Average coverage can mask deep inequalities.

The Zero-Dose Learning Hub is pleased to share a new toolkit: Using LQAS to Monitor and Measure Vaccination Programs.

In immunization programs, national and district estimates are often used to track progress. But those averages can conceal important variation at subdistrict levels, where children may still be missed — often in the same communities. Lot quality assurance sampling (LQAS) is a classification-based survey method that helps program managers move beyond the question, “What is coverage?” and ask, “Where is coverage falling below target?”

The toolkit provides practical operational guidance for using LQAS to support decentralized decision-making, including how to define supervision areas, select thresholds and decision rules, design sampling approaches, and manage data collection and analysis. It also includes step-by-step guidance, practical examples, templates, decision rules, questionnaires, and tools to support survey planning, implementation, and analysis.

For zero-dose programming, this is especially important. Zero-dose and under-immunized children are not evenly distributed; they tend to cluster in specific locations shaped by local barriers to access, service delivery challenges, and social dynamics. LQAS can help teams identify where targeted action may be needed most.

Explore the toolkit on the ZDLH website.