Journal article
Early Lessons From Ethiopia in Establishing a Data Triangulation Process to Analyze Immunization Program and Supply Data for Decision Making
Strengthening data use and quality is critical to achieving high, equitable immunization coverage. One approach that is being increasingly recognized as effective in improving data use and quality is data triangulation, which can provide more information for decision making in public health programs.
In Ethiopia, immunization program data has had ongoing quality challenges, including timeliness, completeness, and accuracy. Some data are reported through different systems to different departments, and coordination between departments is limited.
JSI, through the Universal Immunization through Improving Family Health Services (UI-FHS) project, introduced a data review process and an Excel tool for triangulating immunization program data and vaccine supply data to improve data quality and programmatic decision making. The user-friendly Immunization Data Triangulation Tool (IDTT) provides decision-support information—such as scoring of districts based on performance—and suggests follow-up actions. It also highlights gaps between vaccines supplied and consumed and helps managers determine the next steps to address programmatic, supply, or data quality issues.
The data review process and IDTT were rolled out in 2 regions in Ethiopia. UI-FHS documented learning to understand the feasibility of the IDTT’s application as a decision-making tool by conducting key informant interviews and observing how the IDTT was used at monthly data review meetings.
Health managers who used the tool reported ease of use and clear benefits, including more accessible and synthesized data, which prompted decision making and actions to improve services and supply, such as expanding the number of immunization sites. Challenges with the availability of vaccine supply data hindered managers' ability to leverage triangulated data fully, but the data triangulation process prompted cross-departmental collaboration to address this gap.
These early findings show promise in the ability of immunization programs to successfully use triangulated data to address challenges and provide lessons for introducing new tools or processes into health systems.
Authors
- Disha Ali
- Belayneh Dagnew
-

Wendy Prosser
View profile | More articles -

Lisa Oot
View profile | More articles - Natasha Kanagat
- Daniel Girma
-

Amare Bayeh
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Adriana Almiñana
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Languages
- English
Publication year
2022
Journal
Global Health: Science and Practice
Volume
June 2022
Type
Journal article
Categories
- Programme management
Countries
- Ethiopia
Tags
- Data quality
- EQUIP
- Immunization information systems
- Triangulation
- Zero-dose
WHO Regions
- African Region
IRMMA
| Title | Author | Year | Type | Language |
|---|---|---|---|---|
| Assessing the Governance and Political-Economy Landscape for Evidence-Based Zero-Dose Programming and Policies in Bangladesh | Gavi, the Vaccine Alliance, JSI, IIHMR, Delhi, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2025 | Repository | English |
| Operational Guidance: Estimating the Costs of Interventions to Reach Zero-Dose Children | JSI Research & Training Institute, Inc, Gavi, the Vaccine Alliance, Zero-Dose Learning Hub | 2025 | Guidance | English |
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| Uganda Zero-Dose Learning Agenda | Infectious Diseases Research Collaboration (IDRC), PATH, Makerere University School of Public Health (MakSPH) | 2024 | Repository | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Bangladesh (October 2025) | Gavi, the Vaccine Alliance, JSI Research & Training Institute, Inc, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2025 | Report | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Mali (October 2025) | Gavi, the Vaccine Alliance, JSI Research & Training Institute, Inc, Zero-Dose Learning Hub, The Geneva Learning Foundation, IIHMR, Delhi | 2025 | Report | English |
| Early Lessons From Ethiopia in Establishing a Data Triangulation Process to Analyze Immunization Program and Supply Data for Decision Making | Disha Ali, Belayneh Dagnew, Wendy Prosser, Lisa Oot, Natasha Kanagat, Daniel Girma, Amare Bayeh, Adriana Almiñana | 2022 | Journal article | English |
