Fifth GAVI Board Meeting, 21-22 June 2001, London, England
Immunization Data Quality Audit (DQA)
For the purpose of monitoring the number of children immunized with
DTP3, WHO has developed a tool for data verification; Data Quality Audit
(DQA), to be performed according to a standard methodology. This tool
has been developed to meet two main criteria: to establish the number of
children being immunized (and, in later years, the additional number of
children) and to build on and support the routine health and
immunization reporting system. Specifically the DQA will result in the
establishment of country specific correction factors that can be used
for the calculation of immunization services support for each year.
In order to
maximize information, household surveys or immunization coverage surveys
are encouraged in populations where DQA is being implemented.
The DQA will establish the number of children immunized with DTP3 in a
sample of 24 health facilities in four different districts within each
country concerned, based on the registration of immunization at these
facilities. This number will then be compared to what has been reported
to the national level (and by the country to WHO, UNICEF and GAVI). If
there is a difference, a correction factor that will be applied to
calculate the immunization services support from GAVI/the Vaccine Fund
will be established.
It should be
noted that the DQA can only establish reported immunizations. If
children are immunized without being recorded this will not be picked up
by the audit. Thus the DQA serves to establish the number of children
immunized and reported. This is an advantage as any national monitoring
system needs to keep track of its immunizations.
The audit is
designed to enable two external auditors, with local support, to assess
the immunization data reporting system in a period of approximately two
weeks. In each country the audit will be carried out as follows:
of districts and health units and formation of audit teams;
health unit, recorded immunizations are recounted and compared to
district, individual health unit reports are recounted and compared to
the districts reported values;
level the incoming reported immunization data are compared to the
published computer report.
In addition to the accuracy checks (recounted/reported), all aspects of
the reporting system are assessed; in particular, a quality index of the
system is calculated for the three reporting levels (health facility,
district and national), and performance indicators are also calculated.
The tool provides immediate feedback to national staff on practical ways
to strengthen their recording system.
The audit will initially be implemented on a pilot basis during the
period May-September 2001 in the nine countries that were awarded the
highest immunization services support in 2000 and early 2001. The
countries to be audited this year will be Côte dIvoire, Haiti, Kenya,
Liberia, Mali, Pakistan, Rwanda, Tanzania, and Uganda. The experiences
from this years pilot audits will guide subsequent audits.
the audit it was decided to search for a suitable company/institution/
organization to be in charge of the whole process in the nine countries
in 2001 from start to end. A tendering procedure was carried out
resulting in the award of the contract to implement the DQA to a
consortium that is headed by the Liverpool Associates in Tropical Health
(LATH), UK, in association with the Euro Health Goup (EHG) from Denmark
and the Deloitte and Touche Emerging Markets Group (D&T), USA.
consortium combines the expertise of each of the partners. LATH is
associated with the Liverpool School of Tropical Medicine and has a
strong research knowledge base and extensive global experience in health
assessments and evaluations. The Euro Health Group has considerable
experience in drugs and vaccine programme management and management
information systems and has carried out a number of global assessments
and reviews. Deloitte and Touche, Emerging Markets Goups is one of the
worlds leading professional services firms with some 90,000 partners
and staff in offices in over 130 countries around the world.
has started with a training session in Nairobi in early June followed by
field training in Pakistan and Uganda. If necessary the audit manual
will be revised as a result of these initial audits. The audit in the
remaining seven countries will then be carried out in the period
July-September with the results to be available in time for the annual
reports which are to be delivered by 30 September in the GAVI/the
Vaccine Fund supported countries.
audits in year 2001 will not be used for adjustment of the immunization
services support (the allocation of shares) to countries.
pilot audits in 2001 an evaluation meeting will be held end September to
assess the methodology. After that decisions will be made regarding the
use of the DQA in subsequent years. Based on this assessment, the need
for including surveys to complement the DQA in connection with the
mid-term review will be considered.