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BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION

ACKNOWLEDGEMENTS

These best practices documents for polio eradication have been developed from the contributions of many people from all over the world. The people concerned have themselves spent many years striving to eradicate polio, learning from successes and failures to understand what works best and what does not, and quickly making changes to suit the situation. In writing these best practices the aim has been to distil the collective experiences into pages that are easy to read and detailed enough to be adapted for other health programmes.

‘To strive, to seek, to find, and not to yield’

ACRONYMS iv

INTRODUCTION 1

THE PURPOSE OF THIS DOCUMENT 2

MICROPLANNING ELEMENTS 4

MICROPLAN RESOURCE ESTIMATE 8

COLD CHAIN AND LOGISTICS MICROPLAN 9

OPERATIONAL MICROPLAN 9

SUPERVISION MICROPLAN 23

RECORDING AND REPORTING TOOLS 28

MONITORING MICROPLAN 30

CONCLUSION 33

ANNEX 1 MICROPLAN RESOURCE ESTIMATE 34

ANNEX 2 COLD CHAIN AND SUPPLIES 39

ANNEX 3 CHECKLISTS 41

ANNEX 4 TALLY SHEET 46

SUPPLEMENTS TO THIS DOCUMENT (PROVIDED IN SEPARATE DOCUMENTS)

• BESTPRACTICESINMICROPLANNINGINAREASWITHPOORACCESS(INCLUDINGTHEKOSIRIVERAREAOFBIHAR,INDIA)

• BESTPRACTICESINMICROPLANNINGFORCHILDRENOUTOFTHEHOUSEHOLD:ANEXAMPLEFROMNORTHERNNIGERIA

• BESTPRACTICESININNOVATIONSINMICROPLANNINGFORPOLIOERADICATION

• BESTPRACTICESFORPLANNINGAVACCINATIONCAMPAIGNFORANENTIREPOPULATION

CONTENTS

iv BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION

ACRONYMS

AEFI Adverseeventfollowingimmunization

AFP Acuteflaccidparalysis

GPEI GlobalPolioEradicationInitiative

HC Healthcentre

NGO Nongovernmentalorganization

OPV Oralpoliovaccine

RCM Rapidcampaignmonitoring

SIA Supplementaryimmunizationactivity

SOP Standardoperatingprocedure

1 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION

BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION (POLIO SUPPLEMENTARY IMMUNIZATION ACTIVITIES)

INTRODUCTION

DOCUMENTINGBESTPRACTICESFROMPOLIOERADICATIONObjective4ofthePolio Eradication & Endgame Strategic Plan 2013–2018callsfortheGlobalPolioEradicationInitiative(GPEI)toundertakeplanningto"ensurethattheinvestmentsmadetoeradicatepoliomyelitiscontributetofuturehealthgoals,throughaworkprogrammethatsystematicallydocumentsandtransitionstheGPEI'sknowledge,lessonslearntandassets".AsoutlinedinthePlan,thekeyelementsofthisbodyofworkinclude:

• ensuringthatfunctionsneededtomaintainapolio-freeworldaftereradicationaremainstreamedintoongoingpublichealthprogrammes(suchasimmunization,surveillance,communication,responseandcontainment);

• transitioningnon-essentialcapabilitiesandprocesses,wherefeasible,desirableandappropriate,tosupportotherhealthprioritiesandensuresustainabilityoftheglobalpolioprogramme;

• ensuring that the knowledge generated and lessons learnt from polio eradication activities are documented and shared with other health initiatives.

THE SCOPE OF DOCUMENTING BEST PRACTICESBest practice documents deal with technical aspects of polio eradication. The documents will include clear guidelines, case studies of effective programmes and processes, case studies of failures, and innovations developed at the national, regional and global levels, and will highlight areas where other programmes could benefit from the polio practices to achieve their health priorities. A series of technical subjects are being developed on:

• improvingmicroplanning

• ensuringqualityacuteflaccidparalysis(AFP)surveillance

• monitoringthequalityofsupplementaryimmunizationactivities(SIAs)

• securingaccessforImmunizationinsecurity-compromisedareas

• targetingandplanningforvaccinationofolderagegroupsduringpolioSIAs

• coordinatingcross-bordervaccinationcampaigns

• integratingotherantigensorotherinterventionsintopolioSIAs

• targeting and planning for the vaccination of nomadic populations during polio SIAs

• benefiting from other relevant technical areas where WHO country, regional and headquarter polio teams have significant expertise.


THE PURPOSE OF THIS DOCUMENT

THE RELEVANCE OF THIS DOCUMENT TO OTHER HEALTH INITIATIVESMany public health interventions are currently delivered through a campaign approach, which is likely to continue. This approach not only includes vaccines but other interventions for communicable diseases and nutrition, for children and, in certain circumstances, for an entire population, especially those facing emerging diseases.

THE SCOPE OF THIS DOCUMENTThis document describes best practices in microplanning for polio eradication campaigns, also known as supplementary immunization activities (SIAs) with oral polio vaccine (OPV). A microplan must aim to reach 100% of the target population, usually children aged under 5 years. Experience over the years has shown that the poliovirus can continue to circulate in quite small populations of unvaccinated children, thus requiring that the microplan be sufficiently detailed to reach every child with OPV.

The elements for making a microplan are described, along with the relevant best practices learnt over time. This document is a practical guide with working examples that can be adapted as needed. The best practices can serve as a guide for other public health programmes.

Over the last 25 years, microplanning for SIAs to eradicate polio has undergone changes and innovations. Errors were made and corrected, best practices were learnt through trial and error, without any textbook to follow. This document highlights what works best, but also indicates what does not work as well. The great strength of the polio eradication initiative is its flexibility and ability to identify problems rapidly in order to make significant changes, even at short notice.

This document does not replace the many guides, technical sheets and training materials already in existence; these published documents provide detailed information on strategies, principles, methods and operations. This document outlines the same strategies and elements, but gives advice on how the tried-and-tested practices can best be put into action. It does not include budget examples, which vary greatly from country to country.

DEFINITION OF A MICROPLANA microplan is a population-based set of components for delivering health-care interventions – in this case, supplementary polio vaccination for every child aged under 5 years. The microplan contains technical details and can be adapted as needed at every level, whether by national institutions, health-care workers or community participants. It is not a reference book but a dynamic set of tools that can be used and modified at any time to suit the demands of implementation according to the circumstances.

The microplan is divided into six sections:

• resourceestimate

• coldchainandlogistics

• operations

• supervision

• recordingandreportingtools

• monitoring


OBJECTIVE OF THE MICROPLANEvery person engaged in making and implementing the microplan must have a clear understanding of the objective: to achieve polio eradication through the systematic immunization of every child in the target population with polio vaccine.

Polio eradication microplans have adopted the innovative strategy of house-to-house vaccination over time. The health services in countries in which polio has been endemic did not reach everyone, and underserved communities had a greater burden of polio. Services were therefore brought to the community.

ENGAGING THE OPERATIONAL LEVEL IN MICROPLANNINGThe microplan must work with the health service at the operational level, usually the health centre.

• Microplansmustbevalidatedinthefieldandnotfromafaratahighlevelofcommand.

• Thedetailsoftheirimplementationmustconsidertherealsituationofthepeopleinfieldoperations.

• Standardsmustbesettoplanandsecuresuppliesandlogistics,butflexibilitytomakechangestosuitlocalconditionsmustbepossibleateverystep.

Important lessons learnt

The polio SIA microplan is not just a collection of spreadsheets and budgets, it is a flexible and evolving set of plans at each level of operation that can be adapted and corrected rapidly, even between each campaign round.

The microplan requires field validation; spreadsheets may not reflect the reality of operations at the field level where access is difficult and resources are scarce. Detailed plans must be made at the operational field level (health centre or an equivalent institution).

Assigning teams to vaccinate children in a certain number of households per day in a defined area is often more effective than designating a total number of children per day.

The microplan must be able to show the details of exactly where every person needs to be and when, as well as their duties and movements during the entire period of the SIA.

Coverage data alone are not a reliable way to measure the results of a microplan. It is better to triangulate data using a variety of sources, for example supervisory reports, independent monitoring and surveillance data, to understand whether a microplan is adequate or needs to be modified.


MICROPLANNING ELEMENTS

CAMPAIGN STRATEGY DECISIONThe campaign strategy must be decided and understood by the health service and community:the immunization of all children aged 0 to 59 months with OPV on an equitable basis regardless of prior immunization status, location and social condition in a defined wide area (country, province).

ESTABLISHING A COORDINATION STRUCTUREA structure that can oversee and coordinate the development and implementation of the microplan must be established. It must include national-level decision-makers and representatives at other levels involved in the area of the microplan’s operations. Imposing a plan at any one level should be avoided as full participation at every level is essential to make the plan work.

SETTING THE REQUIRED MICROPLANNING STANDARDSPlanning standards must be set for supplies, logistics, human resources, transport, equipment and the span of management control. The standards should be flexible enough to allow local variations.

ESTIMATING MICROPLAN RESOURCES• Makeaninitialpopulation-basedestimateofthetotalrequirementforsupplies,logistics,human

resources,transportandcold-chainequipmentatthehighestlevel.

• Usethesamepopulation-basedmethodtoestimaterequirementsforsupplies,logistics,humanresources,transportandequipmentateachlevel:province,district,subdistrict,healthcentre.

• Estimateresourcesaccordingtothelocalcharacteristics,suchastheextentofurbanandruralareas,astheyshouldnotbestandardized.

• Use simple form to estimate population distribution, supplies and human resource requirements at the district and health centre levels as conditions may vary greatly from place to place.

PLANNING THE COLD CHAIN AND LOGISTICS ELEMENTSThe microplan should include information pertaining to:

• theavailabilityanddeploymentofcold-chainequipment;

• a plan for transporting vaccine and supplies.

PLANNING THE OPERATIONAL ELEMENTSThe operational aspects of the microplan should include:

• managementprocedures;

• atrainingplan;

• ahealthcentresessionplan(seeFigure1);

• avaccinationteamdailylogisticschecklist;

• anindividualteammovementplan(seeFigure2);

• detailedoperationalmapsanditinerariesfortheteams,organizedbythenumberofhouseholdstovisitwithstartandendpoints;


• fixedsiteinformation;

• house-markinginformation;

• finger-markinginformation;

• aspecialteamdeploymentplanfortransitpoints,marketsandstreets;

• a community engagement plan.

PLANNING THE SUPERVISORY ELEMENTSThe microplan should describe the duties of supervisors in detail. At every stage in its development and implementation, supervisors are expected to observe operations and take corrective action where needed. Their duties include:

• fieldvalidation

• immunizationsupervisionandtraining

• teamplanningandscheduling

• responsibilityforoperationalmaps

• pre-andpost-implementationchecks

• checklistupdates.