| Immunization Coverage Surveys and Linked Biomarker Serosurveys in Three Regions in Ethiopia | Mark A Travassos, Myron M Levine, Robert Steinglass, Marcela F. Pasetti, Samba O Sow, Jaya Goswami, Inna Ruslanova, Yukun Wu, William C. Blackwelder, Mardi Reymann, Jenny Sequeira, Lisa Oot, Tassew Kassa, Seydou S Diarra, Nigisti Mulholland, James D Campbell, Zenaw Adam, Berhane Beyene, Amha Kebede | 2016 | Journal article | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Nigeria (October 2025) | Gavi, the Vaccine Alliance, JSI Research & Training Institute, Inc, Zero-Dose Learning Hub, The Geneva Learning Foundation, IIHMR, Delhi | 2025 | Report | English |
| Contribution of Health Information System to Child Immunization Services in Ethiopia: Baseline Study of 33 Woredas | Abebaw Worku, Hibret Alemu, Hiwot Belay, Afrah Mohammedsanni, Wubshet Denboba, Frehiwot Mulugeta, Shemsedin Omer, Biruk Abate, Mesoud Mohammed, Mohammed Ahmed, Yakob Wondarad, Meskerem Abebaw | 2022 | Journal article | English |
| Sustaining Immunization Gains for All Communities in Ethiopia: Final Report of the RED-QI Sustainability Inquiry | JSI Research & Training Institute, Inc, Universal Immunization through Improving Family Health Services (UI-FHS) | 2020 | Repository | English |
| Primary Health Care Unit Reaching Every District (RED) Guidelines | JSI Research & Training Institute, Inc, PATH, Clinton Health Access Initiative (CHAI), World Health Organization (WHO), Ethiopia Ministry of Health | 2021 | Tool | English |
| Implementing Quality Improvement Strategies: A Quick Reference Guide for Woreda & Health Facility Levels | JSI, Universal Immunization through Improving Family Health Services (UI-FHS) | 2020 | Tool | English |
| Bangladesh Zero-Dose Landscape | JSI, The Geneva Learning Foundation, IIHMR, Delhi, Gavi, the Vaccine Alliance, Zero-Dose Learning Hub | 2023 | Repository | English |
| Electronic Immunization Information Systems: A Case Report of Lessons Learned from Implementation in Pakistan | Sullivan E, Masood Tariq, Javeed Wajiha, Katharine Bagshaw, Steve Ollis, Presha Regmi, Gardezi SMA | 2020 | Journal article | English |
| Sustaining Immunization Gains for All Communities: Lessons from Implementation of the RED-QI Approach | JSI, Universal Immunization through Improving Family Health Services (UI-FHS) | 2020 | Case study | English |
| Key Strategies for Bridging the Equity Gap for Immunization in Ethiopia: Use of Quality Improvement Approaches to Strengthen Immunization Service Delivery and Reach the Hardest-to-Reach Populations | JSI, Universal Immunization through Improving Family Health Services (UI-FHS) | 2021 | Case study | English |
| Linking Health Facilities and Communities Improves Routine Immunization | JSI | 2018 | Report | English |
| Rethinking the Routine_ Modernizing Outreach Services to Immunize Zero-Dose Children | JSI Research & Training Institute, Inc | 2022 | Tool | English |
| Updating and Monitoring Your Immunization Microplan: Guidelines to Support Woreda Health Offices and Their Health Facilities to Routinely Update and Monitor Their Microplans | Universal Immunization through Improving Family Health Services (UI-FHS) | 2020 | Tool | English |
| Use a Fishbone Diagram to Find Root Causes and Effective Solutions | Universal Immunization through Improving Family Health Services (UI-FHS), JSI | 2018 | Tool | English |
| RESOURCE CATALOGUE SERVICE QUALITY AND EXPERIENCE LITERATURE AND TOOLS | Gavi, the Vaccine Alliance | 2023 | Tool | English |
| Pro-Equity Evidence Map | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, fhi360, Zero-Dose Learning Hub | 2023 | Repository | English |
| Primary Health Care Unit Health Post Level Guidelines to Implement the Reaching Every District (RED) Strategy | JSI Research & Training Institute, Inc, Clinton Health Access Initiative (CHAI), PATH, World Health Organization (WHO), Ethiopia Ministry of Health | 2021 | Tool | English |
| Crossing Lanes: Forecasting for Zero Dose | JSI Research & Training Institute, Inc | 2022 | Case study | English |
| Immunization Data Triangulation Tool (IDTT) | JSI | 2020 | Tool | English |
| Improve Data Quality to Make the Most of Important Resources | Universal Immunization through Improving Family Health Services (UI-FHS), JSI | 2018 | Tool | English |
| Key Strategies for Bridging the Equity Gap for Immunization in Ethiopia: Improving Data Use to Achieve More Equitable Service Delivery | JSI, Universal Immunization through Improving Family Health Services (UI-FHS) | 2021 | Case study | English |
