Singogo, Dr. Fwasa
Dear Colleagues,
The Better Immunization Data Initiative is currently testing a number of change management and product vision interventions at selected health facilities in Livingstone District, Zambia to help overcome challenges in abnormal immunization coverage.
Accurate coverage rates are important for decision-making, planning and designing strategies to increase reach. A key challenge in calculating coverage data is the uncertainty inherent in current methods for estimating the size of target populations (Denominators), which are based on Central Statistics Office (CSO) extrapolations from previous census. The denominators obtained from these projections do not reflect the true population on the ground for most districts because censuses are conducted once every 10 years. The use of inaccurate denominators give rise to coverage rates that exceed 100% - a mathematically unlikely outcome.
Consequently, it is imperative that denominators used in immunization programs are accurate/correct at all levels to ensure accuracy in reporting the services provided and the number of children reached.
As we continue to engage the District Health Office over the actual numbers of children for immunisation, we would like to hear from others
1. How you have managed to ensure that districts and or Health Centers are using actual prevailing numbers of children (Denominator) in their catchment area for immunisation
2. What tools/processes can one use to validate the denominator for the immunisation program for the Health Center and District
Sharing of your thoughts and experiences with us will be appreciated.
Fred Shamakondo Njobvu
Provincial Coordinator - Better Immunization Data (BID) Initiative
P.O. Box 60045
Plot # 2898/207
Livingstone, Zambia
Mobile: +260 977867860
Skype: fred.njobvu
Email: fnj...@path.org
caroline phiri
Director Mother and Child Health
Ministry of Community Development Mother and Child Health
Phone 0211223909
LUSAKA
From: "Singogo, Dr. Fwasa" <FSin...@path.org>
To: "bidini...@googlegroups.com" <bidini...@googlegroups.com>
Sent: Monday, February 9, 2015 5:11 PM
Subject: Validating Denominators for Immunization Program
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David Brown
This is a topic of recent interest, and I look forward to learning of the shared experiences. As the conversation evolves, I would also like to share several recent documents that have been put together at the global level that may be of interest to some.
All the best,
David
From: bidini...@googlegroups.com [mailto:bidini...@googlegroups.com]
On Behalf Of Singogo, Dr. Fwasa
Sent: 09 February, 2015 10:11
To: bidini...@googlegroups.com
Subject: Validating Denominators for Immunization Program
Dear Colleagues,
--
Mtenga, Hassan
Indeed, this is one of the biggest challenge that the immunization systems are facing around Sub Saharan Africa and particularly in Tanzania. It’s even a bigger challenge as this is a policy issue that immunization program are required to make use of data from national statistics office despite the fact that the data doesn’t reflect the actual ground picture due to number of reasons one being time lag between census among others.
However with BID initiative, we could turn this into advantage, currently health care worker by using consumption data are able to figure out how many vials of vaccine to order irrespective of their target population. For instance in one of the health facility in Tanzania, their coverage report over 150 % but, they never experience perceived stock out at any time since they are not ordering vaccine using target population rather using consumption data. This tells us that if allow a room of flexibility in adjusting the denominator (target population) then we would actual never had the 150 % coverage reports, but that is against the country policy.
But with immunization registry and child registry as part of BID initiative interventions, we can create the much awaited evidence that the health care worker are struggling to establish to inform the policy maker that the data we are using aren’t as accurate as they may think and by then we would have accurate data coming from immunization registry as evidence and alternative.
We should anticipate challenges from the national offices of statistics since we will be degrading the tasks that they have been doing for years, but with evidence we would at least stand a chance to seat on round table and negotiate.
Hassan Mtenga W,
Project Manager – MoHSW
BID Initiative
Ministry of Health and Social Welfare │ IVD Program │
Vaccine Institute, Mabibo, TFDA Compound │
Tel : │+255 22 2122398 │Fax: +255 22 2122399 │
Mobile: │+255 689 556612 │ +255 717 487578 │
Skype: │ hassan-mw │
From: bidini...@googlegroups.com [mailto:bidini...@googlegroups.com]
On Behalf Of Singogo, Dr. Fwasa
Sent: Monday, February 09, 2015 6:11 PM
To: bidini...@googlegroups.com
Subject: Validating Denominators for Immunization Program
Dear Colleagues,
--
Singogo, Dr. Fwasa
Thanks David for the documents shared.
