WHO IVB 04.05 (Booklet1)

WHO/IVB/04.
05
World Health Organization

WHO
Immunization,
Vaccines and Biologicals
The Common Assessment Tool

for Immunization Services
Booklet 1 Assessment
Methodology
The Department of Immunization, Vaccines and Biologicals
thanks the donors whose unspecified financial support has made
the production of this document possible.
This document was jointly produced by the

Expanded Programme on Immunization
of the Department of Immunization, Vaccines and Biologicals
This document is available on the Internet at:

www.who.int/vaccines-documents/
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World Health Organization
Department of Immunization, Vaccines and Biologicals
CH-1211 Geneva 27, Switzerland
Fax: +41 22 791 4227 Email: vaccines@who.int
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Contents
About this booklet 5
Forms in this booklet 6
1 The Common Assessment Tool (CAT) for Immunization Services 7

What is the CAT? 7
What is the CAT for? 7
Using the methodology for planning 7
Who is the CAT for? 7
Why do we need the new CAT? 8
2 The assessment approach 11

Principles of the methodology 11
Comparing the new methodology with earlier approaches 12
Why take a health system approach? 14
The three elements of the assessment 17
3 The assessment process 19

Overview of the process 19
Step 1 Initiating the assessment 22
Step 2 Preparing for the assessment 30
Step 3 Planning data collection 33
Step 4 Collecting data 38
Step 5 Analysing findings and developing recommendations 43
Step 6 Debriefing 48
Step 7 Planning for implementation and monitoring 49
Annex 1 Key indicators 51
Annex 2 Conducting a SWOT analysis 59

Carrying out the analysis 59
What to look for under each component of the SWOT analysis 60
Annex 3 Data Collection Guides for analysing data and developing recommendations 63
Annex 4 Incorporating the assessment recommendations into the national plan 67
Annex 4a Identifying activities needed to achieve targets and objectives 71
Annex 4b Estimating costs and funding sources 75
Annex 4c Summarizing projected costs of the immunization programme

over the five year period 79
Common Assessment Tool for Immunization Services

Booklet 1 – Assessment Methodology 3
Annex 5 Assessing capacity building 83
Definition of capacity building (CB) 83
Capacity building must maintain and develop existing abilities 84
Capacity building indicators 84
Annex 6 Financial Sustainability Diagnostic Tool (FSDT) 87

Introduction to the FSDT 87
Objectives of the FSDT 87
Methodology of the FSDT 88
Acronyms 89
Annex 7 New Vaccine Discussion Guide 103
Annex 8 Glossary and abbreviations 105

4 Booklet 1 – Assessment Methodology
About this booklet
This booklet gives you the information you need to carry out an assessment
of immunization services.
It includes:
• details of why it’s important to take account of health system functions

when carrying out an assessment
• detailed instructions for carrying out an assessment using the Common

Assessment Tool (CAT)
• detailed instructions for analysing the data you collect
• detailed instructions for making recommendations on how immunization

services can be improved given the opportunities and constraints in the
health system as a whole.

Forms in this booklet
The following photocopiable forms can be found in this booklet on the pages shown.
MS Word versions of the forms are also on the CD enclosed in the folder.
The MS Word versions can be modified and adapted for the country being visited.
Form title Form reference Page
Summary of SWOT analysis Form 1.1 61
Data Collection Guide

Immunization services Form 1.2 64
Data Collection Guide

Health system Form 1.3 65
Summary table
Immunization services activities Form 1.4 72
Summary table
Health system activities Form 1.5 73
Estimated costs and funding sources

Estimated costs and funding sources

Summary of projected costs (five year period)

Summary of projected costs (five year period)

Financial Sustainability Diagnostic Tool

(FSDT) Form FSDT 90 – 102

Chapter
1
The Common Assessment Tool (CAT)
for Immunization Services
What is the CAT?

The CAT describes the methodology for assessing immunization services in the wider context of the
health system.
What is the CAT for?