| Zero-Dose Learning Platforms - Platform Manager and User Surveys Report | Gavi, the Vaccine Alliance, JSI, IIHMR, Delhi, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2023 | Repository | English |
| Microplanning: A Promising Approach to Identify and Reach Zero-Dose Children in Democratic Republic of Congo (DRC) | Gavi, the Vaccine Alliance, fhi360 | 2023 | Case study | English, French |
| Collaborating with Women’s Groups: A Promising Approach to Identify and Reach Zero-Dose Children in Urban Mali | Gavi, the Vaccine Alliance, fhi360 | 2023 | Case study | English, French |
| Zeroing in on Zero-Dose: Challenges and Opportunities for Improving Equity and Coverage among Zero-Dose and Under-Immunized Children in Four Countries | Gavi, the Vaccine Alliance, JSI, IIHMR, Delhi, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2023 | Presentation | English |
| Uganda Zero-Dose Landscape | Gavi, the Vaccine Alliance, IIHMR, Delhi, JSI, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2023 | Repository | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update (October 2023) | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2023 | Repository | English |
| Health Systems Strengthening to Reach Zero-Dose Children in Chad | Gavi, the Vaccine Alliance | 2023 | Case study | English |
| Early Learning from Zero-Dose Practitioners in Nigeria and Uganda: Gavi ZDLH Inter-Country Peer Exchange (ZDLH-X2) | The Geneva Learning Foundation, JSI, Gavi, the Vaccine Alliance, IIHMR, Delhi, Zero-Dose Learning Hub | 2023 | Repository | English |
| Early Learning from Zero-Dose Practitioners in Bangladesh and Mali: Gavi ZDLH Inter-Country Peer Exchange (ZDLH-X1) | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2023 | Repository | English |
| Country Learning Hub for Immunization Equity in Bangladesh: Findings from Rapid Assessment | Gavi, the Vaccine Alliance, icddr,b, redorange communications, Jhpiego | 2023 | Repository | English |
| Mali Zero-Dose Landscape | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2023 | Repository | English |
| Cameroon Increases Reach to Zero-Dose Children through Microplanning and Communication | Gavi, the Vaccine Alliance, fhi360 | 2023 | Case study | English |
| GIS Mapping: A Promising Approach to Identifying and Reaching Zero-Dose Children in Zambia | Gavi, the Vaccine Alliance, fhi360 | 2023 | Case study | English |
| Introduction of Typhoid Conjugate Vaccine (TCV) in Nepal: Role of the Vaccination Campaign in Identifying and Reaching Zero-Dose Children | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2023 | Case study | English |
| Report on a Rapid Assessment of the Zero-Dose Situation in Uganda | Infectious Diseases Research Collaboration (IDRC), Makerere University School of Public Health (MakSPH), PATH | 2024 | Repository | English |
| Knowledge Translation for Zero-Dose Immunization Research | Zero-Dose Learning Hub | 2024 | Tool | English, French |
| Prevalence of and Factors Associated with Zero-dose and Under-immunized Children in Selected Areas of Bangladesh: Findings from Lot Quality Assurance Sampling Survey | Hemel Das, Zerin Jannat, Kaniz Fatema, Jannat-E-Tajreen Momo, Md. Wazed Ali, Nurul Alam, Mahbub E. Elahi Khan Chowdhury, Christopher J. Morgan, Elizabeth Oliveras, Gustavo Caetano Correa, Heidi W. Reynolds, Md. Jasim Uddin, Tasnuva Wahed | 2024 | Journal article | English |
| Sub-National Budget Analysis Focusing on Immunization Under the Nigeria Zero-Dose Learning Hub Consortium in Nigeria | Gavi, the Vaccine Alliance, Africa Health Budget Network (AHBN), AFENET, Zero-Dose Learning Hub | 2024 | Repository | English |
| Closing The Immunization Gap: Enhancing Routine Immunization in Nigeria by Reaching Zero-Dose and Under-Immunized Children in Marginalized Communities: Report of a Rapid Assessment | Gavi, the Vaccine Alliance, Africa Health Budget Network (AHBN), African Field Epidemiology Network (AFENET), Zero-Dose Learning Hub | 2024 | Repository | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Mali (May 2024) | Gavi, the Vaccine Alliance, JSI, IIHMR, Delhi, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2024 | Repository | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Nigeria (May 2024) | Gavi, the Vaccine Alliance, JSI, The Geneva Learning Foundation, IIHMR, Delhi, Zero-Dose Learning Hub | 2024 | Repository | English |
| Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Uganda (May 2024) | Gavi, the Vaccine Alliance, JSI, IIHMR, Delhi, The Geneva Learning Foundation, Zero-Dose Learning Hub | 2024 | Repository | English |