Indicators that describe the strength of the routine immunization system: Preliminary learning

Download this publicationImmunization is at the very core of health programs around the world, yet its performance is commonly measured by just a single number, namely coverage with a third dose of a vaccine that protects against diphtheria, pertussis, and tetanus (DTP3).

While DTP3 coverage is highly useful for describing the ability of the routine immunization system to reach children multiple times, it only tells part of the story. Similar to vaccination drop-out rate (also widely used), DTP3 is an outcome indicator that provides retrospective information on what has already happened. But additional indicators that describe the functioning of the immunization system in real time can provide managers with essential information to guide their actions for improving vaccination coverage and help explain reasons for low coverage.

Such process indicators have long been proposed but not highly valued by health personnel or promoted as useful tools for management. While the WHO/AFRO Reaching Every District (RED) guide proposes several input, process, and output indicators for immunization, MCSP is working to test and validate ten of these indicators to determine their feasibility and value to health personnel from the health facility up to the national level. This brief shares MCSP’s emerging findings from an iterative learning process to understand how such indicators can benefit the immunization system. JSI/Maternal and Child Survival Project. 2018.

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