Using the CAT should increase your knowledge of the current and potential capacity of the health system
and the individual, programme, and system competencies that are necessary to improve performance.
Assessments carried out using the CAT can also provide the information needed to develop or update
national plans and prepare proposals for securing the support of development partners.
Development partners are public and private, national and

multinational organizations that offer technical, management, and
financial support to developing countries.
Using the methodology for planning

You can use the methodology in this booklet when you are planning an immunization programme to:
• increase the accessibility and use of routine immunization services, especially for people who are
not currently reached
• improve the quality of immunization services
• introduce new vaccines and new technologies
• support increased financing for immunization services
• support health system development.
Who is the CAT for?

The guidelines are primarily for national level staff members who are responsible for planning,
implementing, and evaluating immunization services. However, development partners collaborating with
national governments can also use them.
You can also adapt them for local health workers and sub-national staff to use to assess day-to-day
operations and resource management in their areas of responsibility.

Why do we need the new CAT?
National and international experts have been carrying out assessments of immunization services for many
years and these assessments have usually provided valuable information that useful recommendations
could be derived from. However, changes in the healthcare environment mean that we now need a new
approach to assessments.
The table below shows the main reasons why these new guidelines are needed.
The new guidelines ...
... take Health sector structure, the location of authority and responsibility, and the
full account mix of public and private participation are changing significantly in many
countries. The methodology proposed in these guidelines examines the health
of health
system and the external environment in which immunization services operate,
systems as well as the services themselves.
... acknowledge Health systems exist in a wider external environment which is subject
changes in the to many different types of change including epidemiological change,
change in the macro-economic situation and policies, and change in
external
the role of the public sector.
environment
These changes often cause changes in many aspects of health
and their effects systems, including the structure of the health system, the location
on the health of authority and responsibility, and the mix of public and private
system participation in the health system.
a Changes to healthcare mean changes to the way we

approach assessments.
... assess whether existing services It is important to assess existing services to see
are ready for the introduction of if they are ready to introduce and sustain new
vaccines and technologies.
new vaccines and technologies
... meet more If we are to eradicate polio and other vaccine-preventable

challenging disease diseases, new strategies, or improvements to current strategies,
will be needed. So we need to assess the capacity of the health
control goals
system to help determine if new disease control strategies can
be implemented.

... provide Health sector officials, managers of services, development partners,
a common and non-governmental organizations (NGOs) have asked for a common
assessment tool to identify where improvements are needed. They want
assessment
agreement on the improvements needed so that they can plan individual and
tool joint inputs to immunization services.
... make sure new The assessment needs to consider activities which benefit the whole
investments are health system because investments in outcome-orientated
programmes usually have consequences for the whole system.
sustainable and
Your solutions and recommendations should be sustainable, and not
benefit the whole
those which benefit immunization services in the short term while
system having a negative impact on other services.
a Solutions and recommendations should benefit the whole

health system, not just immunizations services
... introduce a In the past, many assessments of immunization services focused on

gathering quantitative data, with people going into the field with set
new approach questions to answer, tables to fill in and boxes to tick. When they met
to fieldwork workers at the sub-national and service delivery levels, they questioned
them to collect the data they needed to
fill in the gaps.
However, it is more productive to look for the ‘issues behind the facts’ –
to identify causes and trace them back to their source. This means you
may have to talk with people and probe for answers and information.
Instead of questionnaires to fill in, we have provided Data Collection

Guides to remind you of the key information you need to collect.
You can adapt these and add any other information you need to get to
the bottom of a particular issue.

Chapter
2
The assessment approach
Principles of the methodology

The assessment methodology described in this booklet is based on the five principles below.
1 Focus on performance
Performance is the measure of quality, efficiency, and the impact of immunization services.
Questions to ask when you are assessing performance

• Is the target population being immunized?
• Are children returning for second and third doses?
• Are health workers using safe practices?
If the answer to any of these questions is ‘no’, what is impeding performance?
2 Focus on the service delivery level and trace problems you find there back to their origin
Initially, you will investigate performance problems at the service delivery level and track those that do
not have local causes through the system until you find their origin.
3 Involve people who know what the problems are, and who will take part
in implementing solutions
Change can only take place if the people who know what the problems are, and who will make the
recommendations, are engaged in identifying and solving the problems.
4 Apply a health system perspective to immunization services
Immunization services don’t operate on their own –

changes to the health system will affect immunization services.
The health system and the external environment strongly influence who is immunized and how
immunizations are provided, so the assessment methodology examines both the health system and its
environment. Immunization is just one of the services the health system provides, so you should not
consider it as operating on its own. The strengths and weaknesses of immunization services will have
implications for the health system, and changes to one will affect the other.