USING RECORDING AND REPORTING TOOLSSimplefield-basedtoolsshouldbeusedtocollectandreportdataontheimplementationofthemicroplan.

MONITORING THE MICROPLANAplanfordeployingmonitorswhowillcheckthepreparationsandimplementationofthemicroplanmustbeputintoplace.

ESTABLISHING A COORDINATION STRUCTUREAcoordinationstructureshould includenational-leveldecision-makersandrepresentativesatotherlevelswhoareinvolvedintheareaofthemicroplan’soperations.OneinnovationhasbeentoestablishEmergencyOperationCentresworkingattheprovinceanddistrictlevelstocoordinatepoliooutbreakactivities,includingtheextentoftheSIA,thebudgetallocation,communicationandtrainingstrategies,monitoringplansandcross-borderactivities.

The coordination structure’s various committees and national and subnational committee members should ensure that:

• thesamestandardsareappliedeverywhere;

• correctandappropriatemessagesaredisseminatedeverywhere;

• allmicroplanningmaterialsandallresourcesareavailablewhenandwhereneeded.


Table 1. Coordination structure committees

National committee is responsible for the overall monitoring of the planning, implementation and evaluation stages.

Technical subcommittee follows up on the technical aspects of the process, verifying the national work plan and its target population and age groups; and assesses the adequacy of the training modules for every level.

Logistics subcommittee ensures the availability of vaccines, adequate cold chain, transportation and supplies; and develops and implements the logistical distribution plan.

Social mobilization subcommittee

develops social mobilization materials and key messages, and plans their dissemination; and coordinates the recruitment of local social mobilization and community engagement focal points at the subdistrict level.

Finance subcommittee ensures the availability of funds and their timely release to all levels, as well as the post-campaign financial report.

SETTING THE REQUIRED STANDARDS FOR SUPPLIES, LOGISTICS, HUMAN RESOURCES, TRANSPORT AND COLD-CHAIN EQUIPMENT

BEST PRACTICE FOR SETTING MICROPLANNING STANDARDSPlanning standards should be set on realistic estimates, especially regarding the amount of work that vaccinators and supervisors must conduct in the time available. To keep an equitable workload throughout, it is necessary to vary the standards according to accessibility, distance and other local conditions including security. Regardless of their assigned workload, all vaccination teams are responsible for vaccinating children in their assigned area whether the children are in the house or out of the household.

ASSIGNING DAILY TARGETS OF TOTAL HOUSEHOLDS PER DAY OR TOTAL CHILDREN PER DAYIntheearlyyearsofpolioeradication,countrieswouldimplementtwoorthreeroundsofpolioimmunizationperyear,andmanychildrenweremissed.Oftenteamsweresettargetsofaround200childrenormoreperdaytovaccinate,andtheywouldstopworkwhentheyhadachievedthetargetnumber.Theywouldthenclaim100%coverage,eventhoughadditionalchildrenmayhavebeenintheassignedarea.Inlateryearsasoperationsintensified,somecountrieswouldholdasmanyas12campaignsperyearbut,asitbecamecriticalthatnochildbemissed,thestrategyofsettingtotalchildrenasatargethadtobemodified.Communitiesbecamereluctanttoacceptmanyvaccinationroundsandhadtobeconvincedoftheirpurpose.Moretimehadtobespentonengagingthecommunityandgainingitstrust.

House-to-house vaccination provided the opportunity to engage families and convince them of its benefits, but it proved more time-consuming and fewer children could be immunized per working day. Microplans were changed; in urban and semi-urban areas, it became more effective to assign each team to a certain number of households per day (approximately 50ะ75) than to designate a certain number of children.

• In urban areas,streetmapscanbeused,andvaccinationteamscanbeassignedacertainnumberofhouseholdstovisit.Ateam’sdailyworkcanbepreciselymapped,withidentifiedstartandendpoints.Thehousescanbenumberedandthevaccinationteamcanmarkthemaccordingtotheimmunizationstatusofthechildrenwithin.Supervisorsandmonitorscanmoreeasilyfollowupontheworkoftheteams.

• In rural areas,suchasvillageswherehousesmaynotbeorganizedonastreetpattern,settingthetargetofreachingeveryhouseholdandeverychildinavillageismoreeffective.However,simplemapsshowingdesignatedstartandendpointscanstillbeused,togetherwithhouse-marking.


Table 2. Example of the standardization of resources (variable according to country and location)

Variable Standard

Population aged <5 years (0 to 59 months) Varies by country (approx. 13.5%)

Population aged <10 years <5 years population x 1.5

Population aged <15 years <5 years population x 2

Vaccinators per team 2 (minimum)

Support staff at post or in team 1–2

District refrigerator capacity 100 litres per refrigerator

Health centre refrigerator capacity Approx. 20 litres per refrigerator

Number of households to be visited for immunization per day

Average number of children aged 0 to 59 months per household

50–100 households

3 children

Number of children immunized per team per day 100–200 in urban areas

60–80 in rural areas

Number of teams per supervisor 4–5 in urban areas

2–3 in rural areas

2 in transit areas

Fuel consumption of a 4x4 vehicle 15 litres per 100 km on good roads

20 litres per 100 km off the road

Fuel consumption of a motorbike 4–5 litres per 100 km

Maximum daily distance for a national supervisor 150 km

Maximum daily distance for a team supervisor 100 km

Maximum daily distance for a vaccination team 30 km, if motorized

OPV wastage in 20-dose vials during SIA 15%; 1.2 wastage factor

Volume of a dose of 1.5 ml OPV 1000 doses per 1.5 litres cold storage volume

Capacity of 1 vaccine carrier with 4 ice packs Approx. 1–1.5 litres

Capacity of 1 ice-pack freezer Approx. 100 ice packs

Number of finger-marking pens needed per team 2 pens per team per day of work


MICROPLAN RESOURCE ESTIMATE (see Annex 1 for examples)

• Makeaninitialpopulation-basedestimateofthetotalrequirementforsupplies,logistics,humanresources,transportandcold-chainequipmentatthehighestlevel.

• Usethesamepopulation-basedmethodtoestimaterequirementsforsupplies,logistics,humanresources,transportandequipmentateachlevel:province,district,subdistrict,healthcentre.

• Estimateresourcesaccordingtothelocalcharacteristics,suchastheextentofurbanandruralareas,astheyshouldnotbestandardized.

• Use simple formats to estimate population distribution, supplies and human resource requirements at the district and health centre levels, as conditions may vary greatly from place to place.

BEST PRACTICE FOR ESTIMATING RESOURCES• Themicroplanmuststartwithanestimateoftotalresources,madeseveralmonthsinadvanceso

suppliescanbeorderedanddeliveredintime.

• Whenplanningacampaign,itisbesttoestimatethetotalresourcesneededinatimelymanner.

• Timewillbeneededtogathertheresources:vaccinemustoftenbeorderedfromoverseas,vehiclesdistributed,personneltrainedandsupervisorsassigned.Theextentofalltheseresourcesneedstobeknownwellinadvanceateverylevel.

• Earlyplanningestimatesarealsoessentialbecauseashortageofresourcesismorelikelyatthedistrictlevel.

• Accurateresourceestimatesarecalculatedfrompopulationestimates,butthelattermayvaryaccordingtotheinformationsource.Planningestimatesshouldbemadefromthebottom-up,usingthesameframeworkdespitevaryingpopulationtotals(i.e.usingthesametypeoflogisticalplanwithstandardizedvariablesbutwithvaluesthatmaychangefromvillagetohealthcentretodistrictduetothemanydifferentpopulationestimatesateachlevel).

• It is always best to slightly overestimate the population to ensure sufficient vaccines and other resources are available.


COLD CHAIN AND LOGISTICS MICROPLAN (seeAnnex2forexamples)

The microplan should include information pertaining to:

• theavailabilityanddeploymentofcold-chainequipment

• a plan for the transport of vaccine and supplies.

BEST PRACTICE FOR PLANNING THE COLD CHAIN AND LOGISTICS• Everyprovinceshouldestimateitscold-chainequipmentsituationearlyon.Duringacampaign,

thedemandforrefrigerators,coldboxestocarryvaccineandfreezerspaceishigh.

• Alldistrictsshouldmanagetheircold-chainresourcesaccordinglyandwellinadvance.

• Adistrictthathasashortfallincold-chainequipmentcanreceiveassistancethroughthedeploymentofequipmentfromtheprovinceleveloraneighbouringdistrict.

• Ifdistrictcentresarenotfarfromeachother,poolingfreezercapacityforicepacksmaybepossibleatasharedlocation.

• Vaccineshouldbedistributedfromtheprovincetothedistrictnolaterthanonemonthfromthestartofthecampaign.Equipmentcanalsobetransportedinadvanceincaseofashortfall.

• The province and district should regularly update their lists of equipment according to local transport information and the cold-chain equipment plan.

OPERATIONAL MICROPLAN

The operational aspects of the microplan should include:

• managementprocedures;

• atrainingplan;

• ahealthcentresessionplan(seeFigure1);

• avaccinationteamdailylogisticschecklist;

• anindividualteammovementplan(seeFigure2);

• detailedoperationalmapsanditinerariesfortheteams,organizedbythenumberofhouseholdstovisitwithstartandendpoints;

• fixedsiteinformation;

• house-markinginformation;

• finger-markinginformation;

• aspecialteamdeploymentplanfortransitpoints,marketsandstreets;

• a community engagement plan.


OPERATIONAL MICROPLAN FOR THE HEALTH CENTRE• Afterthemicroplanresourceestimateshavebeenmade,detailedoperationalplanswillbe

required.Theoperationalmicroplanislikeaworkplan:itdescribesthedatesandplaceswhereteams,communityrepresentatives,volunteersandsupervisorswillneedtobelocatedoneachday.

• Thedetailsoutlinedintheoperationalmicroplandependonanassessmentofthelocalsituationandcannotbestandardized.

BEST PRACTICE FOR MANAGING OPERATIONAL MICROPLANS

1. Send a simple message to all participantsThe goal is to vaccinate all target-age children in a given geographical area. Teams are assigned to specific areas and must visit every household in that area to ensure vaccination.Supervisors will check that teams have visited every household and that no child has been missed.

2. Divide the operational area into three categories of accessThenumberofchildrenorhouseholdstobereachedwilldependonaccessandthetimetheteamshavetowork.Operationalareascanbemapped,andvaccinationteamsandsupervisorscanbeassignedaccordingly.

