Soudan
Somalie
Pakistan
Nigéria
Niger
Mali
Irak
Inde
Éthiopie
Congo
Tchad
Bangladesh
Angola
Afghanistan
Tuberculose
Polio
Campagne
Post00245 POLIO NID QUALITY ASSESSMENT GUIDELINES 28 April 2000
CONTENTS
1. DRAFT POLIO NID QUALITY ASSESSMENT GUIDELINES FOR REVIEW AND COMMENT
1. DRAFT POLIO NID QUALITY ASSESSMENT GUIDELINES FOR REVIEW AND COMMENT
Bob Davis, UNICEF/ESARO, introduces a draft global guidelines for
evaluating polio NIDs from the quality standpoint prepared by Bob and Jane
Zucker.
Bob requests comments by the weekend if you have the time.
* Immediate comments please to: Bob Davis
Date: Wed, 26 Apr 2000 11:49:42 -0700
From: [[email protected]][email protected][/email] (Robert Davis)
To: [[email protected]][email protected][/email]
Subject: DRAFT GUIDELINES FOR REVIEW AND COMMENT
Dear Colleagues,
As you all know, there are no global guidelines currently in use for
evaluating polio NIDs from the quality standpoint. Jane Zucker and I have
been asked to present draft guidelines for assessing the quality of polio
NIDs at the polio tech consultation to be held in Geneva next month.
If any of you have time, could you please review our text below and get me
any comments by this weekend. You will find a plain text copy below
Best regards,
Bob Davis
UNICEF/ESARO
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Annex: Proposed Indicators to Assess the Quality of Implementation of
Supplemental Immunization Activities for Polio Eradication
Background:
Tremendous progress continues to be made toward the goal of
polio eradication -- the total number of polio-infected countries has
decreased to 30 from 50 from 1998 to 1999. The number of cases reported so
far for 1999 is 6,659. This figure is similar to that of 1998, due in part
to improved surveillance, but also to a large outbreak (1,103 cases) which
occurred in Angola. The majority of poliovirus transmission continues to be
found in South Asia and the African continent. Of these, there are 14
countries which are identified as priorities for success of the initiative
- based on size, inaccessibility to children due to conflict, and
documented presence of wild poliovirus: DR Congo, Nigeria, Republic of
Congo, Chad, Niger, Ethiopia, Somalia, Angola, India, Pakistan, Bangladesh,
Afghanistan, Sudan (Khartoum and OLS), and Iraq.
Despite the progress being made, wild poliovirus continues to be identified
in countries that have conducted multiple rounds of NIDs. Experience in
1999 with conducting house to house strategies for NIDs has consistently
demonstrated improved coverage in the range of 10% to 40% with this
approach. One dramatic example is the house to house sNIDS that were
conducted in Nigeria in the spring of 1999 when 40% more children were
immunized than were originally targeted. Similarly, in both India and
Pakistan, approximately 10% to 15% of additional children were immunized
with house to house polio activities. This has highlighted the fact and led
to recognition that the coverage and quality of NIDs has not been
sufficiently high to interrupt poliovirus transmission is some highly
endemic countries.
Two joint strategy meetings between WHO and UNICEF were held in February
and March 2000 to address the need for acceleration in polio eradication
efforts. The March meeting was convened by the Executive Director of UNICEF
and the Director General of WHO with the UNICEF and WHO Representatives of
the 14 priority countries listed above. An key recommendation and priority
action was the need to improve the quality of implementation of NIDs and to
develop indicators to monitor progress and quality. An important vehicle
for this improvement is the National Inter-Agency Coordinating Committees
(ICCs) through direct involvement of WHO and UNICEF country
representatives. Components of quality highlighted were: Better
microplanning, mapping, supervision, and monitoring at the district level,
especially in high-risk, hard to reach, and conflict areas; Monitoring the
total number of children immunized and number of zero-dose children
vaccinated in successive rounds; Timely disbursements and accounting for
cash advances and local procurements; Enhancing social mobilization
efforts; Identifying innovative approaches to sustain motivation; and
Developing independent monitoring and evaluation mechanisms and sharing
lessons learned widely.
Furthermore, it was recommended that indicators to monitor quality if NIDs
be developed, field tested, and the results would be used for further
improvements.
Purpose: To develop and field indicators to monitor quality of NIDs.
