact. | Support NITAGs in using a systematic, standardized decision-making process such as the EtR Process to ensure that NITAG deliberations consider a standard set of criteria and factors, and are consistent, transparent and well-documented. | To support countries in the establishment or strengthening of National Immunization Technical Advisory Groups (NITAGs). | Comparison table of WHO prequalified typhoid conjugate vaccines (TCVs) | The country-specific resources are designed to be used by anyone interested in advocating for typhoid control and prevention in their country. | Costing of oral cholera vaccine (OCV) introduction in LMICs. | WHO and partners have developed a new strategic framework with the National Immunization Strategy (NIS) project, following adoption of the Immunization Agenda 2030 (IA2030) to guide immunization stakeholders action over the next decade. IA2030 emphasizes the need to consider immunization as an entry point for strengthening Primary Health Care (PHC). Consequently the NIS is designed for better integration of immunization with other health interventions, UHC targets and national planning cycles; focus on long term goals with intermediary objectives and prioritized strategies; country ownership with inclusive design processes; tailored approach to local and national context; and increasing reliance on domestic sources in funding negotiations. | This document explains the need for mainstreaming of gender across the core principles and strategic priorities of Immunization Agenda 2030 (IA2030). Its purpose is twofold: (i) to improve awareness and understanding of how gender-related barriers can affect immunization programme performance (ii) to provide practical “how to” concepts, tools and methods, and actions that can be used to effectively integrate a gender perspective into immunization programmes. | This document is intended to support human-centred and tailored strategies to reach under-vaccinated communities. It is designed to be: 1. People focused 2. Community centred 3. Broadly applicable 4. Adaptable to new situations 5. User friendly | This paper summarizes the development of new tools and indicators to assess the behavioural and social drivers (BeSD) of vaccination, enabling decision-makers, programme managers, and partners to address under-vaccination through an enhanced understanding of the underlying causes. It also reports the main findings of a scoping review that examined existing systematic reviews and meta-analyses on interventions to improve vaccine uptake – a first step towards understanding which interventions work to increase vaccine uptake, for whom, and in what settings. Finally, this paper makes recommendations for using the new tools and the resulting data to prioritize local interventions and concludes with future research directions. | This guidebook supports the use of the tools on understanding and addressing behavioural and social drivers (BeSD) of vaccine uptake. It guides programmes, partners and researchers to understand the reasons for low uptake, using globally field tested and validated tools for childhood vaccination and COVID-19 vaccination. It helps to reduce coverage inequities by gathering and using data to systematically design, implement and evaluate tailored interventions. | Summary of Key characteristics of WHO prequalified rotavirus vaccines. | Summary of current technical and programmatic information on WHO Prequalified PCV products to facilitate informed country choices for PCV introduction or product switch for childhood immunization programmes. | Support National Immunization Technical Advisory Groups (NITAGs) in the development of evidence-based vaccination recommendations by simplifying the identification of relevant systematic reviews and access guidance on how to use existing reviews. | To provide countries with easy access to up-to-date and comprehensive information on Gavi supported rotavirus vaccines. | To provide details on reaction rates of selected vaccines. | Information on Gavi-supported vaccines. | Information on Gavi-supported vaccine products, to understand support, supply availability and waste adjusted price (WAP). | To model the processes, locations, equipment and products involved in the supply chain. | Health facility assessment that provides a comprehensive overview of a country's health service delivery. | Tool designed to inform national strategic health planning in low- and middle-income countries. The cost-effectiveness analysis module allows for country-level CEA analysis using local data. | To prepare African countries to decide, in a timely manner, if and how a vaccine should be introduced to complement existing malaria control strategies. | To support policy makers that are interested in and ready to introduce or expand influenza vaccination. | To provide a framework for the systematic examination of arguments for and against the inclusion and prioritisation of particular vaccinations. | To support evidence-based decisions on the introduction of new and underutilized vaccines. | To reduce unnecessary confusion arising from multiple systems for grading evidence and recommendations. | Prioritizing vaccine development. | Database for Health Expenditure Data. | This range of tools supports the introduction or optimization of influenza vaccination in low resource settings. Applicable only to Influenza vaccine. | Costing packages of community health services and to assess performance, plan future services, and prepare investment cases. | To increase the visibility, availability, understanding and use of evidence on the cost of delivering vaccines. Covers a wide range of countries and vaccines, although some information might be limited dependign on the study availability. | To provide guidance on how to estimate the cost of routine immunization from a sample of health facilities and administrative levels of the health system. | To provide an overview of the health worker's wokrload. | Information on available vaccines and vaccines in development. | Will help you estimate the total, annual costs of implementing a 2YL healthy child visit in a country. | To assist governments to estimate the costs of influenza vaccine introduction for several target populations. | List of vaccines that meet WHO standard for vaccine quality, safety and efficacy. | This guide is aimed at supporting the implementation of high-quality immunization services across all levels. It provides clear, actionable steps to assess and systematically make high-quality immunization services possible across the life course. | Universal vaccine impact and cost-effectiveness decision support model. Relevant to Haemophilus Influenzae, pneumococcal disease, rotavirus, human papillomavirus and meningococcal disease. | Aims to deliver a more sustainable, efficient and transparent approach to generating disease burden and vaccine impact estimates. | The Global Health Data Exchange (GHDx) provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. | This guideline describes how to plan for equity in supply chain design. | (1) The cold chain equipment inventory and gap analysis tool assists vaccine inventory management. (2) EPI logistics forecasting tool is designed to guide the process of forecasting the needs for vaccines, safe injections equipment, as well as cold chain and ambient storage capacities for national immunization programmes. (3) Immunization supply chain sizing tool aims to guide the process of planning the cold chain capacity. (4) The WHO Vaccine Wastage Calculator is deigned to estimate, with more precision, vaccine supply requirements and to improve the planning and management of immunization programmes at national and sub national level (down to health facility level). | Provides access to normative guidelines and tools on effective vaccine management for maintenance and improvement of vaccine management practices & supply chain systems. | To provide guidance on development of National Immunization Policy. | To outline approaches to address inequity through the systematic promotion of mutually reinforcing policies across government departments to create synergies towards achieving agreed objectives and to avoid or minimize negative spill-overs in other policy areas. | A comprehensive assessment of the strengths and weaknesses of an immunization programme. Provides evidence for the programme’s strategic directions and priority activities. | (a) To assess and monitor the service availability and readiness and to generate evidence to support the planning and managing of a health system. (b) To generate reliable and regular information on service delivery such as the availability of key human and infrastructure resources, basic equipment, essential medicines, and diagnostic capacities, and on the readiness of health facilities to provide basic health-care interventions. | This toolkit brings together a set of existing tools that are in use for various aspects of country level HRH development, including situation analysis, planning, implementation, monitoring and evaluation. | To improve on-the-job performance with Mid-Level Manager (MLM) Online Training courses. | Assists national governments, national and international partners to improve the design, implementation, performance, and evaluation of CHW programmes, contributing to the progressive achievement of universal health coverage. | Supports the assessment, design, development and evaluation of workforce management and development. It is based on a framework that links the competencies of the immunisation workforce to the objectives of an organization, both for planning and for monitoring. | To monitor health facilities, services, and resources availability in emergencies. The standardized approach supported by a software-based platform aims to strengthening the collection, collation, and analysis of information on the availability of health resources and services in humanitarian context. | To inform understanding of gender-related barriers to immunisation: learning from research | Intended for use by Gavi-eligible countries to help guide the development of proposals to increase community acceptance of and demand for immunisation. | (a) The guidelines provide an overview of contents and uses of a KAP survey. (b) The purpose of KAP surveys reveal misconceptions or misunderstandings that may represent obstacles to implementing activities and potential barriers to behaviour change. | Presents key steps associated with tool design and collection, analysis and interpretation of focus group data. | Guidance on conducting a mostly qualitative study of health workers’ knowledge, attitudes, and practices (KAP), and their interactions with caregivers and infants. | This guidebook supports the use of the tools on understanding and addressing behavioural and social drivers (BeSD) of vaccine uptake. It guides programmes, partners and researchers to understand the reasons for low uptake, using globally field tested and validated tools for childhood vaccination and COVID-19 vaccination. It helps to reduce coverage inequities by gathering and using data to systematically design, implement and evaluate tailored interventions. | Serves to complement existing immunization guidelines by tailoring immunization planning, implementation and monitoring approaches to meet challenging contexts in urban areas especially in slum environments. This tool should be used in conjunction with existing immunization guidelines or strategy documents. | To present the current landscape of inequalities in immunization coverage, how to measure them and the pro-equity strategies and interventions with the best potential to reduce differences in vaccination uptake. | Applicable for acute and protracted emergency situations and aims to provide guidance on effective management and delivery of vaccination services, identify delivery strategies in different types of emergencies, facilitate early recovery of vaccination service delivery and facilitate sustaining and improving routine vaccination coverage during protracted periods of conflict. | To provide an evidence-based, and rigorous methodology for deciding on vaccination options in acute humanitarian emergencies (conflicts, natural disasters, pandemics), with more specific aim of determining whether or not the delivery of one or more vaccines to specific target populations during the acute phase of an emergency would result in an overall saving of lives. | To propose targeted solutions and interventions for improving coverage in specific sub population groups through evidence-based and participatory methodologies for understanding barriers to immunisation uptake. | Documentation of the basic characteristics, effectiveness, or common problems of programs of Periodic Intensification of Immunisation (PIRI). | To provide information on vaccines and immunisation. It can also be used as a training resource during immunization workshops, with the main target being subnational and health facility level. | Describe the process of microplanning to ensure immunization services reach every community. | Building national capacity from district level upward to maximize access to all vaccines. | Provides World Health Organization (WHO)-recommended standards for conducting surveillance for vaccine-preventable diseases (VPDs) and guidance for conducting a surveillance review. | The framework and toolkit support routine, annual and periodic independent assessments of facility-reported data for MCH, Immunizations, HIV, TB and malaria programmes. | Improve the accuracy of reported figures for immunization coverage and for any other immunization system indicator, and to improve the quality of any component of the immunization health information system. | A case study that demonstrates the importance of health inequality monitoring for equity-oriented policies, programmes and practices. | To provide a comprehensive resource to clarify the concepts associated with health inequality monitoring, illustrate the process through examples and promote the integration of health inequality monitoring within health information systems of low- and middle-income countries. | (a) To assess the impact of the vaccine introduction on the immunisation system. (b) User-friendly tools for conducting a comprehensive evaluation of the impact of the introduction of a new vaccine on immunization programmes. (c) To provide recommendations for rectifying typical problems associated with the introduction of a new vaccine. (d) Guidance for analysis of data collected during the evaluation. (e) A template for a final report. | ||
| Content | The Excel-based tool allows users to input data on vaccine procurement, delivery logistics, cold chain requirements, and operational costs. It includes templates for prospective and retrospective cost analysis. | CETSIV provides an Excel-based interface for inputting data on vaccine costs, coverage rates, healthcare expenses, and health outcomes. It generates cost-effectiveness ratios and visualizations of the potential benefits of influenza vaccination. | The resource covers methodologies for calculating direct and indirect costs related to influenza, such as healthcare expenses, productivity losses, and societal impacts. It includes case examples and templates for economic analysis. | The resource summarizes all planned, ongoing and completed work focused on zero-dose economics. It includes principles, methodology and data on zero-dose costing and other related economics evidence. | The resource contains a detailed breakdown of costs related to both vaccine product and immunization delivery costs, including cold chain logistics, health worker salaries, and operational costs. The study provides estimates of the financial investment needed to achieve the aspirational IA2030 coverage targets for different vaccines and regions. | This modeling study presents the global impact of vaccination in terms of numbers of deaths averted, years of life saved, and years of full health gained due to vaccination (i.e. disability-adjusted life-years averted). The analysis estimated vaccination’s contribution to decline in global infant mortality as well as increased survival probability. The article also covers major milestones and achievements that increased global access to vaccines and future directions for expanding immunization coverage. | This resource contains the estimated number of future deaths averted through vaccinations delivered in a given year. It provides estimates by WHO regions, by UNICEF program regions, and by World Bank income classification. | This modeling study estimates the number of future deaths averted through vaccination delivered from 2021-2030 in 194 countries based on the aspirational IA2030 coverage scenario. | The CAPACITI decision-support tool guides users through five steps of a structured recommendation process that is evidence based, context specific and well documented. The CAPACITI tool is based on multi-criteria decision analysis (MCDA) – a structured methodology that brings together different viewpoints and sources of evidence to compare options (products, services, or strategies). The tool can be used to identify if one or more option(s) is better than the others, or for ranking of the options from best to worst (depending on the decision question). The CAPACITI tool is aimed at a secretariat or core team within the national immunization programme or ministry of health (MOH) that is tasked with coordinating the recommendation process. This team should have knowledge of the national immunization programme and policy processes within the country. | In accordance with its mandate to provide guidance to Member States on health policy matters, WHO publishes vaccine position papers providing global vaccine and immunization recommendations for diseases that have an international public health impact. The papers summarize essential background information on the respective diseases and vaccines, and conclude with the current WHO position concerning their use in the global context. The papers are designed for use by national public health officials and immunization programme managers. They follow the recommendations of the WHO Strategic Advisory Group of Experts (SAGE) on immunization and undergo a formal review process both internally and externally prior to publication. | •The Demographic Health Survey (DHS) is a nationally- representative household survey that provides data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. The standard DHS has a large sample size and is conducted usually every 5 years, so country comparisons over time are possible. The DHS survey topics include child health, education, environmental health, family planning, gender/domestic violence, HIV prevalence, maternal health, nutrition, etc. •The Multiple Indicator Cluster Survey (MICS) is a large-scale, nationally representative household survey that collects data through standardized, face-to-face interviews with women aged 15-49 years in LMICs. The surveys include information on coverage, and data is disaggregated per