Table 3. Three categories of access

1. Easy access: households can be reached on foot each day 50–80 households per day or 200 children

2. Intermediate access: transport is needed between areas, but households can be reached on foot

30–50 households per day or 100 children

3. Difficult access: areas include geographical obstacles, such as rivers, hills or bush tracks with poor road conditions

30–50 households per day or 100 children

3. Pay special attention to high-risk areasHigh-risk areas require the best vaccinators and supervisors suited to the areas. Community mobilizers and influencers must be identified in advance to accompany teams.

High-risk areas can include those with:

• recentcirculation

• lowperformancesinpreviousrounds

• lowroutinecoverage

• lowsurveillanceperformance

• settlementsofurbanpoor

• newandinformalsettlements

• remoteruralpopulations

• minoritypopulations

• highlymobilepopulations

• nomads.


4. Select the best vaccinators• LargenumbersofvaccinatorsareneededtodeliverOPVdrops.Ifpossible,selectvaccinators

fromthecommunitybyengagingcommunityleaders.Thismaybemoreeffectivethanrecruitingvaccinatorsthroughhealthserviceofficials.

• Vaccinatorsshouldbefromthesameethnicgroupasthetargetpopulation,befamiliarwiththelocationandspeakthesamelanguage.Previousexperienceisdesirable.

• Sufficientfemalevaccinatorsshouldbeavailable,giventheneedtoengagemotherswithyoungchildren.

• Nursingstudents,otheruniversitystudentsandnongovernmentalorganization(NGO)staffoftenworkwellasvaccinators.

• Supervisors may be health service staff, teachers, NGO staff and other people with knowledge of the community.

BEST PRACTICE FOR TRAINING VACCINATORS• Allvaccinatorsandsupervisorsmustbetrainedpreferablyinsmallgroupsbyexperiencedsenior

staffandpartners.

• Thelocationoftrainingisimportant.Itshouldbelocal,andtheparticipantsshouldbeabletohearclearlyandinteractwithtrainerswithnooutsidedistractions.

• The vaccinator’s basic job is to administer vaccine, tally, and mark the finger and the house. The vaccination team should not be overloaded with other jobs unless they are essential to the plan.

Vaccinator training• Thetrainingofvaccinatorsshouldnotbelefttonewlytrainedsupervisors;itshouldbeundertaken

bythemostexperiencedprofessionals.

• Thetrainingsiteshouldbeneartheareawheretheteamswillwork(suchasschools),withenoughroomforparticipantstobeseated.

• Thevaccinators’attentionshouldbegainedthroughinteractivetraininginanumberofsmallgroups(around20persons)ratherthaninlargegroups.

• Thetrainingcourseshouldtakeoneday,withhalfofthedayspentonhands-ontrainingandroleplayingwithsimulatedvaccinationactivities.

• Thetrainingshouldbecompletedaroundfivedaysbeforethecampaignstarts.

• An additional 5–10% more vaccinators should be trained in case of absentees on the campaign days.

Simple but clear vaccinator training content• Vaccinatorsmustknowthecampaign’spurposeandobjective.

• Everyteamandsupervisormustuseamapduringeachdayofthecampaign.

• Mapsshowingtheboundarieswhereeachteamwillworkcanbemadeduringtrainingorprovidedbysupervisors.

• Themapsforvaccinatorsmustshowlandmarkswheretheyshouldstartandfinisheachday’swork,andtherouteeachteamshouldtaketomovefromhousetohouseeachday.

• Everyteamandsupervisormustprovidetheirmobilephonenumberstofacilitatesupervisionandreportproblems.

• House-to-housevaccinationshouldfollowtheassignedrouteshownonthemap,withvaccinatorsmarkinghousesandfingersastheygo.

• Vaccinatorsshouldcommunicatepolitelywithfamilies,eventhosethatrefusethevaccination.


• Trainingshouldincludeanswerstofrequentlyaskedquestions.

• Teamsshouldknowhowtosystematicallyrecordhouseholdstoberevisitedorabsentchildren,notingthenamesofabsentchildren,lockedhousesandfamilyrefusalsonthebackofthetallysheet.

• Follow-up of absent children should be conducted before the end of the day.

Key questions for vaccinators to avoid missing children• Atthehouseholddoor:“Howmanymothersareinthishouse?”

• Thenaskeachmother:“Howmanychildrendoyouhave?”

• Tomakesureallchildren,especiallyyounginfants,areincluded,askeachmother:

– “Do you have an infant?” – “Do you have any sick children?” – “Do you have any visiting children?” – “Are any children sleeping?”

Vaccine distribution plan for vaccinators and supervisors• Everyvaccinatorshouldknowwheretopickupvaccineandreplenishit.

• Healthcentresshouldsetupcoldboxesand/orrefrigeratorswhereteamscanconvenientlypickupvaccineandicepacksbeforestartingtheday’swork.

• Supervisors should have vaccine carriers with vaccine to replenish teams when needed.


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OPERATIONAL MAP FOR TEAMS

BEST PRACTICE IN OPERATIONAL MAPPING (see also the separate section on GIS mapping)

Each team should have its own map to show exactly where the team will work each day according to the team movement plan.

The image on the left shows a large town map on which team areas have been shaded: Day 1, Day2, Day 3.

Hand-drawn maps are also useful when they show:

• streetsandlandmarkswithineachsettlementandcity;

• housesandhamletslyingoutsidethemainroads;

• majorlandmarks(suchasrivers,bridges,healthcentres,schools,markets,nurseries,train/busstation,policecheckpoints,etc.);

• roadsandtracks;

• the limits of the team’s catchment area (the border of their working area).

The location where each team works can be shown as in the example below.

BEST PRACTICE IN HOUSE-MARKING

House-marking is evidence that a team has visited a house. It informs teams, supervisors, monitors and evaluators about whether a household was visited, all children were immunized or the house needs to be revisited.

The definition of a household should be applied flexibly: a household can be the smallest family unit or a compound. It can include temporary settlements, boat people or nomads. Each household should be marked. In compounds where several households share the same entrance, each household as well as the main entrance should be marked.

Houses should be marked with a crayon, or any other locally accepted product, but never with ink markers. The mark should be placed on, beside or above the door. If that is not possible, any other immobile object (a rock, tree, fence, etc.) should be chosen. The location of the mark should preferably be protected from rain. Houses can be marked in many ways; the marking has not been standardized in all countries.


Examples of simple basic house-markingT15 H23 29/6 4/4

Interpretation: Team 15 visited (√) household number 23 on 29 June and immunized all four children. (The tick mark is circled.)

T18 H74 29/6 2/3 +1

Interpretation: Team 18 visited (√) household number 74 on 29 June, two out of three children were vaccinated. but some children were missed and the household needs to be revisited (no circle). When the team revisits, it adds +1 to the house-marking.

Some houses may be locked and empty. Houses should be marked for revisiting only when individuals in the target age group are absent and can be immunized by a revisit during the campaign. A list of houses to be revisited should be made on the back of the tally sheet and each team should submit it to the supervisor at the end of each day.

The marking on the wall indicates that all 10 children in the household were vaccinated on 2 March 2010.


BEST PRACTICE IN FIXED SITE CAMPAIGN IMMUNIZATIONMany years of experience have shown that a successful campaign cannot be conducted with fixed sites alone. A combination of fixed site and door-to-door vaccination is sometimes used, often on the first day of the campaign, after which the campaign becomes focused on door-to-door visits.

• Thefixedsitesshouldbeinprominentandconvenientplacesintheshadewithenoughspaceformothersandchildrentowait.

• Thesiteisfixed,butthepersonnelarenot.Vaccinators,volunteersandsocialmobilizersshouldallmovearoundthesitetolookforchildrentovaccinate.

• Healthcentresandhospitalscanremainopenandfunctionasfixedsitepostsforthedurationofthecampaign.

• Theexteriorofschools,placesofworship,busstationsandotherlocationscanbevaccinationareasforacertainnumberofdaysbutshouldnotreplacedoor-to-doorvisits.

• Banners and posters should draw attention to the site.

Each fixed site should have at least two vaccinators to immunize children and record doses administered, and two support staff to help manage the flow of waiting clients and to mobilize mothers and children in the area.

Each child of eligible age is tallied on the tally sheets and gets a finger-mark. There is no need to record addresses or other information.

BEST PRACTICE IN FINGER-MARKINGFinger-marking during SIAs allows teams, supervisors, monitors and evaluators to know whether a child has actually been immunized. Fingers should preferably be marked with indelible ink markers, rather than with gentian violet or other products that usually do not stay visible sufficiently long. Fingers marked the correct way and with quality markers, stored and handled appropriately, will normally remain visible for the duration of the campaign and a few days thereafter. It is important that teams strictly follow the recommended method for finger-marking. Always cap the finger-marker pen after use to prevent it from drying out.

Finger-marking process:• Thefingershouldbemarkedafteradministering

theOPVandnotbefore.

• Beforemarking,theteamshouldproperlycleanthechild’snailusingapieceofcloth/cotton.

• Onlythechild’s left little finger shouldbemarked–NOotherplace.

• Theinkshouldbeappliedonthe nail and nail bed.Markingthenailbedisimportantbecausethestainwillremainlonger.

• The ink should be allowed to dry for 30 seconds.

BEST PRACTICE IN TEAM MANAGEMENT AT TRANSIT POINTSThe locations of common transit points include:

• railwaystations

• busterminalsandmajorroadcrossings

• highwaycheckpoints


• tollboothsonhighways

• majorriverbridges

• ferrycrossings

• airports

• children’sparks

• religious and social community event venues.

Vaccinationteamsassignedtoworkattransitpointsneedspecialtrainingandcarefulsupervision.Inmanycountries,thousandsofchildrenmoveinandoutoftransitpointseveryday.Theywouldbemissedbyteamsthatonlyvisithouseholds.Animportantfactorisengagingthecooperationofthepeoplewhoareintransitwiththeirchildren,althoughtheyareofteninahurryandmayresentthepresenceofvaccinators.Itmaybehelpfultoengageyouthgroups,tosteerparentswithchildrentowardsthevaccinators.Localauthoritiesandpolicemustapprovethevaccinationworkattransitpoints.

Planning steps• Everyimportanttransitpointshouldbeidentifiedandmapped.

• Trainedvaccinatorsshouldbedeployedatthetransitpointsdependingonthesizeoftheareaandthemovementoftrafficandpublicatvarioustimesoftheday.

• TransitteamsshouldbedeployedforalltheSIAdays.Thismayrequiretwoshiftstocovertrafficmovingfromearlymorningtolateevening.

• Vaccinationteamsshouldbedeployedatallexit/entrypointsinbigtransitareaswithmultipleentriesandexits.

• Asupervisorshouldbedeployedforevery2–3transitteams.

Microplanning steps• Visitthetransitpointtoestimatethelikelyworkload.

• Estimatethenumberoftargetchildrenpassingthroughthetransitpointandthenumberofentryandexitpoints.

