Immunization is considered one of the most effective interventions for preventing infectious diseases and improving population health. However, for immunization to be effective, it is important to ensure that immunization programs are well implemented and that the target population actually receives the necessary vaccines.
This is where immunization program monitoring comes in. Immunization program monitoring involves the collection and analysis of data on immunization coverage, operational challenges, and efforts to improve the quality and effectiveness of immunization programs. This allows for the identification of bottlenecks and barriers in the delivery of immunization services and the adoption of measures to overcome them. Therefore, information and communication technologies provide an opportunity to improve immunization program monitoring.
In Niger, significant progress has been made in digitizing the health information system for routine immunization. Indeed, after several years of using the DVDMT (District Vaccination Data Management Tool), Niger has been using the DHIS2 as the sole platform for centralizing routine immunization data since 2022. However, as with any information system, there are challenges to be overcome in order to optimize the DHIS2 platform and facilitate timely decision making.
Implementation of an innovative monitoring system
In May 2022, a memorandum of understanding was signed between the State of Niger, the Aliko Dangote and Bill & Melinda Gates Foundations (BMGF), and Gavi to strengthen routine immunization in the regions of Diffa, Maradi, and Zinder covering the period 2022-2024.
In order to guarantee the achievement of the program's objectives and accountability to partners, milestones have been defined and validated with the national party. Among these milestones, the improvement of the monitoring and evaluation system is a key element, in particular the implementation of a real-time monitoring system of the program's activities.
Askaan, funded by BMGF to provide technical assistance to the 3 regions and the Immunizations Directorate (ID) in all thematic areas covered by the MOU, is collaborating with the Bluesquare organization in setting up this platform. This article describes the process and methodology for setting up this program monitoring facility, summarizes progress to date, and identifies key next steps.
Methodology for monitoring the vaccination program
The system put in place to monitor the routine immunization strengthening program in Niger is based on four main areas: data collection, analysis and decision-making, performance monitoring, and immunization coverage surveys.
The process of setting up the program monitoring platform began with a document review based on the experience developed in the DRC by Acasus and the immunization equity analysis document developed by the Niger Immunization Directorate, as well as the DHIS2 indicators. This document review allowed us to identify the program's monitoring indicators, which were then validated with the ID and BMGF through a series of meetings.
Indicators to assess vaccine availability and effectiveness of activities
The indicators identified are intended to evaluate monthly:
- Availability of vaccines
- Health areas meeting the required number of immunization sessions
- District supervision activities by DRSP supervisors
- District supervision of CSIs
- The functionality of the cold chain
- The effectiveness of the search for lost and zero-dose children
More specifically, the following indicators have been selected for monitoring the immunization strengthening program in Niger:
- Proportion of planned immunization sessions completed according to strategy (Immunization Tracker)
- Proportion of facilities that have reserve stock of all antigens at the end of the month
- Proportion of health facilities with a functioning cold chain during the entire monitoring period
- Proportion of planned vaccine/consumable deliveries achieved by level
- Proportion of planned EPI formative supervision visits conducted by level
- Dropout rates Penta1 - Penta3 during the reporting period
- Proportion of children found by the Relais
For each indicator, the method of calculation, the frequency, the source and the person responsible for collection have been defined. The data collected will be as granular as possible (collection at the level of the integrated health centers and districts) in order to better focus the interventions.
Real-time data collection
To facilitate real-time data collection, the Immunization Department, with the support of the Statistics Department, has implemented the Immunization Tracker, which is a DHIS2 module that collects individual data on children in contact with routine immunization services.
All the IHCs and mobile teams in the health districts will be equipped with tablets for recording daily data , in particular the geolocation of the immunization session and the status of vaccine stocks. The other indicators will be filled in at the end of each month by the heads of the IHCs and the immunization focal points of the districts and regions.
Technical proposal for real time monitoring
The technical proposal decided for the monitoring of the indicators through a dashboard is the following
- Setting up the data elements (numerator and denominator for each indicator) in DHIS2
- Monitoring of data entry at the ISC and district levels
- Verification of data quality and organization of a monthly data validation meeting
- Extraction of data from DHIS2 SNIS to an external tool (Table).
- Importing data into the visualization interface
- Produce reports in PDF format and share with central, regional, district and ISC managers
This technical proposal offers moreindependence and flexibility in defining visualizations as well as possible integration with data from IASO, including coverage surveys, formative supervision or supplementary immunization activities.
Final steps in the deployment of the platform
The next steps are to finalize the configuration of the immunization tracker form in DHIS2 through a workshop that is being held in Dosso. We will then have to prepare the tender documents for the purchase of tablets for the IHCs, HDs and regions of the MoU, proceed with the purchase of the tablets, organize the training workshop for the central level on the use of the Iasso, Open Haxa, dashboard and DHIS2 Tracker tools. Finally, we are going to organize training sessions for the CSI chiefs, district and regional management teams on the DHIS2 immunization tracker.