demographic characteristics. The coverage data available is for BCG, Polio 1-4, DTP1-3, Measles, Hep B (Birth dose, 1-3), complete vaccination and no vaccinations at all. The demographic characteristics per which the coverage is disaggregated are: coverage per district, sex, urban/rural, mother’s education, wealth index quintile, ethnicity of household head. DHS indicators other than immunization are also potentially useful. For example, national and subnational percentages for “Assistance during delivery from skilled provider” is informative relative to administration of birth doses of vaccines. | The website provides the latest data available at the WHO. It includes a wide range of data types and different presentations. Some of the featured data sets include: global health estimates, mortality database, health SDGs, triple billion target, immunization data, etc. It also contains information on Demand for Immunization, Immunization expenditure, influenza vaccination policy, maternal and neonatal tetanus elimination, new and under utilized vaccines introduction, planning and management, safety, school-based immunization, system performance, vaccine supply and commodities, vaccine introduction, vaccine schedule, coverage survey data, WUENIC estimates. | The brief covers the costs of Rotavirus illness to governments and healthcare systems, costs of Rotavirus illness to families, Rotavirus vaccine affordability, and the cost-effectiveness of the Rotavirus vaccine. | The guidance comes in two books which should be used together. The first book provides practical guidance on establishing and strengthening immunization in the second year of life (2YL) and beyond. It also suggests ways that immunization visits during the 2YL can be used as a platform for delivery of other child-health services. The second book provides detail on the practical steps for planning, managing, implementing, and monitoring vaccination during a scheduled visit, or visits, in the second year of life (2YL). It also provides useful steps for strengthening vaccination when coverage in the 2YL has not reached programme targets. | The webpage provides a package of tools and guidance to support programmes and partners to assess and address BeSD of vaccination. | This page provides a range of evidence-based guidance for programmes and partners to guide the implementation and evaluation of strategies to increase vaccine demand and uptake. | The data is displayed at the global level for each vaccine in maps and tables. At the country level, a dashboard displays the data and charts display time series data. Every country (194 countries total) has a dedicated page with country-specific information, including a vaccine overview, impact studies for the pneumococcal conjugate vaccine and rotavirus vaccine, economic burden data, and disease burden data. | Six rotavirus-focused briefs cover epidemiology and disease burden, available vaccine products, the impact of vaccination, economic costs of rotavirus disease and the value of vaccines, safety, and introduction and coverage status. The Council’s series also includes a supplemental brief on the broad impact of early childhood diarrhea. | Relevant data on HPV disease burden and associated risk factors, prevention strategies, screening activities, and immunization programmes are available. | The guideline is in tow main sections. The first outlines principles of catch vaccination, and the second describes special catch-up vaccination efforts following an interruption of service. There is also a set of annexes that includes operational tools and job aids. | (a) The case for immunisation; (b) The Strategy; (c) The framework for action (including 7 strategic priorities); (d) Impacts and Strategic Goals; (e) Operationalisation of the strategy. The seven strategic priorities include commitment and demand, coverage and equity, life course and integration, outbreaks and emergencies, supplies and sustainability, research and innovation and immunisation programs for PHC and UHC. | To assist programme managers develop optimal immunization schedules WHO has compiled key information on its current routine immunization recommendations. Table 1 summarizes recommended routine immunizations for all age groups; Table 2 provides detailed information for routine immunizations for children including age at first does and intervals; Table 3 consolidates its recommendations for interrupted and delayed vaccination; Table 4 summarizes WHO’s recommendations for the vaccination of health care workers. The tables are not intended for direct use by health workers. Rather their purpose is to aid technical decisions with respect to the national vaccination schedule. | 3 main content areas (a) a Planning Guide to Reduce Missed Opportunities; (b) Methods for assessing missed opportunities; (c) Guide for implementing activities for reducing missed opportunities. Training Materials and Assessment Tools also available. Missed opportunities for vaccination (MOV) are defined as any contact made with health services by a child (or adult) who is eligible for vaccination, but which does not result in the individual receiving all vaccine doses for which he or she is eligible. The MOV strategy answers three important questions: How many opportunities are missed? - Assessed through: exit interviews with mothers/caregivers. Why are these opportunities being missed? -Assessed through: Health worker KAP questionnaires, focus group discussions (mothers/caregivers and health workers). What can be adjusted or done differently? - Assessed through: In-depth interviews, brainstorming sessions. The cost of visiting a healthcare facility is calculated based on the answers given by caregivers on questions relating to what type of transport they used, the cost and time needed to get to the clinic, their monthly income range and employment type, what medical costs they had incurred during their most recent visit, any childcare costs incurred during the visit, and how much time they had spent at the facility. | The papers summarize essential background information on the respective diseases and vaccines, and conclude with the current WHO position concerning their use in the global context. | This guidance describes a systematic approach called the “Evidence to Recommendation Process” (henceforth called “EtRProcess”) for use by national immunization technical advisory groups (NITAGs). The process described is based on the EtR Process used by the WHO Strategic Advisory Groups of Experts on Immunization (SAGE) and other long-functioning NITAGs, but has been adapted to fit the level of maturity of recently established NITAGs, which often face limited human and financial resources. | The approach is a step-by-step, country-driven process that provides sustainable support to a selection of countries to help them create their own NITAGs or to reinforce the capacities of the existing NITAG scientific and technical secretariat. It provides specific support activities established in consultation with the country and other international partners. The NITAG Resource Centre provides resources, tools and guidance to NITAGs and the immunization community, including on the use of Evidence-to-Recommendation (E2R) Frameworks. | Comparison table of WHO prequalified typhoid conjugate vaccines (TCVs) | These country-specific resources outline the burden of typhoid (provided by the Global Burden of Disease study) and the potential benefits of new typhoid conjugate vaccines in each country. | The costing tool enables the user to estimate the value of incremental (additional) resources required to add oral cholera vaccination campaigns to an existing immunization programme. The CholTool is designed for costing from a payer/provider perspective, and can make the perspective narrower or broader within the viewpoint. For example, the payer/provider may be defined narrowly as the EPI department within a ministry, or it could be broadened to a government perspective. it can also include the perspective of an external partner such as the WHO. The perspective is applied to determine which costs are included in the analysis and how included costs are considered as financial and economic. The CholTool calculates both financial and economic costs. The CholTool provides estimates of two cost measures: 1) total costs of adding the OCV to specific areas; and 2) cost per fully immunized person. It differentiates recurrent (operational) and capital costs as well as financial and economic costs. It also presents expenditures required for initial investments required for the OCV vaccine introduction. | This document explains why gender considerations matter for immunization programming with examples of common gender-related barriers, along with concrete gender-responsive approaches and actions that can be taken to address them. The guide also provides suggested indicators and data sources to identify gender-related barriers to immunization, as well as links to other resources and tools for gender-responsive programming. | This guide is designed to help anyone in the health and immunization system identify and address barriers or leverage drivers to immunization by locally co-designing and evaluating human-centred, tailored immunization programmes. In four stages – diagnose, design, implement and evaluate. This guide leverages UNICEF’s Human Centred Design 4 Health and WHO’s Tailoring Immunization Programmes (TIP) to create a consolidated and simplified strategy for evidence-based co-design suited to low-resource settings. | This position paper discusses the development of the BeSD for vaccine tool. It covers the 4 phases and key activities for the development of the tool. They include: • Initial development of the tool • Field testing • Psychometric validation and indicator selection • Finalisation of all tools and guidance In addition it includes the findings of a scoping review to identify effective intervention, and includes programme recommendations for use of the BeSD tools and resulting data. | The guide includes tools and guidance for understanding behavioural and social drivers of vaccination, as well as guidance on how to gather, analyse and use the resuting data. Furthermore, this document includes recommendations on interventions to increase vaccine uptake, as well as suggestions for related monitoring and evaluation using BeSD indicators. | This document includes information on efficacy; WHO prequalification status; safety; mixed schedules and interchangeability of products. | This document is includes information on WHO position on pneumococcal vaccines in infants in children; vaccine characteristics; safety; PCV performance; programmatic considerations; cost and financial considerations; availability and supply; prioritization among new vaccine introduction decisions. | The SYSVAC registry includes a variety of systematic reviews, including living, rapid and umbrella reviews, allowing users to search for reviews using free text and keywords (e.g., disease/pathogen, population). Reviews in the registry have been assessed for quality, using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) appraisal tool. | This slide deck includes information on various potential criteria to assess rotavirus vaccines. Those include availability for WHO prequalified rotavirus vaccines supported by Gavi; efficacy, safety and interchangeability; cost, including waste-adjusted price per dose and per fully immunized child, sustainability, vaccine cost calculator suggestion, cost-effectiveness; storage and transport with a focus on cold chain requirements and implications; programmatic administration considerations. | WHO’s Immunization, Vaccines and Biologicals department has developed these sheets within its priority area supporting the introduction of vaccines in Members States. They are primarily designed for use by national public health officials and immunization programme managers. Data can be used for the evaluation of Adverse Events Following Immunization (AEFI) reported during national immunization programmes. They include a short summary of the vaccine, details of mild and sever adverse reactions (local and systemic) following immunization. Expected rates of vaccine reactions have been included if available in published literature. | Allows access to up-to-date and comprehensive information on Gavi-supported vaccines. Provides an overview of WHO prequalified products for the vaccine groups that Gavi supports. The easy access to data aims to encourage countries to consider factors beyond procurement cost and impact on country co-financing requirements, including information on vaccine presentation, pricing, indicative wastage rates, manufacturers, cold chain volume and handling. By comparing the information the country can decide what is the most programmatically favourable for the specific country’s context contributing to the sustainability of the immunisation programme. Provides information on vaccine group, type and serotypes, presentation, product availability, recommended schedule, price per dose, dose per fully immunised person, price per fully immunised person, indicative wastage rate, wastage adjusted price per fully immunised person, manufacturers, NRA, WHO-PQ date, Administration, secondary packaging, shelf-life, cold chain volume per dose (cm3), vaccine vial monitor type, handling open vials, controlled temperature chain (CTC). Available Vaccine Detailed product profiles include Rotavirus, PCV, HPV and TCV. | Provides an overview of the most recent and historical data on GAVI supported vaccine products that UNCIEF procures on behalf of countries. Provides information on vaccine, form, presentation, number of awarded manufacturers, storage space (cm3/dose), VVM, product availability, and projected weighted average price per dose. | This simulation model can serve as a 'virtual laboratory' for decision-makers helping to answer what will be the impact of introducing new technologies (vaccines), what may be the effects of altering the characteristics of vaccines and other technologies (e.g., vaccine vial size, vaccine thermostability, or cold device capacity), how do configurations of supply chain affect performance and cost, effects of differeng conditions, how to allocate resources, how to optimize vaccine delivery. Examples of common model outputs include vaccine availability (i.e., the percentage of clients arriving at an immunization location who are successfully vaccinated), vaccine wastage, storage capacity utilization (e.g., the percentage of available space used each day), transport capacity utilization, number of stockouts (i.e., the number of times a location runs out of a particular vaccine), vaccine doses delivered or administered, and time-to-patient. Modeling provides decision-makers an opportunity to see how changes will affect the overall system without makign changes in the actual supply chain. It allows to find the optimal mix of cost, performance and risk based on a country's context and priorities. | The survey has 4 broad groups of questions: what is the availability of different health services in a country, specifically what proportions of the different facility types offer specific health services; to what extent are facilities prepared to provide health services; to what extent does the service delivery process follow generally accepted standards of care; are clients and service providers satisfied with the service delivery environment. Key services and topics assessed in a SPA Survey are: infrastructure, resources and systems; child health (includes a component on availability of vaccines); maternal and newborn health; family planning; HIV/AIDS; Sexually Transmitted Infections (STI); Malaria; Tuberculosis; Basic surgery. It provides context in the health system where immunization services are offered. Vaccine coverage, frequency of availability of child health services- vaccination services, disaggregated by routine vaccine and background characteristics which include facility type, managing authority, ecological region. Provides information on guidelines, trained staff and equipment for vaccination services disaggregated by background characteristics (see example below). Among facilities offering child vaccination services, the percentages that stores vaccines versus the percentage that does not store any vaccine, infection prevention and control for vaccination services. In the section about delivery and new born care it looks at the postpartum checks/advice at the time of discharge and looks at immunization of the baby disaggregate per facility type. A limited number of countries have completed this survey. | •The OneHealth Tool attempts to link strategic objectives and targets of disease control and prevention programmes to the required investments in health system. The tool provides planners with a single framework for scenario analysis, costing, health impact analysis, budgeting and financing of strategies for all major diseases and health system components. The user can choose to plan for intervention target setting by vertical programme or by service delivery level. 