• Takeintoconsiderationvariationsintrafficloadinthemorningsandevenings.

• Judge the most appropriate location for placing vaccination teams.

Transit team vaccinator trainingTransit team vaccinators need dedicated training because their work is different from that of house-to-house teams. Some transit teams are static, working at major crossings to vaccinate children as they pass by. Others are mobile, entering buses or trains and vaccinating children inside them.

Transit team vaccinators need to know:

• thebasicsaboutpolioeradicationandhowtohandlevaccineandvaccinate;

• howtonegotiateentrytocrossingpoints,busesandtrains;

• howtoapproachparentspolitelyincrowdedcircumstances;

• howtocheckforvaccinatedandunvaccinatedchildrenbyfinger-mark;

• howtoconvinceparentsreluctanttoacceptvaccination;

• the importance of actively seeking children.


Vaccine and the cold chain• Transitteamsshouldbegivenenoughvaccinevialsfortheestimatednumberofchildrenpassing

throughthesite.Ateammayneedasmanyas1000dosesofOPV(50x20-dosevials)formajortransitpoints,suchaslargerailwaystations.

• All vials (empty, full or partial) should be returned to the cold store at the end of each day. Every vaccination team and supervisor should have a vaccine carrier to store the daily vaccine requirements.

Information, education and communication/mobilization• Postersandbannersshouldhelpindicateandmakevisiblewheretransitteamsareoperating.

• Teeshirts,capsandidentificationbadgesshouldbewornsoparentscaneasilyidentifytheteammembers.

• Radioandtelevisionmessagingshouldbedevelopedandsharedthroughappropriatechannelstoensureparentsaresensitizedtotransitteamsoperatingintheirareas.

• Thecontrollingauthority(e.g.railwayorbusterminusauthorities)shouldensureendorsementsandannouncementsatthetransitpoint.

• Religious leaders should make announcements at places of worship.

Supervision• Atleastonesupervisorshouldoverseeevery2–3transitteams.

• Iftransitteamsaredeployedinshifts,everyshiftshouldhaveseparatesupervisors.

• Supervisors should move around to check vaccinators’ activities carefully.

Working at transit points• Vaccinatorsmustidentifyparentsandcaretakerswithtargetchildrenattransitpointsandpolitely

asktocheckthechildren’svaccinationstatus.

• Ifunimmunizedchildrenarepresent,vaccinatorsshouldimmunizethemandmarkthefinger.

• Vaccinatorsmustobtainconsentfromparentsbeforevaccinatingchildren.Ifachildisalone,vaccinatorsshouldtrytolocatethechild’sparentsorcaretakerstoaskpermissiontovaccinatethechild.

• Ifparentsrefusevaccination,vaccinatorsshouldpolitelytrytoconvincethemtoacceptOPV.Ifparentsrefuse,vaccinatorsshouldnotwastetimetryingtopersuadethem.

• Vaccinatorsshouldcheckallchildrenforfinger-markings,evenwhenparentsclaimchildrenhavebeenimmunized.

• Every vaccinator deployed must be independent and should carry vaccine, marker pens and tally sheets.

Recording and reportingThe tally sheet should record:

• date,placeandtimingofactivity

• numberofchildrencheckedforvaccinationstatus

• numberofchildrenvaccinated

• number of vaccine vials received, spent and returned.


Figure 3. Transit team management form

Location for transit team

Team number

Names of vaccinators

Name of supervisor and mobile phone number Hours of work

Figure 4. Form for community engagement activities in high-risk communities

Location of community

Names of vaccinators

Name of person selected for community

engagement and mobile phone

number

Name of supervisor and mobile phone

number

Dates of engagement


BEST PRACTICE IN COMMUNITY ENGAGEMENT IN HIGH-RISK COMMUNITIES

High-risk communitiesHigh-risk communities are defined as areas with:

• recentcirculation

• lowperformancesinpreviousrounds

• lowroutinecoverage

• lowsurveillanceperformance

• settlementsofurbanpoor

• newandinformalsettlements

• remoteruralpopulations

• minoritypopulations

• highlymobilepopulations

• nomads.

High-risk communities need careful microplanning to make sure the community is visited by the best possible teams, best supervisors and persons from the local community who can engage and influence the community.

Certain high-risk communities may be reluctant to accept vaccination and other interventions. In these circumstances, it is necessary to engage the community through a person it knows well and trusts. Such a person may be a religious or other leader who is well informed and able to explain why vaccination is needed and its benefits to the community.

Community engagementCommunitiescanbeengagedthroughteamworkinvolvingavisit fromatrustedcommunityperson,asupervisorandthevaccinationteamallworkingtogether.

1. During local planning

• Identifyinfluentialpeopleinthecommunitybyvisitingitandaskingtheadviceofthecommunity.

• Brieftheidentifiedinfluentialpeopleonpolioeradication:describewhatthehealthserviceistryingtoachievewithpolioeradication,anddescribehowimportantitisthateverychildinthetargetagegroupbevaccinated.

• Wheninthecommunity,identifyvolunteerswhocanhelptomobilizethecommunitywiththeinfluentialpersons.

• Aimtofindlocalpeoplewhoarewell-knownandarewelcomeinanyhouseinthecommunity.

• Be prepared to pay volunteers and community influencers for their work. It is better to have a formal engagement with an agreed allowance than to depend on voluntary assistance, especially in poverty areas.


2. During house-to-house campaign visits

• Makesurealleligiblechildreninahouseholdareidentifiedandvaccinated.

• Getacommunityvolunteertohelpbyenteringthehouseandspeakingtomothers.

• Ifthecommunityisknowntobehesitantaboutvaccination,asktheinfluentialpersonpresenttoanswerquestionsandconvincethecommunitytoallowthechildrentobevaccinated.

• Note any households that refuse immunization on the back of the tally sheet, with some indication of why the refusal occurred. Refusals can be addressed by different people according to the reason for refusal.


SUPERVISION MICROPLAN (see Annex 3 for examples)

The duties of supervisors include:

• fieldvalidation

• immunizationsupervisionandtraining

• teamplanningandscheduling

• responsibilityforoperationalmaps

• pre-andpost-implementationchecks

• checklist updates.

DIFFERENCES BETWEEN SUPERVISING AND MONITORING POLIO ERADICATION SIAs• Supervisorssupportteamsduringtraining,preparationandoperations.Theyaremobile,observe

theworkandtakecorrectiveactionoftenonthespot,andreporttheirfindingsatfeedbackmeetings.

– Supervisors should not be burdened with long checklists to complete when they are observing intra-campaign house-to-house team operations. They should devote their time to visiting teams and taking corrective action. They may carry vaccine to vaccinate missed children.

• Monitors observeoperationsandtakenoteofthequalityofoperations,butdonottakecorrectiveaction.Theirreportsarecompiled,discussedatfeedbackmeetingsandusedtotakecorrectiveactionthroughthesupervisors.

– Monitors have more time to complete checklists and to consolidate and report their findings. They do not usually carry vaccine.

BEST PRACTICE FOR MANAGING SUPERVISORSSupervisorsshouldunderstandtheirrolesclearly.Theyneedhands-ontraining,andthequalityoftheirworkismonitored.Districtandhealthcentresupervisorsshouldmonitorteamsupervisors.

Field validation of the microplanSupervisorsmustcheckthedetailsoftheoperationalmicroplansinadvance.


Table 4.The roles of supervisors

Pre-implementation

(see checklist under Annex 3)

District and health centre supervisors Team supervisors•Overseeandfollowupmicroplandevelopment

•UsecheckliststoreviewSIAreadinessandtaketimelycorrectivemeasures

•Reviewandvalidatesupervisoryplansandmaps

• Ensure all teams have supplies, equipment, maps, plans and transport and take corrective action where needed

• Check details on team maps and movement plans and ensure team boundaries are clear

• Make sure all team members have been trained and no untrained people on the team are used as substitutes

Table 5. Implementation observation and corrective action

During implementation

(see checklist under Annex 3)

District and health centre supervisors Team supervisors

•Checkandcorrectmanpowerdeployment,accessandsupplyproblems

•Monitortheworkofteamsupervisors

•Participateinrapidcampaignmonitoringwithexternalsupervisors

•Followandmanagevaccinationteamactivitiesandtakecorrectiveaction

•Overseeteamstravellinghouse-to-house

•Overseerevisitsandthevaccinationofmissedchildren

•Carryvaccineinthevaccinecarriertorestockteams

•Collectandconsolidatereportsfromalllevels

•Providedailyfeedbackateveningmeetingstosolveproblems

Selection of team supervisorsSupervisors should be selected from among people who have some responsibility and respect inthecommunity,suchasschoolteachersandNGOstaff,amongothers.Retaininggoodsupervisorsisessentialbecausetheymakeanimportantcontribution.

TrainingAll supervisors must preferably be trained in small groups by experienced senior staff and partners. They should be trained by the most experienced professionals, which often includes external supervisors. The training course usually lasts two days. It should cover everything in the vaccinator training, plus hands-on field work training on the second day:

• Beforethestartofthecampaign,supervisorsshouldvisitlocationswherethepopulationisknowntobemobiletoupdatetheirmapswithnewsettlements.

• Mapsshouldshowwhereeachteamisworkingsosupervisorscanvisitthemandobservetheirworkclosely.

• Supervisorsshouldbefamiliarwiththehigh-riskareasandknowthenamesofthecommunityleaderswhocanactasinfluencers.

• Supervisorsshouldsolveproblemsandespeciallydealpolitelywithrefusals,requestingthesupportofpeoplewhocanengagewiththecommunity.

• Supervisorsshouldusesimplechecklistsanddebriefwithteamsattheendoftheday,advisingoncorrectiveaction.

• Supervisors should attend evening meetings with external supervisors to report their daily findings.


Mobility• Supervisorsmustbemobileduringthedayandvisiteveryteamassignedtothem.

• Allsupervisorsmusthaveadailyplanandmaptomanagetheirmovements.

• Supervisorsshouldencourageandsupportteamsbymakingregularvisitstothevaccinatorteamsthroughouttheday.

• Supervisors may use some form of transport to move from team to team, but must walk with each assigned house-to-house team.

Evening supervisor meetings• Eveningmeetingsforsupervisorsshouldbechairedbythedistrictadministratororapersonof

equivalentlevelinthepresenceofteamsupervisorsandexternalsupervisors.

• Theagendashouldbeaction-orientedandfocusoncorrectiveaction,includingstrengthsandweaknesses,andtheactiontotakethenextday.Afullaccountoftheday’sproceduresisnotneeded.

• External supervisors can take the opportunity to review tally-sheet samples (a tally-sheet audit).