The
The external health Immunization
environment system Services
Stewardship Immunization service delivery

Human resource development Disease surveillance
Finance Logistics
Service delivery Vaccine supply and training
Advocacy and communications
5 Use in-depth inquiries and analysis to identify strengths, weaknesses,

opportunities, and threats
Use the Discussion Guides in the other booklets as a guide to making inquiries and probing for
information about internal strengths and weaknesses, and external opportunities and threats.
The information people give you should help you find real problems, real causes of the problems,
and practical solutions.
Find real problems, real causes of the problems, and real solutions to the problems.
Comparing the new methodology with earlier approaches
From a quantitative approach to a qualitative approach

In the past, the focus of assessments of immunization services was on gathering quantitative data with
teams using set questions and lists to gather information. However, we now recognise that we need a
more qualitative approach which aims to find more than just facts and figures.
New tools for gathering information

Instead of questionnaires, we have prepared Data Collection Guides for gathering information. These give
people at the sub-national and service delivery levels more opportunity to talk about what they consider
the key issues to be, and what their possible solutions are.
Adapt the Data Collection Guides for each site you assess
• You may have to adapt the Data Collection Guides for each site so that
you can talk to different people at each level about the same problem.

Multi-level problem analysis
The flowchart below gives an example of how a problem identified at service delivery level can be traced
back to its causes at other levels in the health system.
• Facility does not meet national • Immunizations cancelled

coverage targets due to staff shortages
• Staff leaving because they are • Not enough trained

not promoted within the system staff in place
• No training programmes • Teams are not promoted

in place according to scale
• No effort to attain national • No master training plan

standards for staffing levels in place
A circular process
• The new process is circular and so needs to be repeated every three to five years so that
the implementation of recommendations and changes can be monitored and assessed.

A health system approach
The World Health Organization defines a health system as the activities and organizations whose primary
purpose is to promote, restore, and maintain health.
Health systems have four main functions:
• Stewardship
• Human resource development
• Finance
• Service provision.
Functions of a health system in relation to immunization services
Stewardship
Human resource
Service delivery
development
Finance
Why take a health system approach?
Immunization services are part of the health system –

they don’t operate on their own.
There are three main reasons why you need to take a health system approach when you are assessing
immunization services.
1 Immunization services are part of the health system

Immunization services are becoming increasingly integrated with other health services operating in the
health system, so they cannot be viewed as operating on their own.
This means that the strengths and weaknesses of different parts of the health system affect the
performance of the immunization programme. Changes to immunization services can affect other
services and other aspects of the health system both negatively and positively.
Improvements to immunization services will also be affected by health system functions, so if

improvements are to be successful, you need to take these into account.
2 Funding can be focused on health system development

As well as accessing new funds for improving immunization services, there will be opportunities to
improve the health system as a whole, and to create synergies between its parts.

3 Sustainability depends on the health system
One of the main outcomes of an assessment is a set of recommendations for change.
Any change aimed at strengthening immunization services must be sustainable, whether it is based on
routine activities or on the introduction of new vaccines. A health system approach makes it easier to
assess how sustainable a recommendation for change is.
What makes a change sustainable?

For a long-term change to be sustainable, it must be able to:
• secure necessary inputs effectively
• secure necessary support effectively
• provide a continuing stream of activities and outputs that are valued
by its stakeholders as long as they are needed.
What makes a health system sustainable?

A health service is sustainable when it is operated by a system with the long-term ability to
mobilize and allocate sufficient resources (including manpower, technology, information,
and finance) for activities that meet individual or public health needs and demands.
Defining the levels in the health system

The health system in each country operates on three main levels:
National level Responsible for policy-making and standard-setting. This is usually the
top level of government in a country. However, in some large countries
policy-making and other ‘central’ functions can be at state level.
Sub-national level Responsible for providing management support to the service delivery
level in accordance with policies and guidelines issued by the national
level.
Many countries have two sub-national levels:
• regions, states, or provinces
• districts.
Service delivery level Responsible for providing health services including:

• health facilities
• health centres
• health posts, dispensaries
• hospitals
• private practitioners.