8 programmes are included: child health; reproductive and maternal health; immunization; nutrition; water and sanitation (WASH); HIV; TB; and Malaria. • The CEA country contextualization templates are an addition that allows for country-level cost-effectiveness analysis that uses local data. Cost-effectiveness analysis can be conducted using the Spectrum generalized cost-effectiveness tool. Then, can proceed to assess health system implications and financial costs, using the OneHealth Tool to inform the design of health benefit packages and overall health strategies. | The African governments, their partners at the national, regional and global levels. Those involved in the planning process include ministries of health, policy, finance and planning, international organizations, malaria vaccine scientists and donors. This framework helps countries to understand the disease burden, likely impact of future malaria vaccine, impact of current malaria interventions and financing options. The planning tool promotes preparation for a new vaccine at the national level. One of the key aspects in the planning process for country decisions on malaria vaccine introduction is the early identification and gathering of the necessary data. The planning tool outlines a range of data that would inform country decisions- from the malaria disease burden, the likely impact of future malaria vaccine, the impact of current malaria interventions, financing options. The tool supports countries to put processes in place, if a decision is made to adopt a vaccine, many groups and people would have to act on the information for successful introduction. | To provide technical assistance and readiness assessment, helping to build a strong foundation for sustainable influenza vaccine programs. Through technical assistance, PIVI supports country workflow related to developing or strengthening pandemic preparedness and seasonal influenza vaccination programs. PIVI may assist with work such as: Estimation of disease and economic burden of influenza, Development of acceptability surveys, communication campaigns, and training initiatives, Vaccine program implementation and evaluation activities, including adverse event and vaccine coverage monitoring, National Immunization Technical Advisory Group (NITAG) support and strengthening | This paper describes the experience in the Netherlands in developing a framework for assessing whether a vaccination should be included in the National Immunization Programme (NIP). Bearing in mind the public nature, the factors that determine a vaccine's suitability for inclusion in a communal vaccination programme have been translated into seven selection criteria, grouped under five thematic headings: seriousness and extent of the disease burden, effectiveness and safety of the vaccination, acceptability of the vaccination, efficiency of the vaccination, and priority of the vaccination. The seven criteria and the explanation of them provide a framework for the systematic examination of arguments for and against the inclusion and prioritisation of particular vaccinations. The criteria for inclusion of vaccinations in public programmes: seriousness and extent of the disease burden; effectiveness and safety of the vaccination; acceptability of the vaccination; efficiency of the vaccination; priority of the vaccination. | This article proposes a framework for making evidenced-based decisions on the introduction of new and underutilized vaccines. It also highlights the experience of rubella and CRS elimination in the Americas as an innovative strategy to ensure rapid uptake of a vaccine to provide timely protection and more rapid prevention of disease, after the decision to introduce the vaccine has been reached. The target audience are country-level decision-makers in health or government sectors, NITAGs, immunization programme managers. | The aim is to address the shortcomings of grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendation. The aim of the GRADE Working Group is to reduce unnecessary confusion arising from multiple systems for grading evidence and recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is the most prominent of the many frameworks developed over the years to assess the quality of evidence, and has been adopted by WHO and many other national and international organizations. | The target audience for this tool are immunization decision-makers. PriorityVax promotes auditable and rigorous deliberations; enables and captures the decision matrix of users; and generates shareable documentation of the process. The tool is especially useful in highlighting the sensitivity of decisions to inherent bias and uncertainty in the evidence. The platform is designed to capture deliberations around prioritisation, to explicitly evidence the importance of different criteria and produce a consistent documented process that supports transparent EIDM. This improved platform, supported by the Sabin Vaccine Institute, has a more streamlined user experience and a clearer selection and use of attributes. Users can easily tailor PriorityVax to incorporate local evidence-to-recommendation processes. It is a customizable, web-based tool in which users can employ the national and subnational data they have identified as bet-suited to inform their priority-setting decisions and to place equity at the center of vaccine selection, allocation and distribution. In a stepwise process the tool guides the user to define the target population, the disease and vaccine characteristics, and to identify the country vaccine needs, attributes and criteria that can guide the decision making. Weighting can be applied, and the evidence that should be used can be both qualitative and quantitative. The output is a report on the available evidence, and how the decision was made. | It provides internationally comparable data on health spending for close to 190 countries from 2000 to 2019. Supports the goal of Universal Health Coverage by helping monitor the availability of resources for health and the extent to which they are used efficiently and equitably. Contributes to better understanding of how much do different actors contribute, what are the financing arrangements to pay for health, how much money is spent on PHC, how much money is spent on different diseases and programmes such as immunization. | The purpose of this document is to outline the key theoretical concepts and best practice in methodologies, and to provide guidance on the economic evaluation of influenza vaccination in LMICs. The guidance is aimed at those seeking to conduct, commission or critically appraise economic evaluations of influenza vaccination in LMICs. The document is not intended to be a step-by-step manual for producing an economic evaluation but aims to offer high-level guidance on influenza vaccination assessment which can be adapted to the setting of interest. As we will outline, there are important issues that arise when evaluating influenza vaccination strategies that merit particular attention and consideration. The guide is written for a technically literate audi- ence with a basic knowledge of economic evaluation. The document may be particularly useful for those who have never undertaken or commissioned an evaluation of influenza vaccination but have previous relevant experience in evaluating other interventions. | Designed to cost packages of community health services and produce results to help assess performance, plan future services, and prepare investment cases. It is a spreadsheet-based tool designed to be used by health system managers and policy makers. It allows users to calculate the costs of all elements of comprehensive CHS packages, including start-up, training and community-level service delivery costs as well as support, supervision and management costs at all levels of the health system. The tool also has a financing element that can be used to show programme financing sources and gaps in current and future funding. It is used for estimating resource requirements. It automatically produces total programme costs for baseline year and five-year projections, costs per capita, per community health workers, per contact, per program and per resource type. Incremental costs and financing, key drivers of costs and cost categories as a percent of total costs, and five-year projections of financing and financial gaps with sources of funding. The dynamic nature of the tool means that the final cost results are based on key variables, such as target populations, incidence rates and service delivery platforms. When a user modifies such variables, changes are immediately and automatically reflected in all component costs. Dynamic costing tools are suitable for planning because the cost impact of changes related to planning assumptions can be seen immediately and fed back into the planning process. | IDCC presents the most comprehensive, current and standardized global evidence on the cost of delivering vaccines in low- and middle-income country settings. It compiles the evidence from a systematic review of the published literature and selected grey literature from January 2005-March 2019 on immunization delivery costs (IDC) in LMICs. It is intended to support country national and sub-national planners, policymakers, researchers and international partners in planning, budgeting, advocacy, research and other related efforts. It includes immunization delivery unit cost data from 37 countries, representing mostly health facility and school-based delivery and covering nearly all vaccines and vaccination schedules. It presents immunization delivery unit cost data and other information as reported in the literature and in 2016 US dollars in order to ensure ensure comparability across studies and settings. The IDCC contains over 600 unique unit costs from 68 studies/reports. | This Excel-based toolkit provides guidance on sampling, survey instrument development and administration, and calculations. It was developed to help countries more precisely document the shared resource use between the immunization program and other health service provision. Users can define the perspective and scope of the analysis. Part of the ProVac Toolkit. | The approach is based on a health worker’s workload, with activity (time) standards applied for each workload component. Using the WISN approach allows health managers to: determine how many health workers are required to cope with actual workload in a given facility; estimate staffing required to deliver expected services of a facility based on workload; calculate workload and time required to accomplish tasks of individual staff categories; compare staffing between health facilities and administrative areas; understand workload of staff at a given facility; establish fair workload distribution among staff; assess the workload pressure of the health workers in that facility. The WISN method is realistic in providing practical targets for budgeting and resource allocation. | List of available vaccines of certain diseases. For each disease or pathogen provides summary information on internationally available vaccines and WHO policy recommendations together with key resources. Also, provides a list of diseases for which vaccines are in development, overseen by the WHO’s Product Development for Vaccines Advisory Committee (PDVAC), provides information on vaccine research and development. | This tool is part of the guidance materials developed by WHO and UNICEF in order to establish and strengthen immunization in the second year of life (2YL). The tool has various sheets such as basic data sheet, intervention choices, demographics, vaccine parameters and vaccine prices. As well as sheets relating to nutrition, malaria, staff time, training and communication. -Basic data: country information, administrative structure of the health sector, vaccines included in the first year of life schedule, parameter assumptions. -Intervention choices include first dose vaccines (measles, MenA, seasonal influenza, JE, typhoid) as well as place to document other vaccines or second dose, booster dose or additional dose vaccines, catch up of missed under-one year doses, as well as nutrition interventions and malaria interventions. -Demographics: base year population data needs to be included and the tool will forecast for the next 5 years. -Vaccine parameters and vaccine prices include first year of life reported coverage, 2YL predicted coverage, vaccine wastage, vaccine and syringe prices, freight and handling charges. | The WHO Flutool plus- Seasonal Influenza Immunization Costing Tool (SIICT) is an update of the previous Flutool and helps to project total costs of influenza vaccine introduction for different risk groups by type of delivery strategy over a period of up to five years. The tool allows for the inclusion of the particularly affected populations: pregnant women, health workers, children under five, adults aged 65 and above, people with chronic health conditions. The costing tool enables the user to estimate the value of incremental (additional) resources required to add the influenza vaccine to an existing vaccination programme. It estimates only the value of new resources needed and does not include the cost of other goods and services (e.g. transport) already being used for other vaccines. The SIICT enables the user to estimate the additional resource requirements based on the specific strategy that will be used for vaccinating the target populations in the country. | If a vaccine has undergone thorough evaluation of relevant data, testing of samples and WHO inspection of relevant manufacturing sites — and the outcome is positive — it is included in the WHO List of Prequalified Vaccines. This means that it: meets WHO standard for vaccine quality, safety and efficacy standards, as endorsed by the WHO Expert Committee on Biological Standardization (ECBS); is suitable for the target population (in accordance with the recommended immunization schedules) and for use with appropriate concomitant products meets the operational specifications for packaging and presentation of UN organizations interested in procuring that vaccine. The aforementioned recommended standards include independent and appropriate regulatory oversight of the vaccine by the responsible, functional national regulatory authority (NRA). The list is not an exhaustive list of vaccines used to immunize humans. It reflects those vaccines which, following a selection based on immunization priorities set by relevant UN agencies and WHO, have been submitted to WHO for evaluation by interested parties and have — at the time of evaluation and site inspection — been found to meet the aforementioned WHO-recommended standards and operational specifications. | This document includes a guide on how to provide quality immunization services at the national/district, community and point of service levels of the health system, including clear guidance of the necessary actions required at each level. It also provides information on how to ensure equitable access to quality immunization services as well as a framework for monitoring and evaluation of health services" | UNIVAC is a single universal vaccine impact and cost-effectiveness decision support model with a standardized, accessible Excel-based (now based in R), interface and a familiar set of input steps and outputs. Input estimates of age-specific disease burden, age/dose specific vaccine coverage and effectiveness allow for a simple evaluation of direct vaccination impact on health outcomes. Additional input parameters can be included to evaluate indirect effects, which may be important for the evaluation of several vaccines. The tool features automated calculations, options for sensitivity analysis and automatically generated results charts and figures. The primary audience is national multi-disciplinary teams of Ministries of Health personnel. Secondary audiences are national, regional and international academics, donors and partner institutions. | The Consortium aims to deliver a more sustainable, efficient, and transparent approach to generating disease burden and vaccine impact estimates. It works on aggregating the estimates across a portfolio of 12 vaccine-preventable diseases and further advancing the research agenda in the field of vaccine impact modelling. Wide range of publications presenting various models. For example, models on mortality reduction benefits, effect and cost-effectiveness, health impact and economic value, etc. | Allows to browse data along actual datasets. Provides information on the global burden of diseases (globally, regionally, by country and by region). Provides country datasets for the burden of disease and access to health, as well demographic data. The EPI visualisation site provides information on VPD disease prevalence and excess mortality (maps, trends). The Global Burden of Diseases component allows the user to explore estimates on causes of death, risks, population estimates, fertility estimates and life tables. Measures deaths, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), prevalence, incidence, life expectancy, healthy life expectancy (HALE), maternal mortality ratio (MMR) and summary exposure value (SEV). The years available are 1990-2019, includes annual results for all measures disaggregated by sex. It allows visualisation of vaccine coverage and vaccine preventable disease burden. The limitation is that data comes from different sources, and the estimates rely on assumptions. | Describes a four-step process to identify supply chain design strategies to reach under-served populations and track progress reducing inequities. (1) Identify the population; (2) Consider supply chain related challenges; (3) Determine mitigation strategies and (4) Measure progress. The process identifies populations, challenges, strategies, and progress indicators for supply chain for underserved populations. The contents also describe supply chain equity metrics (1) Cold chain coverage per fully immunized child (FIC). (2) Average resupply distance of vaccines between the health facility and resupply store. (3) Inbound resupply distance of vaccines between district store and the next level of the system. | All four tools are Excel based with relevant cover pages, data entry and analysis spreadsheets, and are accompanied by user guides. | The site contains a range of tools and guidelines that include the following: Setting a standard for the vaccine supply chain, EVM background and training resources, EVM Standard Operating Procedures (SOPs), EVM assessment tools and user guides, EVM global data analysis, Vaccine Management Handbook. In the EVM the vaccine supply chain strengths and bottlenecks are assessed. The assessment package enables countries to review supply chain readiness for new vaccines, identify how to expand, rehabilitate and optimize the cold chain system, improve temperature management and control to safeguard vaccines, design more efficient supply chain networks and distribution models, enhance the skills and competencies of human resources for logistics and improve overall supply chain management. Based on the 9 criteria for each level it looks at: pre-shipment and arrival procedures to check whether every shipment of vaccines manufacturer reaches the receiving store in satisfactory condition and with the correct paper work; storage within recommended temperature ranges for all vaccines and diluents; cold storage, dry storage and transport capacity to ensure it is sufficient to accommodate all vaccines and supplies needed for the programme; buildings, cold chain equipment and transport systems enable the vaccine and consumables supply chain to function effectively; maintenance of buildings, cold chain equipment and vehicles is satisfactory; stock management systems and procedures are effective; distribution between each level in the supply chain is effective; appropriate vaccine management policies are adopted and implemented; information systems and supportive management functions are satisfactory. Moreover, in the report there is a section on key recommendations that could be used to identify key points for overcoming some of the barriers that exist in the country. | Identifies key policy content areas and principles for the for development of National Immunisation Policy. | (a) Defines Policy Coherence for Health Equity. (b) Explains how health actors can promote policy coherence. (c) Measuring policy coherence. (d) Indicators for policy coherence. (e)Annexes with examples and guide for assessments. | Provides guidance, tools and templates to implement the five stages: (1) developing concept; (2) planning and preparing; (3) conducting the review; (4) synthesizing findings; (5) translating into action. The EPI Review should be a comprehensive assessment of all seven basic immunization topics: programme management and financing; human resources management; vaccine supply, quality and logistics; service delivery; immunization