Figure 5. Overall district or health centre supervisory campaign plan

Health centre name Supervisor 1 (name)

Supervisor 2 (name)

Supervisor 3 (name)

Supervisor 4 (name)

Team # Team # Team # Team #

Day 1 (date) Teams

1, 2, 3, 4, 5

Teams

6, 7, 8, 9, 10

Teams

11, 12, 13, 14, 15

Teams

16, 17, 18, 19, 20

Day 2 (date)

Day 3 (date)

Day 4 (date)

Day 5 (date)

Figure 6. District or health centre daily supervisory plan

Health Centre Name Date

Supervisor name

Mobile phone number

Team number for supervision

Location of villages for house-to-house vaccination

Location of high-risk areas for rapid campaign monitoring

Mode of transport

A 1, 2, 3, 4, 5 Town South Side marketplace and bus station

motorbike

B

C


SUPERVISORY MAP

EXAMPLE OF BEST PRACTICE IN SUPERVISORY MAP USEThis supervisory map shows the location of each team to be supervised on each day (Day 1, Day 2, Day 3).


Figure 7. Daily schedule of supervisory visits

Health Centre Date

SUPERVISOR NAME AND PHONE NUMBER

TIME

LOCATION

TIME

LOCATION

TIME

LOCATION

TIME

LOCATION

TIME

LOCATION

18:00

AT HEALTH CENTRE

SUPERVISOR 1 TEAM NUMBER

14

TEAM NUMBER

15

TEAM NUMBER

16

TEAM NUMBER

17

TEAM NUMBER

18

09:00

AT BUS STATION

11:00

AT STREET BESIDE

MARKET

13:00

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15:00

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TO HIGH SCHOOL

17:00

MAIN ROAD

SUPERVISOR 2 TEAM NUMBER

19

TEAM NUMBER

20

TEAM NUMBER

21

TEAM NUMBER

22

TEAM NUMBER

23

08:30

AT VILLAGE

A

10:30

AT VILLAGE

B

12:30

AT VILLAGE

C

14:30

AT VILLAGE

D

16:30

AT VILLAGE

E

BEST PRACTICE FOR MANAGING SUPERVISORY WORK

• Allsupervisorsshouldhavedetailedplansanddailyworkschedulesthatdescribepreciselywheretheyshouldbeduringtheday.

• Thedate,placeandtimecanbespecified,whichmakesiteasiertofollowupandoverseethesupervisors.

• Onecopyshouldbegiventoeachsupervisor,andonecopyshouldbegiventothehealthcentre.

• Everysupervisorshouldhavethe:

– overalldistrictorhealthcentresupervisorycampaignplan(seeFigure5)– districtorhealthcentredailysupervisoryplan(seeFigure6) – supervisory map – daily schedule of supervisory visits (see Figure 7).

(See Annex 3 for examples of checklists.) BEST PRACTICE IN SUPERVISORY CHECKLISTS

• Checklistsaremostusefultosupervisorstocheckonteampreparationwhenalargenumberofsupplycomponentsmustbeputinplace.

• Only a very brief and simple checklist should be used for intra-campaign supervision to allow the supervisor time to observe team operations in detail.


RECORDING AND REPORTING TOOLS (seeAnnex4forexamples)

Simple field-based tools should be used to collect and report data on the microplan’s implementation.

• SIAresultconsolidation

• tally sheet.

RECORDING AND REPORTING THE RESPONSIBILITIES OF VACCINATORSTo record vaccinations, use:

• atallysheet(seeAnnex4)

• finger-marking

• house-marking.

Tally sheets can be used at a post or door to door during the vaccination campaign. They should not be filled in after the work has finished.

• Atallysheetshouldbeusedtorecordthenumberofchildrenimmunizedatapostorhousetohouse.

• Fortheassignednumberofhouses,theteamshouldrecordthenumbersofthefirstandlasthouse.

• Everyday,eachteamshouldrecordthedetailsofthehousestoberevisitedonthebackofthetallysheets.

– Some houses may be revisited on the same day and others on the next day, depending on team availability.

• Each day, the details of the vaccine received and vaccine vials returned (used and unused) should be recorded on the tally sheet.

RECORDING AND REPORTING THE RESPONSIBILITIES OF TEAM SUPERVISORSTeam supervisors must:

• reviewalltallysheetswithteams;

• makeaconsolidatedreport;

• attendeveningmeetingsandgivefeedbackoncorrectiveactiontobetaken;

• gothroughthetallysheetsoftheirteamsattheendofeachday:

– to provide appropriate instructions for vaccinators – to compile tally-sheet information and submit a daily report using the reporting form for

supervisors;• comparetheratioofthenumberofchildrenaged0–11monthstothenumberofchildrenaged

12–59months(theratioshouldbe1:5);

• correlatethenumberofvialsusedwiththereportednumberofdosesadministeredaccordingtothetallysheet;

• signthetallysheetshowingthetimeoftheirvisit;

• verify the tally sheet looks authentic and has genuinely been used in the field.


USING A DAILY REPORTING FORM• Thedailyreportingformconsolidatesthedatafromthetallysheets.

• Thesameformcanbeusedateachlevel.

• Attheendofeachdayandeachweek,eachdistrictshouldsendaconsolidatedreportofchildrenimmunized.Allreportsshouldbeanalysedonadailybasistobeinapositiontorespondtoproblemsandadaptthestrategy.Questionstoaskinclude:

– Are there areas with specific problems and how were they corrected? – Were all teams and supervisors present? – Was vaccine availability ensured everywhere?

SIA RESULT REPORTING FORMThis form can be used at any level:

• atthehealthcentreleveltoprovidetheteams’dailyresults;

• atthedistrictleveltoprovideconsolidatedresultsfromeachhealthcentre;

• attheprovinceleveltoprovideconsolidatedresultsfromeachdistrict.

The form should indicate at which level it is being used.

Figure 8. Form to report SIA results

Team/health centre/district/ province (indicate

which level)

Eligible population

Aged 0–11

months

Aged 12–59

months

Total % of eligible popula-

tion

OPV vials received

OPV vials used


MONITORING MICROPLAN (seeAnnex3forchecklistexamples)

Microplan checks occur at three levels:

• pre-campaignmonitoring

• intra-campaignmonitoring

• post-campaign monitoring.

BEST PRACTICE IN USING CHECKLISTSChecklists can become a burden on supervisors and monitors. To avoid this encumbrance, they should concentrate on collecting data that can be used immediately and only listing essential components for which action can be taken.

• The pre-campaign readiness checklist canbeusedbysupervisorsormonitorswhovisithealthcentrestoensureallthecampaigncomponentsareinplace.

• The intra-campaign monitoring checklist canbeusedbymonitorswhocompiletheirobservationsaccordingtothefindingsoneachteam.

Supervisorsshoulduseasimplerchecklist,givingthemtimetoconcentrateoncorrectiveaction(seethesectiononsupervision).

POST-CAMPAIGN RAPID CAMPAIGN MONITORING

The purpose of rapid campaign monitoring (RCM) is to find and vaccinate missed children.• MonitorsconductRCMinselectedcommunities(oftenthoseathighrisk)duringandimmediately

aftertheteamshavecompletedtheirwork(thesameday,orthenextatthelatest).

• Monitorsshouldcheck10householdsdoortodoorfortheOPVstatusofchildreninthetargetagegroup(e.g.aged0–59months)inthosehouses.

• Asampleof10householdsispreferableto10childrenbecauseaselectionofdifferenthouseswillbemorerepresentativethanaselectionofmanychildreninonehouse.

• Any community that fails RCM (two or more children out of 10 missed) should be revisited by a vaccination team.

Method• Monitorsshouldgetasamplethatisasrepresentativeaspossiblebychoosingasmanydifferent

areasasfeasibleinthetimeavailable(forexample,4ะ5differentstreets,or2–3villages,orseveralclustersofhouses).

• MonitorsshouldgodoortodoortoverifythatatleastonechildineachhousereceivedtheOPV,visitingapproximately10householdsbeforemovingontothenextarea.

• Monitorsmuchcheckeachchildaged0–59months(oranothertargetagegroup)ineachhouseandrecordtheOPVstatus.

• Finger-marking is used to confirm OPV status.


Checking finger-marking for immunization status• Vaccinatedchildrenshouldbemarked:√

• Unvaccinatedchildrenshouldbemarked:X

• Ifachildhasnotbeenvaccinated,thenameandlocationofthatchildisnotedontheform.Themothercanbeaskedwhythechildisnotvaccinated,whichisalsorecordedontheRCMform.

• Ifamothersaysherchildwasvaccinated,herresponseshouldbeacceptedandnotedunderthereasons,evenifnofingerismarked.

• Monitorsshouldinformsupervisorsbyphoneifmanyunvaccinatedchildrenarefoundinonecommunity,inordertoorganizeanimmediatemop-upcampaign.

• The results should be totalled by age group: 0–11 months and 12ะ59 months.

Vaccinating missed children• Themonitorinformstheteamsupervisorofmissedchildrenbymobilephoneandprovidesthe

detailedmonitoringform,whichcanbepresentedatfeedbackmeetings.

• Theteamsupervisorputstogetheravaccinationteamtovisittothecommunity.

• The team revisits the community and vaccinates all missed children, including any children not yet identified by the RCM team.

Figure 9. Simple form for rapid campaign monitoring (RCM)

Province/District Village/Community External Supervisor Team Number

RCM OPV – 0–59 months

0–11 months 12–59 months If NO,

writename,houseand

streetnumber

If NO,

writereasonnotvaccinated

Vaccinated OPV

Finger-mark

YES √

Finger-mark

NO X

Finger-mark

YES √

Finger-mark

NO X

1

2

3

4

5

6

7

8

9

10

TOTAL


Figure 10. Form to report results of rapid campaign monitoring

Health Centre Name Monitoring Team Name/Number Date

Location of monitoring visit

Vaccination team #

assigned

Area selected for monitoring

# of households monitored

Total # of children checked

# of missed children

Supervisor notified

Block 44 12 Omega Heights

10 15 2 Yes, team will return tomorrow

13 Rose Garden

10 6 0

BEST PRACTICE IN RAPID CAMPAIGN MONITORING• Monitoringteamsshouldvisitasmanydifferentareasaspossible,includingareasknownforlow

performanceandhighrisk.

• Theresultsshouldbediscussedattheeveningmeeting.

• Themoretheinformationgiventothesupervisorisdetailed,theeasieritistotakeaction.

• Missed children should be identified by name and location so the team can return to vaccinate door to door.


CONCLUSION

These best practices in microplanning for polio eradication are based on many years of success and failure in interrupting poliovirus transmission in many diverse situations. The elements described, and the recommended steps and forms, are all aimed at keeping the microplan as simple as possible and relevant to the situation in the field. There is no ideal microplan; there are only examples. In fact, one of the greatest achievements of polio microplanning has been its capacity to remain flexible and change rapidly, even from one day to the next, when problems arise. For polio eradication, achieving 80–90% of the goal is not an option – the only goal is 100%. Every child must be vaccinated, often through separate doses administered in successive rounds. Children missed results in continued transmission, and a pocket of local transmission, if not halted rapidly, can soon become an international outbreak.