How the three levels in the health system operate
National level
• Sets policies and standards for health systems
Sub-national level
• Manages the implementation of policies and standards

for health services
Service delivery level
• Provides health services

The three elements of the assessment
• Immunization services • Health system • External environment
This assessment methodology is based on collecting and analysing data about immunization services, the
health system, and the external environment.
You will need to collect data for each of these at the national, sub-national, and service delivery levels.
Before you can make any recommendations, you will need to analyse the data separately by level and
then link the data for each level in a final analysis of service components and system functions.
1 Immunization services
Immunization service delivery The strategies and activities involved in immunization delivery.
Disease surveillance Monitoring disease incidence, laboratory testing, record keeping, and
reporting.
Logistics Transport, cold chain, waste disposal, and delivery of vaccines and
other equipment to the place where they will be used.
Vaccine supply and quality Forecasting vaccine needs, procuring vaccines, vaccine utilization
monitoring and safety.
Advocacy and communications Social mobilization, advocacy, immunization education and promotion.
2 Health system
Stewardship Management of the public’s health, and of the individuals and

organizations that provide health services. Stewardship includes:
• policy-making and standard-setting
• planning
• information management
• coordination among public and private health providers
• cooperation with development partners and sectors and with
stakeholders outside the health system
• monitoring
• advocacy
• evaluation
• regulation and legislation
• quality assurance
• infrastructure development and logistics
• programme design and evaluation.
Human resource development Human resource development includes:

• employing and assigning staff
• training
• supervision of staff.
Finance Finance includes:

• budgeting
• identifying funding sources
• collecting and allocating revenues
• tracking expenditures.
Service provision Service provision includes:

• delivery of preventative and curative health services.

3 External environment
Trends Trends include:

• geographic
• political
• economic
• social and technological, for example, macro-economic reforms
• increased pressure for economic self-sufficiency
• decentralization.
Expectations and needs Stakeholders include:

of stakeholders • the public
• politicians
• the education sector and other sectors
• development partners
• competitors and collaborators, for example, private practitioners or
the education sector.

Chapter
3
The assessment process
Overview of the process

There are seven steps in the assessment process. These are illustrated on the chart on the next page and
are described in detail in the rest of this chapter.
Step
1 Initiating the assessment
Step
2 Preparing for the assessment
Step
3 Planning data collection
Step
4 Collecting data
Step
5 Analysing findings
and developing recommendations
Step
6 Debriefing
Step
7 Planning for implementation
and monitoring

1 2 3
Overview
of the Step Step Step
assessment
process Initiating Preparing for Planning data
the assessment the assessment collection
Who Ministry of Health Planning Team All Assessment Team

members
Time 4 to 6 calendar months 1 to 2 person months 2 to 3 calendar days

before the assessment begins
Tasks Task 1.1 Task 2.1 Task 3.1

Decide that an assessment Collect, compile, and review Explain assessment objectives
is needed available information on
immunization operations, Task 3.2
Task 1.2 the health system, and the Brief the team on critical issues
Appoint an Assessment external environment for country immunization
Secretariat operations and health system
Task 2.2
Task 1.3 Identify critical issues for Task 3.3
Prepare Terms of Reference immunization and the health Provide an overview of the
system by conducting a assessment methodology
Task 1.4 SWOT analysis
Identify members of the Task 3.4
Assessment Team Task 2.3 Reach a consensus on which
Compile key materials for critical issues to pursue
Assessment Team members
Task 1.5
Identify members of the Task 3.5
Planning Team Task 2.4 Adapt data collection materials
Prepare to brief the entire
Assessment Team Task 3.6
Task 1.6
Prepare an assessment Reach a consensus on sub-
schedule
Task 2.5 national areas for assessment
If appropriate, select
sub-national areas for visits Task 3.7
Task 1.7
Plan support for the Review the data collection
assessment process
Task 3.8
Task 1.8
Prepare sub-teams for data
Identify funding sources and
collection
mechanisms for all
assessment activities
Task 3.9
Review special issues
Outcomes Comprehensive Terms of Critical issues for Objectives and methodology

