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Monitoring

Monitoring vaccination program activities allows us to assess effectiveness and impact. Watch Eric Mafuta explain more. (Step 2.5)
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ERIC MAFUTA: So the last concept we will try to explore today is about the monitoring. Here we have a team of monitor. The monitoring is an activity that consists of learning about experience, a process of collecting data, analyzing it, and use this information to assess effectiveness, relevance, and impact of program– is a structured way of improving program implementation and decision-making. The monitoring can be used in the fifth phase of the immunization activities, as we see. During the pre-campaign, we can assess the preparedness. During the campaign, we have to assess the ongoing operation and activity– for example, unvaccinated children [? non-remote ?] area. And this can be used to correct– to take corrective measure.
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At the post-phase, we can also do this monitoring to assess unvaccinated children and the [? not-met ?] area. So we can use it for setting mop-up campaign and other activity. Sometimes during a polio program, we are using independent monitoring. In addition to the routine monitoring, we can have these independently monitored by other people. What is important is that they provide their insights in activity what are done and the independent monitoring is done by people who are not in the same supervisory structure as those who implement the campaign. So this is used to contribute to an unbiased perspective for the quality of the immunization activity.
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We would like you to figure out, what are the benefits of monitoring by those inside the government or outside the government? And I invite you to discuss about what you think be the advantage and the disadvantage of these two type of monitoring. We can come back now to talk about the independent monitoring. As we see, for the monitoring, the normal monitoring, the independent monitoring can be used in the different phase of the campaign. Here we provide you some example in process monitoring and post monitoring. So they can also assess the operation about vaccination team, their training, how the vaccine are conserved, the house marking, how the daily meeting are carried out, and to check about, also, immunization.
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So they can see what finger is marked, is all house have a number, such information. And at the end of– after the immunization activity, they can assess the coverage– for example, to check if each children in this area have his finger marked and the reason for no vaccination, for example. And this information can be used for mop-up campaign and future immunization activities. Here we have some results for the monitoring. For example, they can provide information about how many children missed during the immunization or how many children was missed– how tough house during the immunization activity.
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We can have, also, the reason for the no vaccination, and they can check the awareness of parents prior to the team visit and so on. Here we have also another slide, which show information about the missed children during immunization activity in the DRC. And the different map is for different supplementary immunization activity in 2012. For example, here you can see the middle one in October 2012. We have a lot of color. So you can see, it’s green mostly. So if it’s green, it show that you have less than 5% of children we’ve missed during the immunization. For example, for me, I know the DRC in the equator in the north, it’s almost green.
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But you can see, for example, in the south– so this red place, it show that we have more than 15% of childs were missed during the immunization activity. And this represents most of the time where you can have the following outbreak of polio viruses. So this type of information provided by the monitoring can help us to plan other activity as we see mop-up campaign. And what we have also to note is that this monitoring activity is carried out for in-house children. So they are pass house to house to check how many children you have and how many are immunized– vaccinate.
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And in the second activity, they have also to go in the open, the community place where you can find children who are playing together, and they can also check. So the bottom graphs show the information about community place where children are out of their house playing, and they have to check, also, how many of them are immunized. Sometime currently they are using a new methodology. This methodology is called the cluster-lot quality assessment assurance sampling. So if just draw on manufacturer strategy, you have a lot. A lot is a group of products which are produced in the same time.
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So when they try to select this group of product, you can just check if one of this group is in good quality. So you conclude that others is also in the good quality. So we use this strategy to try to sample in the community. We have a big community or a big satellite area. You choose only some lots, some community, and in this community chosen at random, you can choose house. And in this house, you have to check how many children are vaccinated and how many are not vaccinated.
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So we are using this strategy to try to have very large samples of children in several communities to be sure that the immunization campaign or activity has a good quality during its conduction. The lot quality assurance sampling sometimes take place during the post campaign. So they are using this after the campaign, I think, in the two weeks so you can have all the children with their marked fingers and parent have their information in mind so you can have the real and the good information. Here we have, also, for the Democratic Republic of the Congo some results from the lot quality assurance sampling. And we use information on mapping, and we use color codes.
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So when you have less than three unvaccinated children in the lots, the small community, you can put it in green. When it’s between four and eight, you have the yellow. And when you have more than nine in the lot– so around 10 house– you say that it’s a failed activity. So for example, we took about the same region in the southeast of the DRC. As you can see, there is a lot of red community. And all this red community, for the monitor and for the health program, say that it’s a failed campaign, that we have to plan mop-up campaign and to be sure that we will have an outbreak in the future.
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And in July, for example, when they are carrying out the monitoring, there was only very small part in the middle of the Katanga region. In the southwest, we have a yellow and we have a red. And in November, we have all– it was spread. But the red remained almost in the same area. So this provide information for decision-maker and health professionals to plan other activity or to correct– to try to know why there is this problem. Now I would like you just to try to figure it out or to answer this question. After following this session, what are key output about monitoring and evaluation?
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So for the possible answer can be the number of missed children– the characteristic of these children, their age, their location, the main reason for this no vaccination. We can also have the number or the percentage of zone that are poorly covered, the parents who are not aware about the activities, and, in addition, we can also have a lot of information about the social aspect of the polio program. So we will end our session here. And we would like you also to try to figure out why so many way to monitor health program and to deal with what are the advantage and the disadvantage of having so many monitoring system. Thank you.

Eric Mafuta, MD, MPH, PhD School of Public Health, University of Kinshasa, Democratic Republic of the Congo (DRC)

Monitoring program activities allows us to assess effectiveness and impact. Importantly, implementation of activities is an iterative process, where monitoring allows for adapting strategies based on assessed outcomes.

Once you have watched the lecture:

Choose one type of monitoring explained, and list two advantages and two disadvantages for it in the discussion forum. Additionally, read others’ posts that list advantages and disadvantages of the other type of monitoring, and respond by adding at least one more advantage and disadvantage.

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