34 BESTPRACTICESINMICROPLANNINGFORPOLIOERADICATION

ANNE

X 1

MIC

ROPL

AN R

ESOU

RCE

ESTI

MAT

E

Cal

cula

tion

of a

pop

ulat

ion-

base

d es

timat

e fo

r to

tal

supp

ly,

logi

stic

s, h

uman

res

ourc

es,

tran

spor

t an

d co

ld-c

hain

equ

ipm

ent

requ

irem

ents

at

the

high

est

leve

l (u

sual

ly

the

natio

nal l

evel

)

Figu

re A

1.1.

Nat

iona

l res

ourc

e an

d lo

gist

ics

mic

ropl

an o

rgan

ized

by

prov

inci

al p

opul

atio

n

This

spr

eads

heet

is a

n ex

ampl

e of

a p

opul

atio

n-ba

sed

natio

nal r

esou

rce

estim

ate

for

a co

untr

y w

ith a

tota

l pop

ulat

ion

of 2

0 70

0 00

0 im

plem

entin

g a

natio

nwid

e ca

mpa

ign

to

imm

uniz

e ev

ery

child

age

d 0–

59 m

onth

s (e

stim

ated

to b

e 13

.5%

of t

he to

tal p

opul

atio

n) w

ith O

PV,

rega

rdle

ss o

f pri

or im

mun

izat

ion

stat

us. E

ach

prov

ince

is li

sted

in th

is n

atio

nal

spre

adsh

eet,

and

supp

lies

and

reso

urce

s ar

e es

timat

ed a

ccor

ding

to th

e pr

ovin

cial

pop

ulat

ions

.

1. N

ame

Pro

vinc

e/

Stat

e

2. T

otal

P

opul

atio

n fo

r ye

ar

3. O

PV

targ

et

popu

lati

on

13.5

%

(0 T

O 5

9 M

ON

THS)

4. #

ho

useh

olds

va

ccin

ated

by

one

te

am p

er

day

5 #

of

team

day

s re

quir

ed*

6. #

day

s sc

hecu

led

for

impl

emen

ta

tion

7. #

if

team

s re

quir

ed

(2 O

PV

vacc

inat

iors

pe

r te

am)

8. #

of

vacc

inat

ors

need

ed

( 2 p

er

team

)

9. #

su

ppor

t st

aff

(2 p

er

team

)

10. #

of

team

su

perv

isor

s (1

per

5

team

s)

11.

Tota

l #

of s

taff

re

quir

ed

( sum

of

8+9+

10)

12. #

of

20 d

oes

OP

V vi

als

requ

ired

=

(tar

get

popu

lati

on

x w

asta

ge

fact

or

(1.2

0/20

)

13. D

aily

Tr

ansp

orta

tion

N

eed

(1ve

hicl

e pe

r su

perv

isor

m

oto,

or

car)

14. V

olum

e of

OP

V do

es

requ

ired

in

Lit

res

= (t

arge

t po

pula

tion

x

was

tage

fa

ctor

x

volu

me

of 1

doe

s O

PV)

/100

0

15. T

otal

re

frig

erat

or

spac

e re

quir

ed in

Li

tres

(+2

to

+8 C

)

16.

Est.

#

of

frid

ge

unit

s (2

0 L

per

frid

ge)

17. #

of 2

0 L

cold

box

re

quir

ed

(1 p

er

supe

rvis

or)

18. #

of

vacc

ine

requ

ired

(2

per

te

am)

19. #

of

ice

pack

s (2

x 4

ic

epac

ks

for

vacc

ine

carr

ier)

pl

us 2

0 pe

r co

ld

box

20. E

st.

# o

f fr

eeze

rs

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er

100

ice

pack

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21. #

of

imm

uniz

ati

on fi

xed

post

s (1

per

5

team

s)

22. #

C

opie

s of

re

cord

ing/

re

port

ing

form

s (t

eam

day

s x

2)

23. #

set

s of

wri

ting

m

ater

ials

(e

xerc

ise

book

s an

d pe

ns)

24. #

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nger

m

arke

r pe

ns

(tea

m

days

x

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ldre

n ag

ed 0

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r ho

useh

old

35 BESTPRACTICESINMICROPLANNINGFORPOLIOERADICATION

BEST

PRA

CTIC

E FO

R ES

TIM

ATIN

G RE

SOUR

CES

The

mic

ropl

an m

ust s

tart

with

an

estim

ate

of to

tal r

esou

rces

, mad

e se

vera

l mon

ths

in a

dvan

ce s

o su

pplie

s ca

n be

ord

ered

and

del

iver

ed in

tim

e.

This

spr

eads

heet

is b

ased

on

stan

dard

s se

t by

the

coun

try

for

supp

ly, l

ogis

tics,

hum

an r

esou

rces

, tra

nspo

rt a

nd c

old-

chai

n eq

uipm

ent.

It is

onl

y an

exa

mpl

e an

d do

es n

ot

repr

esen

t any

pol

icy;

all

field

s ca

n be

mod

ified

acc

ordi

ng to

the

stan

dard

s se

t at t

he n

atio

nal l

evel

. In

this

spr

eads

heet

, eac

h va

ccin

atio

n te

am o

f tw

o pe

ople

plu

s tw

o su

ppor

t st

aff v

isit

50 h

ouse

hold

s pe

r da

y an

d va

ccin

ate

ever

y el

igib

le c

hild

in th

ose

hous

ehol

ds. T

his

exam

ple

assu

mes

thre

e ch

ildre

n ag

ed 0

ะ59

mon

ths

per

hous

ehol

d (a

n av

erag

e of

150

chi

ldre

n pe

r da

y). T

he s

prea

dshe

et c

an b

e us

ed a

t the

pro

vinc

e an

d di

stri

ct le

vels

as

show

n in

the

follo

win

g ta

bles

.

Figu

re A

1.2.

Pro

vinc

e re

sour

ce a

nd lo

gist

ics

mic

ropl

an o

rgan

ized

by

dist

rict

pop

ulat

ion

Figu

re A

1.3.

Dis

tric

t res

ourc

e an

d lo

gist

ics

mic

ropl

an o

rgan

ized

by

heal

th ce

ntre

pop

ulat

ion

1. N

ame

Pro

vinc

e/

Stat

e

2. T

otal

P

opul

atio

n fo

r ye

ar

3. O

PV

targ

et

popu

lati

on

13.5

% (0

TO

59

MO

NTH

S)

4. #

ch

ildre

n to

be

imm

uniz

ed

by o

ne te

am

per

day

5 #

of

team

da

ys

requ

ired

*

6. #

day

s sc

hecu

led

fo

r im

plem

en

tati

on

7. #

if te

ams

requ

ired

(2

OP

V va

ccin

atio

rs

per

team

)

8. #

of

vacc

inat

ors

need

ed (

2 pe

r te

am)

9. #

su

ppor

t st

aff (

2 pe

r te

am)

10. #

of

team

su

perv

isor

s (1

per

5

team

s)

11. T

otal

#

of s

taff

re

quir

ed

( sum

of

8+9+

10)

12. #

of

20 d

oes

OP

V vi

als

requ

ired

=

(tar

get

popu

lati

on

x w

asta

ge

fact

or

(1.2

0/20

)

13. D

aily

Tr

ansp

orta

tion

N

eed

(1ve

hicl

e pe

r su

perv

isor

m

oto,

or

car)

14. V

olum

e of

OP

V do

es

requ

ired

in

Lit

res

= (t

arge

t po

pula

tion

x

was

tage

fa

ctor

x

volu

me

of 1

doe

s O

PV)

/100

0

15. T

otal

re

frig

erat

or

spac

e re

quir

ed in

Li

tres

(+2

to

+8 C

)

16. E

st.

# o

f fr

idge

un

its

(20

L pe

r fr

idge

)

17. #

of 2

0 L

cold

box

re

quir

ed

(1 p

er

supe

rvis

or)

18. #

of

vacc

ine

requ

ired

(2

per

te

am)

19. #

of

ice

pack

s (2

x 4

ic

epac

ks

for

vacc

ine

carr

ier)

pl

us 2

0 pe

r co

ld

box

20. E

st.

# o

f fr

eeze

rs

(1 p

er

100

ice

pack

s)

21. #

of

imm

uniz

ati

on fi

xed

post

s (1

per

5

team

s)

22. #

C

opie

s of

re

cord

ing/

re

port

ing

form

s (t

eam

da

ys x

2)

23. #

set

s of

wri

ting

m

ater

ials

(e

xerc

ise

book

s an

d pe

ns)

24. #

fi

nger

m

arke

r pe

ns

(tea

m

days

x

2)

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1. N

ame

Pro

vinc

e/

Stat

e

2. T

otal

P

opul

atio

n fo

r ye

ar

3. O

PV

targ

et

popu

lati

on

13.5

% (0

TO

59

MO

NTH

S)

4. #

ch

ildre

n to

be

imm

uniz

ed

by o

ne

team

per

da

y

5 #

of

team

da

ys

requ

ired

6. #

day

s sc

hecu

led

fo

r im

plem

en

tati

on

7. #

if te

ams

requ

ired

(2

OP

V va

ccin

atio

rs

per

team

)

8. #

of

vacc

inat

ors

need

ed (

2 pe

r te

am)

9. #

su

ppor

t st

aff (

2 pe

r te

am)

10. #

of

team

su

perv

isor

s (1

per

5

team

s)

11. T

otal

#

of s

taff

re

quir

ed

( sum

of

8+9+

10)

12. #

of

20 d

oes

OP

V vi

als

requ

ired

=

(tar

get

popu

lati

on

x w

asta

ge

fact

or

(1.2

0/20

)

13. D

aily

Tr

ansp

orta

tion

N

eed

(1ve

hicl

e pe

r su

perv

isor

m

oto,

or

car)

14. V

olum

e of

OP

V do

es

requ

ired

in

Lit

res

= (t

arge

t po

pula

tion

x

was

tage

fa

ctor

x

volu

me

of 1

doe

s O

PV)

/100

0

15. T

otal

re

frig

erat

or

spac

e re

quir

ed in

Li

tres

(+2

to

+8 C

)

16. E

st.

# o

f fr

idge

un

its

(20

L pe

r fr

idge

)

17. #

of 2

0 L

cold

box

re

quir

ed

(1 p

er

supe

rvis

or)

18. #

of

vacc

ine

requ

ired

(2

per

te

am)

19. #

of

ice

pack

s (2

x 4

ic

epac

ks

for

vacc

ine

carr

ier)

pl

us 2

0 pe

r co

ld

box

20. E

st.