Proposed indicators:
Caveats: focus is on quality of NIDS ? going beyond traditional coverage
statistics, looking at process and qualitative assessments, in addition to
quantitative assessments. Surveillance is not included. Intended to
complement field guides and implementation manuals.
1) COVERAGE OF TARGET POPULATION ? disaggregated by district
Note: population-based estimates are the most available and most often
quoted, but lack in reliability in those countries which have not had a
good recent census.
Recommended to use indicators based on year to year and round to rounds
comparisons. At all levels, and especially in pinpointing districts, the
crude vaccination statistics, if kept in the same way from round to round,
avoid the pitfalls of demographics. One can reliably say that if District X
halved (or doubled) its NIDs vaccinations between 1999 and 2000, this is
statistically significant.
Another, related indicator, again based on available data, is performance
over time in districts where the door to door strategy has been introduced.
If house to house starts in 2000, then 2000 vaccinations should, district
by district, exceed 1999 vaccinations. If they don't, something went wrong.
2) ZERO DOSE MONITORING
Zero dose reporting as a proportion of the total is useful if and only if
infant vaccinations are excluded. It should be based on 12- to 59-month-
olds; otherwise, you are mixing kids who should have been vaccinated with
those who were too young to have been. Zero dose reporting is most useful
in doing district to district comparisons.
3) INDICATORS BASED ON IDENTIFICATION OF UNDERPERFORMING DISTRICTS
This is the heart of the matter. If you want to make an impact, you find
the underperformers and send in the marines. How to identify? Informal
polls of nationals. Better yet, meetings of district NIDs managers after
the first round of NIDs to prepare (by secret ballot) a list of the
underperfomers. Anonymous postcard polls are the ideal way to identify
underperforming districts, especially when done among peripheral health
workers, who know in more detail than their superiors what went wrong. Here
is my anonymous ballot paper for NIDs performance.
ANONYMOUS BALLOT PAPER, DISTRICT ..........., STATE OF ............
PLEASE RETURN THIS PAPER UNSIGNED TO YOUR MEDICAL OFFICER OF HEALTH,
CIRCLING FOR EACH OF THE QUALITY INDICATORS LISTED HOW YOU PERCEIVE THE
PERFORMANCE OF THE MOST RECENT POLIO CAMPAIGN IN YOUR DISTRICT.
4) COLD CHAIN AND LOGISTICS VERY GOOD GOOD MEDIOCRE POOR VERY POOR
Was the cold chain implemented and managed according to standards Were VVMs
still showing potent vaccine when examined by supervisors was there
sufficient quantity of OPV for each team
5) PLANNING and TRAINING VERY GOOD GOOD MEDIOCRE POOR VERY POOR
were microplans developed at the district level
6) SOCIAL MOBILIZATION VERY GOOD GOOD MEDIOCRE POOR VERY POOR
timely distribution of materials strategies to identify minority or
unreached population employed were additional strategies besides
posters/banners/T- shirts used were special efforts undertaken in
underperforming districts
7) CASH ADVANCES VERY GOOD GOOD MEDIOCRE POOR VERY POOR
available in a timely way not to disrupt or delay activities
8) IMPLEMENTATION VERY GOOD GOOD MEDIOCRE POOR VERY POOR
were maps used for house to house activities were special plans made for
"border" areas in urban areas were there plans to go to everyone floor in
high rise buildings? was supervision sufficient (numbers, checklists
completed, results reviewed) were independent monitors used were specific
efforts to target low performing and/or "high" risk areas were special
plans undertaken to immunize "unreached", hard to reach communities (for
example, displaced communities, nomads, urban slums) for house to house
activities, were children (or houses) who were immunized "marked"
9) OVERALL MANAGEMENT VERY GOOD GOOD MEDIOCRE POOR VERY POOR
Proposed Timeline, Plans, and Use of Indicators:
1) Timeline: Review proposed indictors in UNICEF April 28
Circulate proposed indicators among partners May 1 Present to TCG
May 9 Field test
June/August Revise for use in
Autumn NIDs September/October
2) Disseminate at appropriate meetings: TCGs for EMRO - June, SEARO -
August, AFRO ? December and respective UNICEF meetings
3) UNICEF and WHO will test these indicators in a sample of the 14 priority
countries (to be decided)
4) UNICEF and WHO will use the (ICCs) to establish consensus on the quality
of each NID round by using the indictors. The ICC should use the
information to advocate with the government for necessary support to
improve quality.
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Selected items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
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