coverage and AEFI Monitoring; Disease Surveillance; Demand Generation. The review can also put emphasis on any other special area that is relevant, for example, gaps between survey and administratively reported data, EVM management scenario, urbanization and equity, human resources capability for surveillance. The reports evaluate the strengths and weaknesses of each of the immunization components, often include a SWOT analysis, and outline recommendations for the changes and adjustments needed to improve the immunization programme. Information on barriers may appear in different parts of the report. | A Reference manual which includes an overview of the survey process, tools, and indicators. An Implementation guide which provides a step-by-step instruction for a SARA survey. SARA is a health facility assessment tool designed to generate a set of tracer indicators of service availability (physical presence of services) and readiness (capacity to deliver services) and measurement methods to detect change and monitor progress in HSS. It builds on experiences of SAM, SPA, working with USAID and partners to scale up SARA in countries. The SARA survey generates a set of tracer indicators of service availability and readiness that can be used to: detect change and measure progress in health system strengthening over time; plan and monitor the scale-up of interventions that are key to achieving the SDGs; generate the evidence base to feed into country annual health reviews; support national planners in planning and managing health systems In a sample report, the following information on immunization can be found: Percentage of health facilities offering child immunization services (measured through DTP+Hib+HepB, Polio, BCG) either in the facility or as outreach, according to level of service, managing authority, ownership and residence. Among health facilities offering child immunization services, the percentage with trained staff, guidelines, equipment, and medicines, according to level of service, managing authority, ownership and residence. Among health facilities offering child immunization services, the percentage of staff and training, equipment, medicines and commodities, readiness to provide child immunization services, total number of facilities offering child immunization services. The number of countries that have conducted this assessment is limited, and data can be accessed at national level. | (a) Information is provided on the HRH framework and action cycle along with definitions and subcomponents. (b) Components include the following topics: Leadership, Partnerships, Policy, Finance, Education and HRH management systems. (c) A set of resources for each component is identified with links to each resource. | Online courses with a range of Middle Level Management Training Modules including 14 management topics including the role of the National EPI manager, solving immunisation problems, planning, new vaccine introduction, planning and monitoring SIAs, immunisation safety, conducting an EPI Review, planning, community engagement, and costing and financing of an immunisation program, vaccine stock management, cold chain management, monitoring immunisation systems, immunisation safety, VPD surveillance & supportive supervision. | (a) Guidance on CHW selection, education, continuing training, linkage with other health workers, management, supervision, performance enhancement, incentives, remuneration, governance, health system integration and community embeddedness; (b) Identifies relevant contextual elements and implementation and evaluation considerations at the policy and system levels; (c) Tools to support the planning and implementation of CHW programmes; and (d) Identification of priority evidence gaps to be addressed through further research. | Provides details on organisational objectives, organisational attributes (capacities across the six system areas of EPI), work functions, and related competencies for immunisation at each level. | The HERAMS App generates data and reports on health facilities (number, type, geographical location, functionality, accessibility) resources for service delivery (human resources, electricity, water supply, cold chain, communications, waste management), availability of health services (according to health program) and reasons for gaps in service availability (staff, equipment, medical supplies, finances, training and other). Can be applied in a range of emergencies, post-emergencies, recovery and development contexts. The approach is simple and rapid to implement, adaptable to any emergency or country context, designed to overcome access, security, time and resource constraints, is cost and time efficient without diverting resources from the emergency response. extensive training not needed. The modularity and scalability of the app make it an essential component of emergency preparedness and response, health systems strengthening, universal health coverage and the humanitarian development nexus. | Provides examples of gender related barriers and possible interventions to tackle them. | An overview of demand generation and its key elements and guidance on the country dialogue and process for developing the demand generation component of Gavi HSIS proposals. It outlines five main categories of demand generation. | Brief description, uses, tools (survey protocols, preparing for survey, conducting the survey, data analysis, conclusions), and operations of a KAP survey. | Includes guidance on sampling and selection of focus group participants and explains special considerations when working with children. | A KAP document for health workers describing the decision points and the pros and cons of various choices at different stages of planning, implementing, and using study findings. Includes question guides, job descriptions and practical aids, and a training plan. Also includes actionable recommendations for improving health worker / caregiver interactions based on study findings. Potentially of high relevance to C & E, as the KAP studies may address supply side factors that reduce trust & utilisation of health services. | The guide includes tools and guidance for understanding behavioural and social drivers of vaccination, as well as guidance on how to gather, analyse and use the resuting data. Furthermore, this document includes recommendations on interventions to increase vaccine uptake, as well as suggestions for related monitoring and evaluation using BeSD indicators. | Structured around five major areas: Planning, Coordination and Management of Resources; Reaching all Eligible Populations; Engaging with Communities; Monitoring and Using Data for Action; and supportive supervision. The toolkit provides a menu of tailored strategies to deliver life-saving vaccines in urban areas especially to urban poor populations. | Presented as a set of published discussion papers. Main theme areas examine immunization equity from the perspectives of: Universal Health Coverage, gender, conflict, urban, rural and remote settings, human rights, data triangulations and innovations, with two page summaries of each topic. The papers examine determinants of vaccination, commonly used metrics, available data and guidance, and program approaches to the provision of equitable vaccination services and closing of coverage gaps between population groups with a focus on the most disadvantaged. | Guidance on planning (including planning templates), implementing vaccination services in a humanitarian emergency (including service delivery strategies, securing access, community-based interventions, and schedules), and early recovery of immunisation services post emergency. | The strategy provides content on the three steps of humanitarian intervention; 1) assessing the local epidemiological risk of VPDs among the affected population, 2) assessing vaccine selection and characteristics to consider, and 3) assessing local contextual constraints that further assist in effective and timely decisions. | Content includes overview of approach, the detailed steps of process for the three main areas of TIP (identifying susceptible groups, determining barriers and drivers, designing interventions based on evidence). | Provides a snapshot of the range of PIRI activities and experiences across countries, describes common features and issues, and provides some practical suggestions for country planners to consider. | Information and planning tools for subnational and health facility level on vaccines and diseases, the vaccine cold chain, ensuring safe injections, microplanning for reaching every community, managing an immunization session, monitoring and surveillance, partnering with communities. | Content areas include- mapping, identifying priority communities/centres, identifying barriers, identifying solutions and workplans, session planning, defaulter tracing and working with the community. | 5 operational components (outreach, supervision, linking services to communities, monitoring and use of data for action and planning and management for resources). | Introducing VPD surveillance, conducting VPD Surveillance, VPD data, quality, the role of VPD surveillance in outbreaks, introduction to disease specific standards, followed by an overview of how to conduct surveillance for each VPDs. | Guidelines and tools that lay the basis for a common understanding of data quality. The toolkit includes an implementation guide, associated tools and training materials organized into 3 distinct modules: of 1. Framework and metrics, 2. Desk review of data quality and 3. Data verification and system assessment. | A flexible toolbox of methods used to evaluate different aspects of the immunization monitoring system at district and health unit (HU) levels. The assessment includes a review of data accuracy at different levels and a self-designed questionnaire reviewing monitoring quality issues (availability of vaccination cards, use of tally sheets, directly observed recording and reporting practices). | It provides examples of application of the health inequality monitoring cycle, discusses practical challenges of monitoring health inequalities, and suggest strategies for strengthening health inequality monitoring. The 5 steps in equality monitoring described are: (1) determining the scope of monitoring; (2) data collection; (3) analysing and interpreting the data; (4) reporting results and (5) knowledge translation. | Overview of health inequality monitoring, data sources, measures of health inequality, and examples of inequality monitoring in practice (a set of ppt lectures and e-learning module accompanies the handbook). Topic areas include concepts and measurements of health inequalities, data sources, reporting, health inequality assessment, and appendix of indicator definitions. | The manual consists of an overview of the PIE, a description of what needs to be evaluated and what the evaluator should be looking for, and an explanation of how to synthesize the data and present the findings. Annexes include checklists, questionnaires, and report templates. | |||
| Expected outcomes | (a) Improved coverage and equity of access through reaching individuals who miss routine vaccine doses for any reason and who can be identified and vaccinated in the second year of life. (b) Policies, Strategies and field guides are in place for commencing a life course approach to vaccination services with 2YL approach as a first step. | (a) Improved coverage and equity of access through reaching individuals who miss routine vaccine doses for any reason and who can be identified and vaccinated at the earliest opportunity. (b) Policies, schedules and strategies are in place in preparation for responding to emergency situations or in the event of disruption to health services or interruption to routine EPI or campaigns services. | (a) Development of regional and operational plans that are aligned to the global strategic framework, but which are adapted to the national context. (b) Implementation is intended to achieve “a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being.” | Improved timeliness and coverage of immunisation and reduced inequity. | Increased awareness and understanding of gender-related barriers to immunization and how to manage them to improve immunization coverage. | Increased engagement of local partners and communities in understanding reasons for low uptake and co-designing, implementing, and evaluating related strategies. | Programmes and partners will have local data (based on use of globally field-tested and validated tools) to guide planning, implemention and evaluation of tailored interventions. Further the paper offers recommendations to programmes, partners, NITAGs and RITAGs for using the BeSD tools and resuting data. | Programmes and partners will have local data (based on use of globally field-tested and validated tools) to guide planning, implemention and evaluation of tailored interventions. | Evidence and information to support programmes and partners to improve immunization services and equitable access to it. | Vaccines must be both available and potent whenever a caregiver reaches a point in the health system where immunizations are provided. | More equitable allocation of supply chain equipment attributable to accurate assessment of gaps in the supply chain inventory, prevention of vaccine stock outs due to accurate forecasting of needs and according to the resupply cycle, improved vaccine management due to assessment and expansion of vaccine storage and transport capacity. | Gaps in the cold chain and vaccine management system have been identified through the assessment method, and corrective actions will be taken through development of an improvement plan and recommendations for development of the supply chain system. | Development of a National Immunisation Policy that is consistent with National Health Sector and Development Goals as well as global health and development goals. | •Use of the guide should promote the following: (a) Coherence across all areas of public policy to realize health equity. (b) Increased use of the SDGs to provide a framework to strengthen policy. (c) Establishment of governance mechanisms for policy coherence that enables action for health equity to operate across a decision-making system. (d) Inclusion of equity analysis in inter-sectoral initiatives. (e) Development of a health equity approach in all health-related departments. | Evidence and recommendations to inform multi-year planning, development and implementation, including identification of sustainable sources of financing. | Generates a set of core indicators on key inputs and outputs of the health system used to measure progress in health system strengthening over time. Tracer indicators provide objective information about whether a facility meets the required conditions to support provision of basic or specific services with a consistent level of quality and quantity. | Increased capacity to effectively lead, plan and manage the health workforce in an integrated way within their overall health system. | Each of the 14 on line courses (which range from 1.5 hours to 5 hours) have identified learning outcomes for each topic, but with the overall outcome expected of improved on the job management performance. | Has a potential to contribute to the reduction of inequities by strengthening the competencies, motivation, performance, and management of CHWs. | Competencies in immunisation program management and service delivery can be defined at each level of the health system. | During an emergency, a rapid assessment is provided of health facilities, resources for service delivery, availability of health services in the and reasons for gaps in service availability. | Increased awareness and application of gender analysis and interventions into health policies, plans and proposals. | (a) Demand side barriers and interventions are reflected in health system and new vaccine proposals and through country dialogue with Gavi Alliance partners. (b) Well designed and executed demand generation interventions for immunisation engage and mobilise caregivers, communities and other key in-country stakeholders to - increase coverage and equity. | Baselines set for future assessments on KAP for any topic, that can assist with design or redesign of interventions. | May lead to the discovery of attitudes and opinions that may not be revealed through methods targeting the individual, such as structured interviews, surveys, or semi-structured key informant interviews. | Immediate outcome is better understanding of health worker attitudes and practices regarding client interactions. In the long term, the findings if the health workers’ studies could be used to improve quality of interactions with clients leading to improved caregivers’ trust. | Programmes and partners will have local data (based on use of globally field-tested and validated tools) to guide planning, implemention and evaluation of tailored interventions. | Users of the toolkit will become more familiar with the range of strategies and service delivery methods that are applicable in urban settings. | Programme managers and providers will be much more informed on different determinants and perspectives on the topic of immunisation inequities. | Maintained or re-established routine vaccination services during and post emergency. | Prioritizing interventions in humanitarian emergencies will result in overall saving of lives, and a reduction in the population burden of disease. | Improved coverage and improved equity in coverage between social groups or geographic areas. Through involvement of stakeholders, TIP can also improve community participation and ownership in health services. | Planners will be aware of the operational principles and inputs required to design their own PIRI strategy e.g. choice of interventions, planning, budgeting, coordination, processes to record and report achievements, supplies and logistics management, training, orientation, and human resource issues, communication, social mobilization, and community engagement. | Community and facility planners will be more informed on immunisation. Planning will be more matched to needs based on application of RED planning and monitoring tools. | (a) Improved planning of service delivery by making health facility specific microplans. (b) Improved coverage. (c) Improved planning capacity. (d) Improved use of data for planning purposes at the local level. | (a) Improved planning of service delivery by making health facility specific microplans. (b) Improved coverage. (c) Improved planning capacity. (d) Improved use of data for planning purposes at the local level." | Surveillance systems are established and functioning according to an agreed international standard, adapted to each health system and epidemiological context. | The results will point to weaknesses in data management, which should then trigger development of a Data Quality Improvement Plan. | Analysing the data enables identification of strengths and weaknesses of reporting systems which need to be corrected. | Facilitates development of inequality monitoring systems, and promote understanding of the steps in inequality monitoring. | Development of inequality monitoring systems, promotion of understanding of concepts and processes of inequality monitoring. | Evaluation of impact of NVI on the immunisation system, and a set of recommendations to make corrective actions. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Use | National immunization program managers, policymakers, and financial planners can use this tool to develop budgets and advocate for funding to introduce TCVs. It supports planning and decision-making by estimating the financial implications of TCV introduction. | Health economists, policymakers, and immunization program planners can use this tool to assess the value of seasonal influenza vaccination and prioritize resource allocation. | Health economists, policymakers, and researchers can use this manual to assess the financial impact of seasonal influenza and justify investments in vaccination programs and other preventive measures. | Policymakers, immunization program managers, and global health organizations can use this resource to plan and allocate resources effectively in order to reach zero-dose children. It helps in budgeting and designing strategies to close immunization gaps and achieve equity in vaccine coverage, which is a key goal of the Immunization Agenda 2030 (IA2030). | This article can be used by policymakers, global health organizations, and national immunization planners to understand the financial implications of meeting IA2030 coverage goals. It supports the development of cost-effective immunization strategies by identifying where the most significant investments are required and how resources can be allocated to maximize impact. | This review can be used by health professionals, policymakers, and researchers to understand the long-term health benefits of global immunization efforts. It serves as evidence for continued investment in immunization programs and informs strategic decisions for future vaccination initiatives, especially in low- and middle-income countries. | This indicator can be used by global and regional partners for tracking progress made on performance of immunization programs and for informing advocacy to secure commitment and resources for immunization programs. | The modeled impact estimates from this analysis are used as target estimates for the Impact Goal indicator (IG 1.1) of IA2030 Framework for Action. The analysis helps in advocacy for stronger immunization policies by providing evidence on the large-scale health benefits of vaccines. It also supports strategic planning for vaccine programs by highlighting the most impactful interventions. | Does not require user input. Easily accesible list. | Does not require user input. Data is available. | Does not require user input. Database, so the user needs to select the desired information. | To inform decision-making on Rotavirus vaccine introductions. | All data on VIEW-hub are available for download. | Does not require user input. Database, so the user needs to select the desired information. | Does not require user input. Strategy document, used to guide the thinking. | Does not require user input. The tables are availble to bring awareness to recommendations and general practices. | •To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. Might not be availble in all countries, and shouldn't be conducted just for the purposes of informing a criterion for CAPACITI, as it is resource intensive. | The papers are designed for use by national public health officials and immunization programme managers. They may also be of interest to international funding agencies, the vaccine manufacturing industry, the medical community, and the scientific media. | Comparing of WHO prequalified typhoid conjugate vaccines (TCVs). | They are designed to be used by anyone interested in advocating for typhoid control and prevention in their country. | Requires user input. The user can customize the tool with country specific characteristics, as well as some country specific information. | It is a streamlined planning document that focuses on a strategic period of 5 years. | Does not require user input. Easily accessible list. | Does not require user input. Easily accessible list. | Does not require user input. Database can be searched using already existing filters. | Does not require user input. Easily accessible list. | Does not require user input. Information sheets are available. | Does not require user input. Easily accessible list. | Does not require user input. Easily accessible list. | Requires user input. As it is a modeling tool requires the user to input various details, such as storage, locations, shipping routes, capacity, transport devices, etc. | •To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. It shouldn't be conducted just for the purposes of informing a criterion for CAPACITI, as it is resource intensive. Make note of when it was published. | Requires user input. The tool is populated with country-specific default information on epidemiology and estimated costs, but they can be changed by the country user to more locally relevant information. | Does not require user input. Database, so the user needs to select the desired information. | Requires user input. There is detailed guidance on the economic evaluation of influenza vaccination, but the user needs to do the analysis. | Requires user input to some extent. The tool automatically produces key results, but requires update/input on key variables such as target populations, incidence rates and service delivery platforms. | Does not require user input. It is availble as a web-based catalogue or Excel tool, and it is user friendly and the several available filters allow for a streamlined search. | Requires user input. Users can define the perspective and the scope of analysis, and can produce estimates. | Requires user input. The WISN process needs to be applied to answer a clearly defined question, but does not require special data collection exercise because it uses available service statistics. | Does not require user input. Easily accesible list. | Requires user input. While the tool has some features allowing for automatic calculations the user is required to input data. | Requires user input. The user should enter data, specify information on the service delivery strategy, and gather data required for the analysis. | Does not require user input. Easily accessible list. | Requires user input. It is a modeling tool, and thus the user needs to select what data will use and also set the assumptions. | Does not require user input. Collection of various publications, the user needs to review the publications. | Does not require user input. Database, so the user needs to select the desired information. | •To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. It shouldn't be conducted just for the purposes of informing a criterion for decision-making (e.g. when CAPACITI decision-support tool is used), as it is resource intensive. Make note of when it was published. | •To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. It shouldn't be conducted just for the purposes of informing a criterion in decision-making (e.g. in CAPACITI decision-support tool), as it is resource intensive. Make note of when it was published. | To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. It shouldn't be conducted just for the purposes of informing a criterion for decision-making (e.g. criterion for CAPACITI decision-making tool), as it is resource intensive. Make note of when it was published. | Depends- does not require user input for the countries for which data is availble online, but in general requires data collection and analysis. | •To be used if report available at the country level. •Does not require user input. This is an assessment that would have been conducted before. Might not be available in all countries, and shouldn't be conducted just for the purposes of informing a criterion for decision-making (e.g. criterion for CAPACITI decision-support tool), as it is resource intensive. | Does not require user input. Does not provide information for criteria, but these are paper that give a general overview of the global problem. | ||||||||||||||||||||||||||||||||||||||||||||||||
| Strengths | (a) A strong platform in the 2YL provides the first step in extending immunization beyond infancy and encouraging the continuity of routine vaccination into preschool, school, adolescent and adult populations. (b) The guidance also provides information on integration of other interventions into the 2YL approach. | (a) As well as identifying catch up policy, schedule, and strategy as an effective means by which to improve coverage and equity, the guidance also demonstrates linkages with routine immunisation and health system strengthening. (b) In addition to principles and policies and procedures for catch up immunisation strategy, the guidance also includes a set of job aids, tools, worksheets, and schedules to support practical applications of catch-up strategy. | The seven strategic priorities provide a clear framework for policy and plan development for immunisation, as well as supporting stronger alignments and linkages with primary health care in support of universal health coverage. | Enables improved coverage and timeliness of vaccination through better use of existing services and resources by linking and translating findings into actionable solutions to reduce MOV. The MOV assessment methodology includes both qualitative and quantitative component. Intervention guide includes MOV-lite option, which encourages countries to make better use of data to address MOV. | The guidance outlines gender related barriers and related interventions in a detailed manner. | Provides clear guidance on how to diagnose susceptible populations, and design and implement tailored immunization programmes | The paper sets strategic directions for programmes to better understand and address reasons for low uptake through the use of globally validated tools and related indicators for tracking and evaluation. | Tools and guidance have been developed through an intensive process of global field-field testing and validation. This tool is useful for assessing childhood vaccination and COVID-19 vaccination. | Provides clear evidence-based guidance on strengthening immunization systems | (a) The guidance provides a good example of pro equity planning based on situation analyses and strategies adapted to context. (b) The guide provides access to a set of “equity metrics” that includes (i) Cold chain coverage per fully immunized child (FIC): litres of cold chain per surviving infant available measured against cold chain that would be needed for the target population; (ii) Average resupply distance of vaccines between the health facility and resupply store (e.g. division, district or other warehouse); (iii) Inbound resupply distance of vaccines between district store and the next level of the system from which it received vaccines (e.g. province, state, or division). | Accurate gap analysis of supply chain equipment, storage needs and vaccine and equipment forecast, should enable more equitable distribution of resource to underserved or low coverage areas (given that low coverage can be an outcome of lack of adequate vaccine supply close to communities). Application of the tools should also result in improved availability, efficiency and quality of vaccines/immunization logistics and supply chain system. | The EVM assessment site contains EVM Tools, user guides, and templates for the assessment report and improvement plan. The templates are all in readily accessible excel formats with integrated or attached guidance. The assessment method generates data on supply chain performance indicators and criteria scores for individual facilities, for each level of the supply chain, and for the entire supply chain. The linking of an improvement plan to the assessment means that planning is tailored to address gaps identified in the assessment process. | (a) Outlines 22 suggested requirements for development of a comprehensive National Immunisation Policy, as well as 9 principles underlying policy development. (b) Provides description of the characteristics of comprehensive policy more generally. | Outlines a clear conceptual framework for Health Equity in All Policies (HEiAP) through application of 5 main governance concepts of transparency, accountability, participation, integrity and capacity of the system for development of policy coherence for health equity. | Provides a comprehensive evidence-base for multiyear planning. | Provides objective information whether a facility meet a defined standard. Findings can be summarised using composite indicators or "indices." | A clear and comprehensive framework is provided of HRH management and planning. | (a) There is comprehensive coverage of immunisation management topics. (b) There is an online assessment and certification system. (c) Participants have the capacity to enroll online ii specific topics or all 14 topics. (d) The distance learning mode promotes efficiencies through reduced costs and absence from workplace, as well as providing wider access to educational resources. | Based on a systematic review of published evidence for effectiveness of CHW programmes, and therefore provides a good international evidence base for development of CHW policies and human resource strategies. | Provides a framework for human resources management for EPI and strong links between organisational objectives work functions and EPI competencies. The document has a system wide scope, as attributes, work functions and competencies are outlined for national sub national and community level. | Can be applied in a range of emergencies, post-emergencies, recovery and development contexts. The approach is simple and rapid to implement, adaptable to any emergency or country context, designed to overcome access, security, time and resource constraints, is cost and time efficient without diverting resources from the emergency response. extensive training not needed. | The guidance note summarises gender related barriers and related interventions in a concise manner. | (a) The guide provides a comprehensive demand generation framework including 5 main interventions. (b) The guide provides a set of links to country cases studies and global documents for details on how to implement each of these interventions. | The KAP survey, by providing quantitative and qualitative assessments of the KAP of the target group, serves as an evidence base for the design of interventions that considers demand side factors. | FGDs enables rapid collection of multiple perspectives on the topics under investigation, generating more information faster than in individual interviews. Interaction among FGD participants provides rich insights, and checks and balances, minimizing unique or outlying opinions. An excellent method for obtaining information from, and hearing the concerns and ideas of, communities that cannot read or write. Can also contribute to trust building, greater ownership and participation of communities in health matters. | Provides examples of health worker behaviours and decisions that impact on caregiver practices. Outlines steps in development of a research study, as well as an overview of methods. The sample study guides and questionnaires enable local researchers to adapt the study to context. | Tools and guidance have been developed through an intensive process of global field-field testing and validation. This tool is useful for assessing childhood vaccination and COVID-19 vaccination. | Users of the toolkit will become more familiar with the range of strategies and service delivery methods that are applicable in urban settings. | (a) Provides in depth up to date information on the main determinants of health inequities. (b) Provides actionable recommendations focussing on community level agency to reduce inequities. | Provides a clear operational framework for vaccination services in emergency contexts. | Provides context specific strategic frameworks for management and delivery of services during humanitarian emergencies. | Participatory approach, involving a wide range of stakeholders to enable deeper understanding of barriers to immunisation for particular social groups or geographic areas. Enables more specific tailoring of services for these populations, while improving ownership and accountability of the tailored solution. | Summarizes experiences with periodic intensification of routine immunization based on a review of documents and interviews with personnel involved in these activities. | A comprehensive source of information on all aspects of EPI and vaccines relevant to immunisation practice at health facility and subnational levels. | (a) An opportunity for community and health facility level data collection and analysis. (b) Provides comprehensible materials and methods with job aids for local levels. | A comprehensive approach that includes management, service delivery and community engagement components. | Provides a set of standards that countries should consider in establishing and improving existing VPD surveillance. Countries may adapt these standards based on local epidemiology, policy, disease control objectives and strategies. | Assesses data quality at every level of this system and is not program specific. The approach promotes efficient use of resources for a harmonized approach rather than uncoordinated single program reviews. | There is a strong link between diagnosis and implementation. Data and systems are analysed, strengths and weaknesses identified, conclusions reached and practical recommendations which aim to improve the use of accurate, timely and complete data for action at all levels are made. | Outlines five practical steps for implementing health inequality monitoring. | (a) The concepts and processes outlined in the handbook are complemented by eLearning modules and ppt presentations. (b) Uses real examples from low- and middle-income country settings to explain and apply the main concepts. | (a) Assessment of the extent to which NVI can contribute to immunisation system improvement. (b) Enables undertaking of corrective actions to address gaps in introduction planning so that subsequent introductions are more effective. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Contraints/Limitations | The tool’s accuracy relies on the quality and completeness of input data. Costs may vary based on local factors such as infrastructure, procurement prices, and healthcare delivery capacity. | Results depend on accurate input data and assumptions about vaccine effectiveness and disease burden. Context-specific factors, such as healthcare infrastructure and population demographics, may influence outcomes. | The accuracy of estimates depends on the availability and quality of local data. Variations in healthcare systems, data collection practices, and societal factors may affect comparability across regions. | The methodology of zero-dose costing is still evolving. The resources on this page will continue expand. The cost estimates may vary based on local factors such as geographical challenges, political instability, or variations in healthcare infrastructure. Additionally, reaching zero-dose children often involves addressing broader systemic issues (e.g., health worker shortages, security concerns) that may not be fully accounted for in the cost analysis. | Any limitations present in the underlying data sources have also been reflected in this analysis. The cost estimates are based on available price and delivery cost data and future projections. Additionally, the study may not address context-specific factors, such as political landscape or local health system capacity, which can affect the real costs of immunization delivery. | Any limitations inherent to underlying model outputs are also present in this analysis. The results presented are a conservative estimate because they does not include deaths that will yet be averted by vaccines given in the last 50 years (e.g. longer term benefits of HepB and HPV), flow-on effects of vaccines on non-communicable disease are not captured, and quantification of vaccine impact is limited to 14 diseases only. | The scorecard relies on available data, which may vary in quality and completeness across regions. Projections are based on assumptions about future vaccine coverage, disease prevalence, and healthcare access, which can introduce uncertainties. Links to related resources or supporting documents can be found on the Immunization Agenda 2030 (IA2030) platform, potentially offering further details on methodology or related indicators. | A counterfactual of “no vaccination”, as opposed to partial vaccination, is used to calculate the estimates, and vaccine coverage estimates capture only vaccines delivered through the routine immunization system (the impact on vaccine coverage from supplementary immunization activities (SIAs) is not captured). Any limitations inherent to underlying models and outputs from the Vaccine Impact Modelling Consortium or Global Burden of Disease study are also present in this analysis. | Includes only WHO pre-qualified vaccines. | •Cross-sectional data, which means only one point in time is captured. •When vaccination cards are not present, the information is collected from the mother's report. | The database contains large amounts of data and thus it is recommended for the users to know what data they are looking for before starting to browse, otherwise might be time consuming to find relevant data. | Outlines only the first steps (2YL) in adopting life course vaccination approaches and should therefore be applied as a complement to other initiatives to expand vaccination services across the life course. | Application of catch-up strategy is considered as a complement and not a replacement for strengthening of routine immunisation services and health system strengthening. | The IA230 Agenda is a global vision and strategy. Translation into operations will require significant adaptations to regional and national contexts. | These tables are meant to aid technical decisions with respect to the national vaccination schedule. | Method applies to populations that are already accessing health services and may not be applicable in situations where populations are not accessing or utilising health services at all. | •It only estimates the value of new resources needed and does not include the cost of other goods and services (e.g. transport) already being used for other vaccines. • The tool is availble upon request. | The document is generalized. These concepts will have to be tailored to the local context. This document also does not extend to address barriers to immunization faced by the gender-diverse/non-conforming. however many of the principles and tools can be adapted for these groups. | For specific low-resource settings, added technical support may be required in the case of limited capacity or financial resources. | Related to effective interventions to increase uptake, further research is needed to understand what interventions are effective in what settings and for whom. | Further research is needed on effective interventions for specific settings, including the context-specific factors that contribute. | This document should not be seen as formal WHO recommendations or guidelines. | This document should be seen as a summary, rather than an endorsement of the use of specific branded products over others. | As this is a database of already existing resources the applicability of the resources might vary, as well as the year of publishing. | Relates only to Gavi-supported rotavirus vaccines. The information contained in the slides is current as of November 2021. | Expected rates of vaccine reactions are not included if not available in published literature. | This list is only for Gavi supported vaccines. | This list is only for vaccines supplied by UNICEF for Gavi, the Vaccine Alliance. | The model will depend on the quality of data available, as well as the knowledge of the user. | •The questionnaires are adapted to the information and health needs of each country by local technical experts in each service area, which might make the information less comparable. •It is a cross-sectional data, so it provides information for one point in time. | •The tool has preset assumptions. •The formulas used are not visible in the software, but the user can still review them in the accompanying technical documentation and programming source code available upon request. | While WHO works collaboratively with Member States and updates the database annually using available data such as health accounts studies and government expenditure records, where necessary modifications and estimates are made to ensure comprehensiveness and consistency of data. | Country specific, quality will depend on how closely the guidance was followed. | As this is a costing tool, it is important to have realistic planning assumptions and make sure the key variable data is the latest availble data. | •Includes a wider range of articles/reports from January 2005- March 2019, and thus the quality of each varies. •The last update has been December 2019, so might not include the latest available evidence. | The quality of the estimates will depend on the data used and the assumptions made by the user. | Given that WISN uses available service statistics, it is important to check the timeliness of the data used in case it is outdated. | The list of available vaccines includes only WHO pre-qualified vaccines. | Since the tool requiers user input the calculations the quality of the calculations will depend on the quality of the data included as well as the assumptions made. | Requires the user to make assumptions for each target population in the country, and thus the results will be as good as the assumptions are. | The list is not an exhaustive list of vaccines used to immunize humans. It reflects those vaccines which, following a selection based on immunization priorities set by relevant UN agencies and WHO, have been submitted to WHO for evaluation by interested parties and have — at the time of evaluation and site inspection — been found to meet the aforementioned WHO-recommended standards and operational specifications. The fact that certain vaccines are not included in the list does not mean that, if evaluated, they would not be found to comply with the above mentioned standards and operational specifications. | May need to be combined with broader guidance on quality policies and quality in primary care to leverage political commitment to investments in this field. | • Now based in R and thus requires basic knowledge of R. •The quality of the model will depend on the data used and the assumptions made by the user. | The publications and models might not be relevant to the specific context setting, but they still provide a strong background reading material for building a stronger case. | The Global Burden of Disease numbers are estimates, and thus dependent on the underlying assumptions; not very clear what the assumptions are. | Measuring equity and addressing it in the immunization supply chain is a challenge given the lack of previously used metrics as well as limited access to data. | (a) No specific user guide is available at the internet site for use of the tools, other than the guidance provided throughout spreadsheets in the tools. (b)Unless the data in the cold chain inventory is regularly and frequently updated (monthly or quarterly intervals), the information becomes outdated. | (a) EVM assessment require resource commitments. (b) Gaps identified in the assessment should be included in the recommendations and improvement plan. Implementation of improvement plans and recommendations are reliant on management commitment and resource mobilisation. (c) EVM assessment focuses only on supply side factors (vaccine management and supply). | The guide is extensive in its coverage of issues relating to policy principles and content. Although recognising the need for stakeholder engagement in policy development , there is limited information on the policy development process. | Understanding health equity impact requires epidemiological, sociological and econometric expertise; understanding political feasibility and durability requires administrative, legal, political and political science expertise. | •The process is highly resource intensive. •The EPI Review is designed to give a qualitative overview of the situation in the country, but some countries include a quantitative overview or interpretations based on quantitative information from a limited number of districts which can be misleading. •If the guidelines are not followed then there is a risk that the document will turn into a surveillance report, or in a program implementation evaluation. | (a) Service availability refers to the physical presence of the delivery of services and encompasses health infrastructure, core health personnel and aspects of service utilization. This does not include more complex dimensions such as geographical barriers, travel time and user behaviour, which require more complex input data. (b) For SARA, composite indices are useful to compare districts or regions or to look at change over time. However, composite indices also have limitations. It can be difficult to understand the individual factors contributing to an index score, and thus it is important to have information on individual indicator items in addition to composite index scores. All categories of facilities are assessed and indices calculated together which may not be consistent with immunization programme priorities. (c) The general survey template is comparable across countries and years, but it can be adapted to the country context limiting this comparability. | The framework and components do not refer to immunisation workforce planning specifically, although the resource should still be of value for supporting involvement of immunisation managers in PHC HRH management and planning processes. | As with any distance learning experience, the main limitation to be overcome is lack of face-to-face interaction with teachers and students. | The existence of overlapping terminology in the literature for CHWs (such as “lay health workers”, “front-line health workers”, “close-to-community providers”), as well as widely differing policies relating to scope of practice, education, and relation with health systems, have contributed to undermining efforts to strengthen service delivery systems at community level. Most of the recommendations are based on low and very low certainty of evidence, pointing to the need for additional documentation. | Not intended as a regulatory document nor a training curriculum. It is expected that countries or agencies will customize it to fit their needs. | Limits the data collection to information that is deemed critical for coordination and planning purposes and that is available at the central level. | The paper is a brief guidance note only. Details on research methodologies and gender related policy reforms would need to be identified from additional or alternate resources. | This guide provides an overview of main concepts and main interventions in demand generation. It is limited in so far as it does not provide a “how to” guide for assessing barriers and designing implementations (but refers to and provides links to resources that do). | (a) There is a reasonable degree of technical complexity, and the surveys can be costly and time consuming. (b) Multiple ways in which a KAP survey is conducted, with approaches customized according to the purpose and subject area of the study. When deciding to undertake a KAP survey a range of approaches should also be considered. | As with any qualitative method, the data generated through FGDs cannot be generalized to the entire population. FGDs require experienced facilitators to generate rich and reliable information and skilful analysis and interpretation to make the most of the effort. | This is not a research manual, although includes references to available manuals. | Further research is needed on effective interventions for specific settings, including the context-specific factors that contribute. | Urban health strategies and terminology is highly context specific, so the guide recommends careful tailoring of strategy and terminology to local settings. | The papers serve as a source of information for strategies on closing coverage gaps and increasing of overall coverage through equitable services and interventions, rather than context specific guidance. | Does not provide “modular guidelines” or standard operating procedures, which would need to be developed in local context. | Meant for use in short term emergencies, rather than protracted crisis situations. Depends on availability of comprehensive data and information. | EURO’s TIP is seen to be very resource intensive, with the recommendation being to budget a dedicated consultant to move the process forward. TIP is being updated for global use, with more considerations given for how to apply it in resource-constrained environments. | (a) There is no set strategy for design and implementation of PIRI. Countries need to adapt the approach to local conditions and needs. It is challenging to generalize across highly diverse experiences in countries with vastly varying levels of development. (b) PIRI activities are intended to augment routine immunization services rather than be the primary means of providing it. | Designed as information source rather than as a training module (but can still be used as a resource for training). | Requires investments in training and supportive supervision to be effective. | Reaching the last 10-15% may require a more demand side planning focusing at health facility and community levels. | These guidelines are not intended to be comprehensive for all aspects of VPDs. This document does not include step-by-step surveillance protocols, detailed laboratory methods, templates for line lists or databases, recommendations for monitoring adverse events following immunization or guidance on vaccination coverage surveys. | Data verification component (part 3 of framework) requires a high level of field work and financial commitment. | The findings are only important if strengths and weaknesses that were identified can be discussed at each level. The main intention is to present appropriate and realistic recommendations for improving the system. The major challenge is to ensure that the assessment is useful to the district concerned and that the recommendations are implemented. | (a) The main constraint associated with applying health inequality monitoring systems relates to incomplete or inaccurate sources of data. The 5 main data sources for health inequality monitoring (census, vital registration systems, surveys, institution based records and surveillance systems,) all have data limitations related to sampling, timing, data gaps, data quality and lack of representativeness of data, fragmented data and non-disaggregated data. (b) Feasibility depends on the level of development of health information systems, as well as the capacity that exists to conduct monitoring, and the extent to which addressing health inequalities has been prioritized. | The 5 main data sources for health inequality monitoring (census, vital registration systems, surveys, institution based records and surveillance systems) have data limitations related to sampling, timing, data gaps, data quality and lack of representativeness of data. | There may be multiple opportunities for conducting such reviews. Where possible, these opportunities can be sought out to integrate PIE considerations into other evaluations (cMYP situation analysis, EPI Reviews etc). | |||||||||||||||||||||