# o

f fr

eeze

rs

(1 p

er

100

ice

pack

s)

21. #

of

imm

uniz

ati

on fi

xed

post

s (1

per

5

team

s)

22. #

C

opie

s of

re

cord

ing/

re

port

ing

form

s (t

eam

da

ys x

2)

23. #

set

s of

wri

ting

m

ater

ials

(e

xerc

ise

book

s an

d pe

ns)

24. #

fi

nger

m

arke

r pe

ns

(tea

m

days

x

2)

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0 3

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016

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000

1,4

85

200

75

13

31

789

13

30.

11

344

01

1515

15C

12,

000

1,6

20

200

85

23

31

797

13

30.

11

346

01

1616

16D

17,

000

2,2

95

200

115

25

51

1013

81

44

0.2

15

571

123

2323

E 1

9,00

0 2

,565

20

013

53

55

111

154

15

50.

21

551

11

2626

26F

16,

000

2,1

60

200

115

24

41

1013

01

44

0.2

14

551

122

2222

G 1

4,00

0 1

,890

20

09

52

44

19

113

13

30.

21

450

11

1919

19H

11,

000

1,4

85

200

75

13

31

789

13

30.

11

344

01

1515

15I

14,

000

1,8

90

200

95

24

41

911

31

33

0.2

14

501

119

1919

J 1

0,00

0 1

,350

20

07

51

33

16

811

22

0.1

13

420

114

1414

TOTA

L 1

47,0

00

19,

845

20

4040

989

1,1

91

936

361.

89

4050

05

919

819

819

8


EXPLANATION OF THE FIELDS IN THE RESOURCE AND LOGISTICS MICROPLANThese examples show a resource and logistics plan with 24 fields. Each field must comply with standards initially set at the national level. The advantage of this spreadsheet is that it shows the total resources needed such that, when prepared in advance, it allows organizing total needs in a timely manner and ordering the required resources.

1. Name of the province/state for implementation2. Total population in the year of implementation3. Target population (0–59 months = 13.5% of the total population)4. Number of households to be visited for immunization by one team in one day (= 50 households).

The assumption of three children aged 0–59 months per household represents an average of 150 children per day. (This field can be standardized in various ways, for example 100 or 200 children per day.)

5. Number of team days required (the target population is divided by the number of children to be immunized in one day, in this case, 50 households x 3 = 150 children per day)

6. Number of days scheduled to implement the plan (in this example, five days)7. Number of teams required for implementation (the number of team days is divided by the number

of days scheduled)8. Number of vaccinators required (in this example, 2 vaccinators per team)9. Number of support staff required (in this example, 2 support staff per team to help manage the

team’s work)10. Number of team supervisors required (in this example, 1 supervisor per 5 teams)11. Total number of staff needed (total vaccinators + support staff + supervisors)12. Number of 20-dose vials of OPV required (target population x wastage multiplication factor for

vaccine divided by 20)13. Daily transportation required; total number of various vehicles needed for supervisor transport (1

per supervisor)14. Volume of OPV doses expressed in litres (target population x wastage factor x volume of 1 dose in

ml divided by 1000)15. Total refrigerator space at 2ะ8 °C required in litres (same as the volume of OPV doses)16. Estimated number of 100-litre refrigerator units required (refrigerator space divided by 100)17. Number of 20-litre cold boxes required (1 per supervisor)18. Number of vaccine carriers required (2 per team)19. Number of ice packs required (4 ice packs per vaccine carrier x 2 per team = 8 per team + 20 ice

packs for each supervisor cold box)20. Estimated number of freezers required to freeze ice packs each day (1 freezer per 100 ice packs)21. Number of immunization fixed posts required (1 fixed post per 5 teams) where a fixed post can

immunize and be used to replenish team supplies22. Number of copies of recording and reporting forms (2 sets of forms per team day)23. Number of sets of writing materials for teams (exercise books and pens for each team day)24. Number of finger-marking pens (2 finger-marking pens per team day)


NOTE

S ON

BES

T PR

ACTI

CE F

OR E

STIM

ATIN

G RE

SOUR

CES

Whe

n pl

anni

ng a

cam

paig

n, it

is b

est t

o es

timat

e th

e to

tal r

esou

rces

nee

ded

in a

tim

ely

man

ner.

Tim

e w

ill b

e ne

eded

to g

athe

r th

e re

sour

ces:

vac

cine

mus

t of

ten

be o

rder

ed fr

om o

vers

eas,

veh

icle

s di

stri

bute

d, p

erso

nnel

trai

ned

and

supe

rvis

ors

assi

gned

. The

ext

ent o

f all

thes

e re

sour

ces

need

s to

be

know

n w

ell

in a

dvan

ce a

t eve

ry le

vel.

Earl

y pl

anni

ng e

stim

ates

are

als

o es

sent

ial b

ecau

se a

sho

rtag

e of

res

ourc

es is

mor

e lik

ely

at th

e di

stri

ct le

vel.

Accu

rate

res

ourc

e es

timat

es a

re c

alcu

late

d fr

om p

opul

atio

n es

timat

es, b

ut th

e la

tter

may

var

y ac

cord

ing

to th

e in

form

atio

n so

urce

. Pla

nnin

g es

timat

es s

houl

d be

mad

e fr

om

the

bott

om-u

p, u

sing

the

sam

e fr

amew

ork

desp

ite v

aryi

ng p

opul

atio

n to

tals

. It i

s al

way

s be

tter

to s

light

ly o

vere

stim

ate

the

popu

latio

n to

ens

ure

suffi

cien

t va

ccin

es a

nd o

ther

res

ourc

es a

re a

vaila

ble.

Figu

res

A1.4

. Dis

tric

t and

hea

lth ce

ntre

est

imat

es o

f pop

ulat

ion

dist

ribu

tion

and

hum

an re

sour

ces

Dis

tric

t ___

____

____

____

___

Heal

th

cent

re

Tota

l po

pula

tion

Targ

et

popu

latio

n (#

)

Villa

ges

(#)

Fixe

d po

sts

High

-ris

k ar

eas

(#)

Bord

er

poin

ts

if ap

plic

able

(#

)

Tran

sit

poin

ts

#

Team

s (#

)Va

ccin

ator

s (#

)Vo

lunt

eers

(#

)Ve

hicl

es

(#)

Com

mun

ity

mob

ilize

r na

me

and

phon

e #

Supe

rvis

or

nam

e an

d ph

one

#

HC 1

HC 2

HC 3

HC 4

HC 5

Tota

l


Hea

lth

Cen

tre

____

____

____

____

_

Heal

th

cent

re

Tota

l po

pula

tion

Targ

et

popu

latio

n (#

)

Fixe

d po

sts

High

-ris

k vi

llage

Y/

N

Bord

er

villa

ge

Y/N

Tran

sit

poin

ts

#

Team

s #

Vacc

inat

ors

(#)

Volu

ntee

rs

(#)

Com

mun

ity

mob

ilize

r na

me

and

phon

e #

Supe

rvis

or n

ame

and

phon

e #

Villa

ge 1

Villa

ge 2

Villa

ge 3

Villa

ge 4

Villa

ge 5

Tota

l

NOTE

S ON

BES

T PR

ACTI

CEAt

the

dist

rict

and

hea

lth c

entr

e le

vels

, whe

n de

alin

g w

ith s

mal

ler

popu

latio

ns a

nd s

carc

er re

sour

ces,

big

spr

eads

heet

s ar

e a

star

ting

poin

t but

are

inad

equa

te

to d

eal w

ith th

e re

aliti

es in

the

field

. At t

his

leve

l, it

is b

ette

r to

cre

ate

sim

ple,

mor

e de

taile

d re

sour

ce p

lans

that

will

ena

ble

heal

th c

entr

es to

sha

re a

nd m

ove

reso

urce

s, a

nd id

entif

y th

ose

peop

le w

ho w

ill s

hare

sup

ervi

sory

dut

ies

and

will

be

avai

labl

e to

wor

k at

the

com

mun

ity le

vel.


ANNE

X 2

COLD

CHA

IN A

ND S

UPPL

IES

Figu

re A

2.1.

Col

d-ch

ain

equi

pmen

t ava

ilabi

lity

and

depl

oym

ent

Pro

vinc

e-le

vel c

old-

chai

n an

d lo

gist

ics

plan

org

aniz

ed b

y di

stri

ct (w

orki

ng e

xam

ple)

Dis

tric

t (N

ames

) Ta

rget

P

opul

atio

nTe

ams

(#)

OP

V VI

ALS

Vacc

ine

Car

rier

sC

old

Box

Ic

e pa

cks

Stor

age

capa

city

(Lt)

in

Ref

rige

rato

rN

umbe

r of

Fre

ezer

s R

equi

red

for

Ice

Pac

ks

Required

Available

Shortfall

Required

Available

Shortfall

Required

Required

Available

Shortfall

Required

Available

Shortfall

1 1

6 20

016

972

3225

73

21

324

2910

00

32

1

2 3

2 80

5 33

1968

6670

07

80

656

5910

00

75

2

3

4

5

6

7

8

9

10

TOTA

L


NOTE

S ON

BES

T PR

ACTI

CEEv

ery

prov

ince

sho

uld

estim

ate

its c

old-

chai

n eq

uipm

ent

situ

atio

n ea

rly

on. D

urin

g a

cam

paig

n, t

he d

eman

d fo

r re

frig

erat

ors,

col

d bo

xes

to c

arry

vac

cine

an

d fr

eeze

r sp

ace

is h

igh.

All

dist

rict

s sh

ould

man

age

thei

r co

ld-c

hain

res

ourc

es a

ccor

ding

ly a

nd w

ell i

n ad

vanc

e. T

his

exam

ple

show

s th

at a

dis

tric

t may

ha

ve a

sho

rtfa

ll in

col

d-ch

ain

equi

pmen

t but

can

rece

ive

assi

stan

ce th

roug

h th

e de

ploy

men

t of e

quip

men

t fro

m th

e pr

ovin

ce le

vel o

r a

neig

hbou

ring

dis

tric

t. If

dist

rict

cen

tres

are

not

far

from

eac

h ot

her,

poo

ling

free

zer

capa

city

for

ice

pack

s m

ay b

e po

ssib

le a

t a s

hare

d lo

catio

n.

Figu

re A

2.2.