Very informative.
Fwasa
Danovaro, Dr. Carolina (WDC)
Thank you for sharing. In Latin America we face the same question on what to do about the denominators. For countries with good birth registration, census projections are compared. Nevertheless, this is very difficult for small populations such as those in sub-national levels.
We have advised countries to focus on their numerators to see if they behave consistently overtime and monitor their drop-out rates. As the denominator is a very difficult problem to solve, we have shifted the focus to ensure adequate follow-up of each person using tickler files, or follow-up books. We can do this more comfortably in countries with few 0-dose children. Honduras and Paraguay have created “inter-sectoral working groups” (see here: http://www2.paho.org/hq/dmdocuments/2010/SNE3201.pdf ) to review denominators; the experience has been mixed.
All the best,
Carolina
M. Carolina Danovaro, MD, MSc
Regional Immunization Advisor
Department of Family, Gender and Life Course/Comprehensive Family Immunization Unit (FGL/IM)
Pan American Health Organization,
525 Twenty-third St, NW, Washington DC 20037 - USA
Tel. 1-202-974-3856 E-mail: dano...@paho.org Web: www.paho.org/immunization
From: bidini...@googlegroups.com [mailto:bidini...@googlegroups.com] On Behalf Of David Brown
Sent: Monday, February 09, 2015 2:37 PM
To: Singogo, Dr. Fwasa; bidini...@googlegroups.com
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GREVENDONK, Jan Peter Kamiel
Thanks for raising this important and timely discussion.
Fred started this discussion with stating that “Accurate coverage rates are important for decision-making, planning and designing strategies to increase reach.”
That is true, but as previous posters such as Carolina and David have mentioned, accurate denominators and thus accurate coverage rates are really hard to obtain, especially at subnational level. This problem is worse in countries that already achieve high coverage. I love this table from one of David’s papers that shows what the impact of +/- 10% denominator uncertainty is on coverage estimates: it clearly shows that for countries with 80% + coverage, administrative coverage estimates are a blunt measure that are more likely to mislead than to inform policies such as district prioritization. Furthermore, I also think that there is no really good way to improve denominators, and even if there were, that this is most often something that goes beyond the responsibilities of immunization program people. Even if you had a good way to estimate real populations at district and health facility level, you would still often need to use the “official” denominators instead.
I therefore agree with Carolina: we should try to understand the limitations of the data, and focus on what we can do, not on what we cannot change.. Some concrete ideas:
· Looking at numerator trends is often more informative than calculating coverage: the reported numbers of doses is a harder number than coverage: if that drops or stagnates then the program is probably in trouble.
· The target for a health centre could be to immunize 5% more children than last year, instead of reaching 95% of an unknown population.
· Focus on reducing drop out, as that is not dependent on denominators
· Calculate a “BCG denominator”: i.e. use an early dose like BCG or DTP1 for which you have high confirmed coverage, and infer a denominator from that
· As Hassan said: look at past consumption rates, not (only) target population for planning purposes
· Validate the target population with the reported numbers of doses administered during campaigns. (The latter is often a bit higher because of doses given to people outside of the target range, but it can still give an idea)
· There are finally also experiments going on with the use of technology to estimate demographic information, especially in Nigeria and for the use of polio: this encompasses the use of GIS with feature recognition, cell phone traffic picked up at local GSM antennas etc.
Hope to see more people weigh in on this denominator discussion!
Jan Grevendonk
Technical Officer, Strategic Information Group
Expanded Programme on Immunization (EPI)
Department of Immunization, Vaccines and Biologicals (IVB)
Family, Women's and Children's Health (FWC)
World Health Organization (WHO)
20 Avenue Appia, 1211 Geneva 27, Switzerland
O: +41 22 79 12589
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