| Why use it | (a) An increasing number of vaccine doses are recommended to be given after one year of age, and most infant vaccination can be caught up in the 2YL (if missed earlier). (b) A strong platform in the 2YL is the first important step in extending immunization beyond infancy and encouraging the continuity of routine vaccination into preschool, school, adolescent and adult populations. (c) Provides the opportunity to reach children older than one year, who are who have had delayed or missing vaccine doses. | Zero Dose – Under-immunised – Post emergency or following disruption to the health system, specialised efforts will be required to reach the most vulnerable groups through intensified immunisation services (while still maintaining routine services). | (a) To provide a framework for immunisation policy, planning and implementation over the next decade. (b) One of the strategic priorities is coverage and equity, which will sharpen the focus on improving access and utilisation in zero dose communities. | (a) To detect reasons for missed vaccinations. (b) To improve coverage through reductions in missed opportunities at clinic or outreach visits. (c) To improve timeliness of vaccination and improve coordination with other health services. (d) Zero dose / Under immunized: Outlines steps in developing strategy for MOV, including field assessment to identify barriers to service use, and then designing interventions to address these barriers. Guidance is provided on analysis and response to factors relating to health workers knowledge, attitude and practices, factors due to health system issues or constraints and demand-related issues (caregiver/community behaviours) that prevent uptake of immunisation services. | Measurement of gender-related barriers is often not routinely included in country assessments and therefore understanding of the impact of gender in some contexts may be limited. This guide should be used to guide data collection efforts to probe and understand the impact of gender on immunization and design tailored, gender-equitable programmes that can help improve coverage and equity. | In specific settings with low coverage and with inequities, to work closely with local partners and community representatives to understand and address low uptake, through a practical, step-wise and evidence-driven process. Offers added benefits for generating local ownership and involvement in designing and evaluating tailored strategies. | This guidance should be used to better understand reasons for low uptake, and to gather related local quantitative and qualitative data. The findings may offer added insights to improve access, availability, and affordability of services, as well as to increase uptake in areas with high dropouts or low coverage. The paper also includes recommendations for programmes, partners, NITAGs and RITAGs. | This guidance should be used to better understand reasons for low uptake, and to gather related local quantitative and qualitative data. The findings may offer added insights to improve access, availability, and affordability of services, as well as to increase uptake in areas with high dropouts or low coverage. | It provides guidance and practical steps to strengthen immunization service delivery through acting at different levels of the health system. | To address inequities in supply chain distribution, and support design features adapted to the context of underserved populations including targets supply chain design to the urban poor; people living in remote, rural areas; people in conflict or security-compromised areas; and internal and cross-country migrants. | (a) To identify gaps in supply chain, vaccine and equipment supply, and supply chain capacity in order to take corrective actions through improvement plans. (b) Zero dose and under immunised: Expand access to and availability of vaccines through expansion of supply chain systems. | (a) The guidelines/tools can be used to improve the quality of vaccine management, assure quality and safety of vaccination, and expand access to vaccines through continuous improvement of the cold chain and supply chain systems. (b) Zero dose and under immunised: Expand access to and availability of vaccines through expansion of cold chain systems. | Can be used to develop policies for national immunization programmes that are consistent with national health policy, and global goals relating to the Sustainable Development Goals (SDGs). | To identify policy initiatives and policy-making procedures that can reduce health inequities, or diagnostically, to identify policies that are not coherent with an approach to government that tries to reduce health inequities. | (a) Links review findings to the multi-year planning process, and identification of unreached populations. (b) Facilitates problem solving on zero dose/under-immunised through selection of both high and low performing geographic areas and health facilities, mapping of areas where there have been VPD outbreaks, and development of recommendations based on criteria of targeting the underserved and improving equity. | (a) For monitoring of facilities and their readiness to deliver services. It is a way of monitoring performance by tracking how health systems respond to increased inputs in terms of improved outputs and outcomes. (b) Identifies system strengths and weaknesses that will enable scaling up of interventions. (c) The use of composite and tracer indicators to assess performance will enable health system / program managers to identify service availability gaps. (d) Zero dose and under immunised – Identifies supply side health system gaps to service delivery that impede availability and reach of services | To support implementing and monitoring evidence-based HRH plans. It may also be used to review or validate current HRH plans and interventions. | To strengthen middle level management capacity for immunisation. | (a) CHWs and other types of community-based health workers are effective in the delivery of a range of preventive, promotive and curative health services, and that they can contribute to reducing inequities in access to care. (b)Addressing health workforce shortage, maldistribution and performance challenges is essential for progress towards all health-related goals, including universal health coverage. (c) The potential of community health workers (CHWs) should be utilised as part of broader efforts to strengthen PHC and the health workforce more generally. (d) Zero Dose and under-immunised - There is growing recognition that CHWs and other types of community-based health workers are effective in the delivery of a range of preventive, promotive and curative health services, and that they can contribute to reducing inequities in access to care. | (a) To address gaps in human resources which are a major contributing factor globally to low and inequitable coverage. (b) To improve human resources management and planning. (c) To better distribute human resources as per required functions and more adequately define roles and responsibilities of the health workforce. | (a) To improve information gathering for effective decision-making, resource allocation, mobilization, and advocacy for health in emergencies. (b) To provide a rapid assessment of health facility availability, which enables better targeting of resources by national level emergency response planners and health clusters. (c) Zero dose and under immunised: To identify gaps and assist to prioritise resource allocation during emergencies. | To promote understanding and detailing of the relevant gender-related barriers affecting immunisation coverage and equity and plan strategies to address barriers. | Demand related barriers are emerging in many countries as a major reason for zero dose or under immunised children. There is growing recognition of the role that demand generation interventions can play in helping countries increase the coverage and equity of immunisation, as well as making progress towards the universal health coverage targets in the Sustainable Development Goals. | (a) KAP surveys reveal misunderstandings that may represent obstacles to the activities that we would like to implement and potential barriers to behaviour change. (b) Provides an evidence base to support design of context specific interventions. (c) Guides intervention strategy that reflects specific local circumstances and the cultural factors that influence them. (d) In relation to zero dose and under-immunised, assists to support design and intervention strategy adapted to local contexts. | (a) Provides insights into people’s motivations and social practices, as well as how they view or perceive their experiences, communities, and other aspects of life. (b) This enables planners to design services to respond to peoples’ perceptions and needs. (c) In relation to zero dose and under-immunised: Can assist to identify demand and supply side barriers from client perspective. | (a) As the critical link between clients and health services, health workers’ attitudes towards clients, the manner in which they treat clients, their technical performance, and the quality of their communication with caregivers all have important impacts on treatment effectiveness as well as on clients’ knowledge, trust, and willingness to use health services. (b) In relation to zero dose and under immunised, health worker qualities are reflected in coverage and dropout rates, and therefore in use of health services and individual and community protection from VPDs. | This guidance should be used to better understand reasons for low uptake, and to gather related local quantitative and qualitative data. The findings may offer added insights to improve access, availability, and affordability of services, as well as to increase uptake in areas with high dropouts or low coverage. | With rapidly growing urban populations especially in developing regions, immunization programmes need to adapt programme policies and strategies to meet needs of mobile, high density, more diverse urban populations particularly those in slum environments. | (a) Each paper considers determinants and programmatic approaches in specific social or geographic settings. (b) Can be used as a resource to guide strategy development to reduce immunization equities in specific social or geographic settings. (c) Of high relevance to zero dose and under immunised: In addition to papers on topics relevant to zero dose such as the urban poor, gender, conflict etc, contains a specific paper “A focus on “zero dose” children: Key issues for consideration” relevant for policy and programming on zero dose and under immunised populations. | (a) VPD outbreaks occur frequently in humanitarian emergencies due to disruption to health systems. (b) Humanitarian emergencies are an important reason for stagnating vaccination coverage, which indicates the need for guidance on supporting recovery of routine services post conflict. (c) Of relevance to zero dose and under immunised: This guide provides operational guidance on reaching hard to reach children in emergency situations. | (a) To reach decisions on vaccine selection and program strategies in humanitarian emergencies. (b) To adapt strategy based on sudden changes in the burden of VPDs, either in their incidence or their case-fatality ratio, increased risk of epidemics and changes in patterns of disease. (c) Of relevance to zero dose and under immunised: Guide supports design of strategies in context of disrupted health and logistics systems and in contexts of insecurity. | (a) Reasons for low immunisation coverage are complex and context specific. Social and behavioural studies and engagement of stakeholders can help to understand problems and tailor solutions according to local barriers. (b) Of high relevance to zero dose/under immunised populations, as the approach is applied where there is low or declining or there are vaccine preventable diseases in specific sub population groups or geographic areas. | (a) To support design of programs and service delivery strategies to accelerate improvement in immunisation coverage. (b) PIRI activity is prompted by concern over low routine immunization performance and the belief that existing routine services will not increase coverage in the near term. (c) The approach also enables delivery of immunisation services with other maternal and child health interventions. | (a) Provides information on services for reaching every community, and on RED Planning tools and partnering with communities; (b) Used during both planning and training sessions; (c) To improve understanding of immunization planning and service delivery at health facility level; (d) Of high relevance to zero dose and under immunised, as the process involves identifying priority health centres and communities, barriers to access, and describes methods for tracking of defaulters and partnering with communities. | Zero Dose – Under-immunised - discusses the process of microplanning to ensure immunization services reach every community, including tools/methods for prioritising hard to reach/unreached communities (barriers, solutions, work planning and defaulter tracing). | (a) To improve coverage through service delivery and diagnostics, reduce inequity reductions through problem solving and corrective action, and link services to communities. (b) Builds capacity of local levels to improve coverage and equity through the five RED components. (c) In relation to zero dose/under- immunised, the micro-planning method applies a method of social mapping to identify populations at high risk of not accessing or using immunization services and developing pro-equity program actions to overcome these barriers. Guidance provides a more granular community level “reaching every community” approach that aims at reaching populations with context specific community-based interventions. | Establishment and maintenance of surveillance standards for the purpose of monitoring disease control targets, detection and response to outbreaks. Evidence for decisions around new vaccine introduction, evaluation of immunization programme performance and risk assessments for decisions around preventive supplementary immunization activities (SIAs) introduction or optimizing vaccine schedules, vaccine effectiveness, impact on disease burden, or both, changes in disease strains or types. Surveillance data should be used with immunization coverage data by geographical area to identify areas of poor programme performance. | The DQR assists to form an accurate picture of health needs, programs, and services. It informs appropriate planning and decision making at every level of the health system, as well as effective and efficient allocation of resources and support ongoing monitoring, by identifying best practices and areas where support and corrective measures are needed. High-quality data provides evidence to providers and managers to optimize healthcare coverage, quality, and services. | (a) Assists countries in diagnosing problems relating to data collection and providing orientation to improve district monitoring as highlighted in the Reaching Every District (RED) approach. (b) Zero dose and under immunised: Diagnosis of reasons for the accuracy of reported coverage will enable managers to detect more rapidly pockets of lower coverage. | (a) Zero dose and under immunised: Can be used as an information resource on the importance of health inequality monitoring process, as well as a source of information when establishing or improving health inequality monitoring systems or developing pro equity health policies and strategies. (b) An educational resource to understand concepts and processes for monitoring of health inequalities. | (a) Zero dose and under immunised: An information resource on immunisation inequities to inform development of pro equity policies & strategies. (b) Supports establishment of monitoring systems for health inequalities in national health information systems, and also as a capacity building resource for health managers. | (a) Provides a systematic method for evaluating the impact of the introduction of a vaccine on the existing immunization system in a country. (b) Assists countries to identify specific problems or issues with the introduction that can provide evidence-based recommendations for corrective actions or strengthening of routine immunisation. (c) In relation to zero dose and under immunised of some relevance: Contains a section on measuring coverage and drop out. Also recommends selection criteria for evaluation that includes assessment of hard-to-reach sites so that the evaluation is geographically representative and takes equity issues into account. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Who should use it | National and sub national planners and technical advisers as well as health facility managers and health providers. The intended users include those who will be managing the introduction of a vaccine scheduled in the second year of life, strategies to improve coverage of 2YL vaccines, and catch-up of infant vaccinations. This will include immunization programme managers and staff, other programme managers and their staff and national-, regional-, and global-level immunization and child health advisors working with partner organizations such as WHO and UNICEF and also civil society and faith-based organizations. | National and sub national planners as well as health facility managers and health providers. | Global, Regional, National policy makers and planners and other stakeholders in global immunisation. | Different stakeholders such as: Assessment coordinator, data manager, qualitative expert/social scientist, field teams and representatives from MOH and partners. | The target audience is everyone engaged in supporting, managing, or implementing immunization programmes – managers and service providers, as well as the staff of ministries of health and other sectors, civil society, international organizations and donor partners involved in realizing the IA2030 vision | It is intended for immunization programme managers, partners, implementers, civil society, and others who are collecting, analysing, and using data and working together to close coverage gaps. | It is intended for immunization programme managers, decision-makers, policy-makers, implementers research advisors and others who are collecting, analysing and using data for immunization programme planning and evaluation. | It is intended for immunization programme managers, research advisors and others who are collecting, analysing and using data for immunization programme planning and evaluation. | Policy makers, immunization programme managers working at national and subnational levels, nongovernmental and civil society organizations, donors, and persons with planning and management responsibilities for the delivery of immunization or broader health services | Governments, National and sub national program managers, the private sector and implementing partners. | •National EPI planners and supply chain officers in partnership with sub national EPI managers and partners. | The guidelines include standards, training, standard operating procedures, assessment methods and management and monitoring systems. The guidelines and tools could therefore be used at every level of the system, but particularly by immunisation managers and supply chain officers/specialists. | National planners and policy makers and other stakeholders in policy development (civil society, development partners). | Policy makers and managers from all sectors who have the intent to reduce health inequities. | National and sub-national EPI and health system planners and partners. | Can be applied nationally, sub nationally or at facility level to set a baseline assessment for health system readiness. | Human Resource Managers or Program Planners. | EPI managers at national level and sub national level. | The primary target audience is policy-makers, planners and managers responsible for health workforce policy and planning at national and local levels. Secondary target audiences include development partners, funding agencies, global health initiatives, donor contractors, researchers, CHW organizations, CHWs themselves, civil society organizations and community stakeholders. | National and sub national human resource planners and national EPI managers. | Central level planners and partners (Health Cluster) at national level responding to emergencies. | Could be used at any level of the health system when seeking to understand or research gender related barriers to health care. | The guide should be used by proposal developers to ensure demand related barriers and interventions are integrated into immunisation and health system proposals. This includes core EPI staff and partners, health promotion and education staff of the MoH, other relevant sectors and civil society agencies. | Program managers, project managers, researchers and policy-makers. | New practitioners, and experienced staff that wants to reinforce good practices and improve data quality. | Primarily intended for district health management teams and any persons or organizations they may work with to carry out a mostly qualitative study of health workers’ knowledge, attitudes, and practices (KAP), focusing on their interactions with caregivers and infants. | It is intended for immunization programme managers, research advisors and others who are collecting, analysing and using data for immunization programme planning and evaluation. | For all stakeholders involved in planning, implementation and monitoring of immunization services in urban areas including Governments (City, Municipal, local), Policy makers, Programme managers, Frontline health care workers, Civil society organizations and civil society, Private sector and urban community members. | Planners, managers and providers to inform their strategy development, or to refocus plans on reducing inequalities and offer equitable services. | Immunization Task Force in charge of planning and managing routine and/or additional vaccination service delivery in a humanitarian emergency context. | Senior level government, partner agency officials and relief organizations. | Usually led and implemented by national (or subnational) health authorities including immunization programme, with a wide range of stakeholders engaged in implementation of interventions. | Immunisation planners at national level and sub national level. | Health facility and sub-national level managers and health workers. | Health facility and sub-national level. | District and community health facilities to make microplans to identify local problems and find solutions using their own data. | Country managers of immunization programmes and communicable disease surveillance and response . Standardized global surveillance data are also useful for developing global vaccination policy. | National HMIS, program managers. District/Facility managers. | For staff collecting and using immunization data at national, provincial or district levels. | Of relevance to policy makers, planners, and as a an educational resource to understand the determinants of immunisation inequities. | Policy makers, planners, researchers, public health professionals, advisers and educators. | National program managers after new vaccine introductions. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Example criteria this resource could address | Estimating the budget required for TCV introduction, analyzing cost drivers for typhoid vaccination, supporting resource mobilization for TCV programs. | Evaluating the cost-effectiveness of influenza vaccination programs, informing policy decisions on vaccine funding, identifying high-impact strategies for influenza prevention. | Estimating the economic burden of seasonal influenza, supporting cost-benefit analyses for vaccination programs, informing public health policy on influenza prevention. | Estimating the budget required to implement strategies for reaching zero-dose children. | Estimating the financial resources needed to scale up immunization programs to meet IA2030 targets, identifying the cost drivers for immunization delivery and vaccine procurement, supporting budget planning and resource mobilization efforts for national and global immunization programs. | Assessing the cumulative impact of global vaccination efforts on public health. | Tracking the progress of immunization programs toward reducing mortality, identifying high-impact diseases or regions where more vaccination efforts are needed, evaluating the cost-effectiveness of immunization strategies in terms of lives saved. | Estimating the impact of improved vaccine coverage on reducing child mortality, identifying priority vaccines and regions to focus on for the greatest health impact, supporting global immunization advocacy by providing quantifiable health benefits. | Users are free to define the criteria that will be used to assess the different options. | Can help decision-makers to prioritize vaccines that have been recommended by WHO and/or that contribute to global and regional goals and strategies. | Coverage data disaggregated by vaccine and demographic characteristics. | The immunization dashboard provides information on reported cases of vaccine-preventable diseases (VPDs) at the global, regional and country level. | Health impact, vaccine effectiveness, cost-effectiveness, budget impact analysis, additional costs, introduction and recurrent costs | Demand | Demand | Burden of disease | Burden of disease; safety | Burden of disease | Not directly informing criterion, allows to understand alignment. | Can be used to understand the recommendations on adequate number of doses, or booster doses, and the expectations when providing additional vaccine antigens. | The data can be used to understand the missed opportunities for vaccination (e.g. during what type of visit did they occur), and determine whether the decision-question might affect this aspect by either reducing it or increasing it. | Vaccine efficacy; vaccine effectiveness; Temperature sensitivity of vaccines | Different types of criteria areas can be included in the analysis. | Vaccine efficacy, vaccine effectiveness, vaccine schedule alignment, safety/AEFI | Burden of disease, health impact | Can be used to estimate the economic delivery cost per dose including service delivery and programmatic costs. | Efficacy at different mortality levels. | Cold chain volume per fully immunized child in cm3, etc. | Given the large number of resources, there is wide range of criteria that can be extracted. The resources can be searched by diseases, as well as region and country. | Information on vaccine availability for Gavi supported countries, vaccine efficacy, safety and interchangeability. Waste-adjusted prices of awarded Rotavirus vaccines. | Information on reaction rates, as well as details of the expected adverse reactions can be used to evaluate the safety or be linked to acceptability. | Wide range of data on vaccines that can be used to understand the economic impact and sustainability. | For Gavi supported countries important to understand whether the vaccine product considered is supported. | The modeling can provide information about how different vaccine characteristics affect the supply chain, and thus their suitability for the immunization programme. | Data shows the number of trained staff and equipment for vaccination services, disaggregated by different background characteristics. | Can be used for a cost-effectiveness analysis, and then can proceed to assess health system implications and financial costs. | The data collection can focus on any of the criteria areas. | Can be used to assist with health impact, economic impact and programmatic suitability. | Takes into consideration the aspects of health impact and programmatic suitability. | Relating to programmatic suitability and health impact. | Guide for evidence assessment. | The tool allows the user the select from a wide range of criteria, thus it can be used to explore many areas. | Can extract data on how much money is spent on different diseases and programmes, as well as the contributions of different actors. | Can support the assessment of the economic and social benefits of introducing influenza vaccination or to expand existing vaccination strategies. | Information on total programme costs, costs per capita, per community health worker, incremental costs and financing, key drivers of costs, etc. | Depending on the availble studies, can extract data on cost details such as paid human resources, per diem and travel allowances, cold chain equipment, vehicles, transport and fuel, vaccine supplies, other supplies and recurrent costs, etc. | Cost estimates of routine immunization from a sample of health facilities. | The WISN allows to plan future staffing on health facilities, by using data on anticipated workloads of planned future services, meaning can see what the impact on health workforce would be due to changes affected by the decision question. | To become familiar with the different vaccines for each disease and/or pathogen, and to understand the pipeline vaccines. | Can be used to estimate the number of children reached, the 2YL cost estimate, and savings from reduced vaccine wastage, as well as costs per child reached. | Cost components of influenza vaccination, recurrent costs, capital costs, financial and economic costs. | To check whether the vaccines that are compared in the decision-making process are WHO prequalified. | Estimation of the direct and indirect impact of vaccination on health outcomes. | •Example publications include Estimates of the global burden of Japanese encephalitis and the impact of vaccination from 2000-2015 (Quan et al, 2020) •Comparative evaluation of the potential impact of rotavirus versus HPV vaccination in GAVI-eligible countries: a preliminary analysis focused on the relative disease burden (Kim et al, 2011) | Quantitative data extracted on deaths, DALYs, YLDs, disease burden, etc. | Information on vaccine distribution, cold chain capacity can be extracted. | As this is the most comprehensive review of the NIP, it is imprtant to review it to understand the strenghts and weaknesses, in order to decide whether the options in consideration would be suitable. | Information can be extracted to understand the service provision, disaggregated by background characteristics such as level of service, managing authority, ownership, residence. This is useful to determine supply side gaps to service delivery that impede availability and reach of services. | The data can be used to understand the availability of essential health resources and thus to determine how the decision will impact them. | The data might be used to provide insights into demand side factors that could be barriers to uptake, and thus be used in the decision-making process by examining whether the considered products/strategies might address any of those barriers or their use might be impacted by the barriers. The findings may offer added insights to understanding access, availability, and affordability of services, as well as uptake in areas with high dropouts or low coverage. | While these papers do not provide direct data to be used in the decision making process, they provide a contextual information about determinants and programmatic approaches in specific social or geographic settings. | ||||||||||||||||||||||||||||||||||||||
| If available, notes on the development process | Developed by WHO with input from global immunization and costing experts to provide a comprehensive approach to TCV costing. | Pilot version created by WHO with input from global health experts to standardize cost-effectiveness analysis for influenza vaccination. | Developed through collaboration with global health economists and influenza experts to provide standardized methodologies for economic burden estimation. | It draws on data and modeling outputs from international health organizations, national immunization programs, research institutions, and vaccine manufacturers to create a comprehensive cost analysis. | The article has been developed through a collaborative effort among global health experts, modelers, epidemiologists, and vaccine researchers. | The development of this scorecard involved collaboration between global health organizations, modelers, and statisticians. It would include input from data collected by national health systems and international bodies like the WHO and UNICEF. | The development process involved advanced epidemiological and mathematical modeling methods. | WHO position papers follow the recommendations of the WHO Strategic Advisory Group of Experts (SAGE) on immunization and undergo a formal review process both internally and externally prior to publication. | DHS: in the past 5 years, 47 countries have conducted at least one, and in the past 10 years 63 countries in total. MICS: in the past 5 years, 40 countries have conducted at least one, and in the past 10 years 76 countries in total. | The ROTA Council was created in collaboration with an advisory group of 24 child health leaders from around the world. | The content and guidance on this page is curated and maintained by the Demand and Behavioural Sciences team, within the Essential Immunization Programme, WHO Department of Immunization, Vaccines and Biologicals. | The content and guidance on this page is curated and maintained by the Demand and Behavioural Sciences team, within the Essential Immunization Programme, WHO Department of Immunization, Vaccines and Biologicals. | Data presented on VIEW-hub are continually updated based on the frequency of data release or data availability. Targeted searches for new vaccine introduction data are conducted quarterly and a full data audit is conducted every six months. Immunization experts are routinely consulted about new updates or for verification of data. WHO and Gavi are the primary data sources. | Data are derived from the systematic review and meta-analysis of published literature and official reports by the WHO, the United Nations, The World Bank, IARC's Globocan and Cancer Incidence in Five Continents. | Endorsed by the World Health Assembly. | These recommendations are only a compilation of existing WHO routine immunization recommendations. All the recommendations come from WHO Position Papers that are published in the Weekly Epidemiological Record. The tables are updated as soon as any new WHO recommendation is published. | It is conducted by the country, and thus the quality of the report varies depending on how the review was conducted. | WHO Vaccine Position Paper Process WHO position papers follow the recommendations of the WHO Strategic Advisory Group of Experts (SAGE) on immunization and undergo a formal review process both internally and externally prior to publication. Processes to manage potential conflicts of interest and to ensure careful and critical appraisal of the best scientific evidence have become more rigorous in recent years. A register of interests of SAGE members is maintained by WHO with summaries of interests declared relevant to SAGE topics published on the SAGE web site. | This guidance was developed using available materials from the Advisory Committee on Immunization Practices (ACIP), the German NITAG STIKO, the Joint Committee on Vaccine and Immunization (JCVI), WHO and WHO Strategic Advisory Group of Experts on Immunization (SAGE). | For the TCV vaccines discussed in this document, the following disclaimer applies: WHO does not approve or endorse the use of specific branded products over others. | These country-specific resources outline the burden of typhoid (provided by the Global Burden of Disease study). | Four examples of applications of CholTool were presented in three countries- one in Ethiopia, two in Malawi and one in Nepal. The cost projections conducted before the campaign using the tool and a retrospective costing using the tool in Nepal resulted in no significant difference between the cost calculated. | The NIS builds on the experience of cMYP (in use by countries since 2005). | The document is based on published sources except for content related to the newest prequalified product, PNEUMOSIL where the manufacturer provided the unpublished Clinical Study Report confidentially. The document should not be viewed as formal WHO recommendations or guidelines. | Information contained comes from a variety of sources including the Gavi Secretariat, WHO PQ vaccine webpages, WHO position papers and UNIECF's product menu for vaccines supplied by UNICEF for Gavi-supported programmes. | The source is licensed to the public under AGPL v3 open-source license. The development of the model is ongoing. HERMES has been used to develop vaccine supply chains in Niger, Benin, Senegal, Thailand, and Vietnam. | Developed by the country. Although there are development guidelines, the quality will be context specific. | The development of the OneHealth tool is overseen by the UN Inter Agency Working Group on Costing (IAWG-Costing). WHO provides technical oversight to the development of the tool, facilitates capacity building and provides technical support to policy makers to inform national planning and resource needs estimates. The first official version of the OneHealth Tool was released in May 2012. Since then the tool has been applied in over 55 countries to date, most of which in sub-Saharan Africa. | ThinkWell and John Snow Inc. (JSI) are supporting the Immunization Costing Action Network (ICAN), a research and learning network working to increase the visibility, availability, understanding, and use of immunization delivery cost information. The ICAN is building country capacity to generate cost evidence that is policy relevant and a priority for the immunization program. It is supported by the Bill & Melinda Gates Foundation. | Part of the PAHO's Provac e-Toolkit. It has been reviewed during an expert review, where participants represented a wide range of institutions UNICEF, PATH, Sabin Vaccine Institute, CDC, Bill and Melinda Gates Foundation, Argentina’s Ministry of Health, Instituto de Efectividad Clínica y Sanitaria, INSP/Universidad Nacional de Colombia, London School of Hygiene and Tropical Medicine, University of Washington, University of North Carolina, Rutgers, Universidad de Cartagena. The ProVac toolkit, which UNIVAC is part of has supported 43 country-level vaccine cost-effectiveness analysis. | Part of the PAHO's Provac e-Toolkit. It has been reviewed during an expert review, where participants represented a wide range of institutions UNICEF, PATH, Sabin Vaccine Institute, CDC, Bill and Melinda Gates Foundation, Argentina’s Ministry of Health, Instituto de Efectividad Clínica y Sanitaria, INSP/Universidad Nacional de Colombia, London School of Hygiene and Tropical Medicine, University of Washington, University of North Carolina, Rutgers, Universidad de Cartagena. The ProVac toolkit, which UNIVAC is part of has supported 43 country-level vaccine cost-effectiveness analysis. | The papers are published in a wide range of journals, and by a wide range of authors. Hence, the quality of the papers needs to be determined on case by case basis. | Since the release of Global Burden of Disease in 2015, the GBD study has been aligned with the suggestions outlined in the Guidelines for Accurate and Transparent Health Estimates (GATHER) statement. Meaning data inputs, analyses and methods, and results on which the estimates are based are documented. | Developed by the country. Although there are development guidelines, the quality will be context specific. | Developed by the country. Although there are development guidelines, the quality will be context specific. | Developed by the country. Although there are development guidelines, the quality will be context specific. | 21 project, 17 countries, with 4691 contributions are reported on the website. | The ERG has developed a series of products focusing on immunisation equity. It has created a series of discussion papers to explore the landscape of inequity in immunization coverage. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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