Vac

cine

and

sup

ply

tran

spor

t pla

n (workingexample)

Nam

e of

di

stri

ct

Tota

l po

pula

tion

for y

ear

OPV

targ

et

popu

latio

n 13

.5%

(0–5

9 m

onth

s)

# of

20

-dos

e OP

V vi

als

requ

ired

= (ta

rget

po

pula

tion

x w

asta

ge

fact

or

(1.2

)/20

)

# of

20

L co

ld b

oxes

re

quire

d (1

per

su

perv

isor

)

Vacc

ine

tran

spor

t ve

hicl

e

Date

of

dist

ribu

tion

to d

istr

ict

Nam

e of

pr

ovin

ce

pers

on

resp

onsi

ble

for t

rans

port

an

d ph

one

num

ber

Nam

e of

di

stri

ct p

erso

n re

spon

sibl

e fo

r tr

ansp

ort a

nd

phon

e nu

mbe

r

Refr

iger

ator

/fr

eeze

r/co

ld b

ox/

vacc

ine

carr

ier

shor

tfall

need

ing

tran

spor

t or

relo

catio

n

Loca

tion

of ic

e pa

ck fr

eeze

r (in

th

is d

istr

ict o

r a

shar

ed lo

catio

n)

112

0 00

0 16

200

97

2 3

Pro

vinc

e tr

uck

22 J

an

1 co

ld b

ox fr

om

prov

ince

to

dist

rict

1

Loca

ted

in d

istr

ict

1

214

0 00

0 18

900

1

134

4

313

0 00

0 17

550

1

053

4

415

6 00

0 21

060

1

264

4

524

3 00

0 32

805

1

968

7

613

6 00

0 18

360

1

102

4

711

4 00

0 15

390

92

3 3

810

0 00

0 13

500

81

0 3

916

0 00

0 21

600

1

296

4

1013

5 00

0 18

225

1

094

4

Tota

l1

434

000

193

590

11 6

15

40

NOTE

S ON

BES

T PR

ACTI

CEVa

ccin

e sh

ould

be

dist

ribu

ted

from

the

prov

ince

to th

e di

stri

ct n

o la

ter

than

one

mon

th fr

om th

e st

art o

f the

cam

paig

n. E

quip

men

t can

als

o be

tran

spor

ted

in a

dvan

ce in

cas

e of

a s

hort

fall.

The

pro

vinc

e an

d di

stri

ct s

houl

d re

gula

rly

upda

te th

eir

lists

of e

quip

men

t acc

ordi

ng to

loca

l tra

nspo

rt in

form

atio

n an

d th

e co

ld-c

hain

equ

ipm

ent p

lan.


ANNEX 3 CHECKLISTS

Figure A3.1. Team logistics checklist

Supervisory role for team logistics• Everyteammustbecheckedeachdayatthehealthcentretomakesuretheyarepreparedandall

logisticsareinplacetoproceedontheirassigneditineraryfortheday.

• Supervisors at the health centre can use this checklist at the beginning of the day to ensure all supplies and personnel are available.

DATE TEAM LOGISTICS CHECKLIST

District or HC Province

Staff & Supplies & Transport needs VACCINATION TEAMA

Team #:1 Team #:2 Team #:3 Team #:4 Team #:5

Assignment area

Vaccinator names

Volunteer names

Supervisor Names

Target Pop estimated (#)

OPV needs (does)

Finger markers (#)

House Mark Chalk (#)

Vaccine carrier (#)

Cold box (#)

Ice packs (#)

Tallysheet (#)

Summary sheet (daily)

Supervisory check list #

Vehicle

Motorbike

Other (specify): ………..(#)

Fuel (Lt)


Figure A3.2. Supervisory checklist for pre-implementation

At the health centre: check each item for campaign readiness Comments

Microplan

All villages are included in the district plan

All items are included according to the template, with correct calculations

Any supply shortfall has been identified, with the action needed

Maps show catchment areas and location of posts/teams/supervisors per day

Budget has been accurately calculated

High-risk areas/RCMs

High-risk areas have been identified

Rapid campaign monitoring plan is available with supervisors/monitors/sites/dates

Supervisors understand RCM methods

Cold-chain logistics supply

Adequate vaccine storage space for OPV is available in regional and provincial stores

Adequate vaccine carriers/ice packs/freezer capacity is available at each level

Logistics/supply transport plan is available to supply all areas

Standard operating procedures (SOPs) are in place for replenishment in health centres if stocks run low

Advocacy

Local politicians have been informed and are ready to participate/contribute

Local NGO meetings are held to enlist their support for monitoring and for the transport of supervisors/teams

Social mobilization

Each region/province has a local media plan to promote/advertise SIA

Any other local social mobilization materials are available

A plan for community volunteer training is available

A plan for involving community officials and volunteers is available

A plan for identifying community engagement focal points is available

Immunization safety

All supervisors know how to report adverse events following immunization (AEFI)

AEFI Investigation forms and SOPs are available to supervisors

Team management

A plan for team training is available with simple training materials/tally sheets

A team strategy, with fixed post in the morning and mobile post in the afternoon, is in place

Teams are available for mop-up if RCM fails

A team/post distribution plan is available

Supervisor management

The plan shows available supervisors or a shortfall

A plan for training supervisors, including RCM training, is available


At the health centre: check each item for campaign readiness Comments

A supervisor mobility/transport plan is available to follow an assigned area

Supervisors have checklists

External supervisors have a system for calling teams to do mop-ups when RCM fails

Reporting system

A system for the daily collection and consolidation of tally sheets into reports is available

A computerized database for the consolidation of reports and their dispatch by email to provincial/regional/national offices is accessible

Monitoring system

Region/provinces have a system for the daily monitoring of results

The health centre has a system to react daily to a failed RCM by ordering an immediate mop-up

A system exists at the national level to receive and react to regional reports on at least a weekly basis

Figure A3.3. Simple supervisory intra-campaign checklist

Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action

Cold-chain/vaccine supplies

Marker pens/tally sheets

Post organization, staffing, working hours

Recording on tally sheets/missed children

Team movement plan and map

Team operating hours

Finger-marking quality

House-marking quality

High-risk communities

Presence of community leaders and volunteers

Availability of community engagement persons if needed


Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action

Revisiting houses with missed children

End of day or next day

Vaccinating children out of the household, in streets and markets

BEST PRACTICE IN SUPERVISION DURING CAMPAIGNSThemaindutyofthesupervisorduringacampaignistotakecorrectiveactionduringteamoperations.Thisveryshortchecklistisusedasareminderofwhattolookfor;itisnotamonitoringformthatrequiresanalysis.Supervisorsshouldplantovisiteachteamat least twiceduringtheday.Theyshouldobserveteamoperationsandtakecorrectiveaction,whichtheyrecordonthesimplechecklist.


Figu

re A

3.4.

Intr

a-ca

mpa

ign

mon

itori

ng ch

eckl

ist

Intr

a-ca

mpa

ign

mon

itori

ng ch

eckl

ist q

uest

ion

Yes/

NoCo

mm

ents

Team

1Te

am 2

Team

3Te

am 4

Team

5C

omm

unit

y en

gage

men

t

Is th

e po

st c

lear

ly id

entifi

ed b

y ba

nner

s an

d po

ster

s?

Are

heal

th w

orke

rs/v

olun

teer

s ac

tivel

y se

arch

ing

for

ever

y el

igib

le c

hild

, at h

ouse

or

out o

f hou

se?

Col

d ch

ain/

supp

lies

Are

vacc

ines

sto

red

in v

acci

ne c

arri

ers

with

two

ice

pack

s?

Are

suffi

cien

t via

ls o

f OP

V in

side

the

vacc

ine

carr

ier?

Are

ther

e an

y st

ock-

outs

of O

PV?

Are

suffi

cien

t mar

ker

pens

ava

ilabl

e?

Are

suffi

cien

t tal

ly s

heet

s/re

cord

ing

form

s av

aila

ble?

Org

aniz

atio

n of

the

post

Is th

e po

st w

ell o

rgan

ized

, with

goo

d cl

ient

flow

?

Are

suffi

cien

t vac

cina

tors

and

vol

unte

ers

avai

labl

e? D

oes

the

post

hav

e en

ough

peo

ple?

Rec

ordi

ng a

nd r

epor

ting

pra

ctic

es

Are

tally

she

ets

bein

g us

ed c

orre

ctly

?

Is e

very

chi

ld b

eing

fing

er-m

arke

d?

Are

mis

sed

child

ren

liste

d on

the

back

of t

he ta

lly s

heet

for

a ho

use

revi

sit?

Hou

se-t

o-ho

use

oper

atio

n

Doe

s th

e te

am h

ave

a pl

an a

nd m

ap?

Is th

e te

am g

oing

hou

se to

hou

se a

ccor

ding

to p

lan?

Are

hous

es b

eing

mar

ked

corr

ectly

?

Are

team

s as

king

for

all m

othe

rs a

nd a

ll ch

ildre

n?

Are

team

s w

orki

ng m

orni

ng a

nd a

fter

noon

acc

ordi

ng to

pla

n?

Hig

h-ri

sk c

omm

unit

ies

Are

team

s vi

sitin

g hi

gh-r

isk

com

mun

ities

?

Are

com

mun

ity le

ader

s an

d vo

lunt

eers

invo

lved

in h

ouse

-to-

hous

e op

erat

ions

?

Are

loca

l lea

ders

eng

agin

g th

e co

mm

unity

app

ropr

iate

ly?

Hou

se r

evis

itin

g

Are

team

s re

visi

ting

hous

es a

t the

end

of t

he d

ay w

here

chi

ldre

n w

ere

prev

ious

ly a

bsen

t?


ANNE

X 4

TALL

Y SH

EET

Figu

re A

4.1.

Dai

ly ta

lly s

heet

of v

acci

nate

d ch

ildre

n fo

r tea

ms

Regi

on___________P

rovi

nce/

City___________D

istr

ict_

__________V

illag

e/Lo

catio

n___________

Date___________T

eam

Num

ber:____

Num

ber o

f hou

seho

lds

to b

e vi

site

d fo

r OPV

_____

Tota

l vac

cina

ted___________

Star

t hou

se n

umbe

r ____

End

hous

e nu

mbe

r ____

Inst

ruct

ions

: Put

a c

heck

mar

k (√

) in

each

box

app

ropr

iate

for t

he c

hild

’s ag

e.

Sign

atur

e of

sup

ervi

sor

and

tim

e of

vis

it

NU

MB

ER O

F C

HIL

DR

EN IM

MU

NIZ

ED W

ITH

OP

V

0–11

mon

ths

12–5

9 m

onth

s

Tota

l num

ber __________

Tota

l num

ber __________

Gra

nd to

tal __________

OP

V vi

als

rece

ived

……

…. O

PV

vial

s us

ed …

……

… A

FP c

ases

foun

d……

…..

A L

IST

OF

HO

USE

S TO

BE

REV

ISIT

ED IS

ON

TH

E B

AC

K O

F TH

IS F

OR

M

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