GAVI Board Meeting, 21-22 June 2001, London, England
Update: 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 audit tool
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:
- Selection of districts and health units and formation
of audit teams;
- In each health unit, recorded immunizations are
recounted and compared to reported immunizations;
- In each district, individual health unit reports
are recounted and compared to the districts reported values;
- At central 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
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.
To implement 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.
The 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.
The project 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.
The pilot audits in year 2001 will not be used for
adjustment of the immunization services support (the allocation
of shares) to countries.
After the 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