Reference outlining the immunization and the understood
reasons for the assessment health system identified
Information from Planning
Team members Gaps in information Team reviewed
identified uncovered

Step
4
Collecting data
Step
5
Analysing findings
Step
6
Debriefing
Step
7
Planning for
and developing implementation
recommendations and monitoring
National, Sub-National All Assessment Team All Assessment Team All Assessment Team
and Service Delivery members with technical members members with technical
Sub-Teams staff from key stakeholders staff from key stakeholders
5 calendar days 3 calendar days 1 to 2 calendar days 1 to 2 calendar days to

develop first draft
Task 4.1 Task 5.1 Task 6.1 Task 7.1

Visit the national, sub-national Analyse information by Debriefing Incorporate
and service delivery level sub-national area recommendations into a
facilities Task 6.2 draft multi-year national
Task 5.2 Complete the final draft of the plan
Task 4.2 Analyse information by Assessment Report
Collect data from the national, technical area Task 7.2
service delivery and Prepare a draft budget
sub-national level facilities Task 5.3 and financing plan
Prepare the main conclusions
Task 4.3 of the assessment Task 7.3
Debrief staff from the national, Plan how
service delivery and Task 5.4 implementation
sub-national level facilities Develop main will be monitored
recommendations of the
assessment
Task 5.5
Compile information and
prepare the first draft of the
Assessment Report
Task 5.6
Prepare for debriefing
Data collected from all levels Findings reviewed Debriefing report delivered Implementation of the
recommendations planned
Staff at each level debriefed Recommendations agreed
on findings and preliminary
conclusions Priorities for actions set
Debriefing report prepared

Step
1 Initiating the assessment
What happens during Step 1?

The Ministry of Health (MOH) decides that an assessment is needed and liaises with the Interagency
Coordinating Committee (ICC) to decide the dates for the assessment and who should take part in it.
They outline their expectations in a Terms of Reference document.
Tasks for Step 1
Task 1.1 Decide that an assessment is needed
Task 1.2 Appoint an Assessment Secretariat
Task 1.3 Prepare Terms of Reference
Task 1.4 Identify members of the Assessment Team
Task 1.5 Identify members of the Planning Team
Task 1.6 Prepare an assessment schedule
Task 1.7 Plan support for the assessment
Task 1.8 Identify funding sources and mechanisms for all assessment activities
Task 1.1 Decide that an assessment is needed
The Ministry of Health and the national ICC decide if an assessment is needed and when it is needed.
This decision should be made four to six months before the assessment to make sure there is enough time
to prepare for the assessment and to translate the assessment booklets if necessary. The MOH may ask for
the help of a technical partner such as WHO or UNICEF in the preparation phase and in other phases.
Task 1.2 Appoint an Assessment Secretariat
The MOH may decide to appoint an Assessment Secretariat to arrange the logistics for the assessment.
A secretariat is a team of two or three people, often including staff from the immunization programme,
WHO or UNICEF, and other key partners. The secretariat supports the Planning Team’s activities before the
Assessment Team arrives, and provides support during the preparation, data collection, analysis, and
recommendation steps.
Task 1.3 Prepare Terms of Reference
The reasons for conducting an assessment will be different for each country but they should be explicitly
stated in a Terms of Reference document.
This document should tell stakeholders, such as MOH officials and development partners, what the
purpose of the assessment is and how it will be conducted. The Terms of Reference should not be more
than three pages long.

Task 1.4 Identify members of the Assessment Team
Who should be on an Assessment Team?

Most Assessment Team members will need knowledge and experience of immunization programmes.
Team members can include:
• planning or health system specialists who have extensive knowledge of how health systems work in
different contexts
• finance staff
although they can contribute to a broader view of the health system, these staff need to be assigned to a team
with people who have experience of immunization programmes
• maternal and child health staff

although they can contribute to a broader view of the health system, these staff need to be assigned to a team
with people who have experience of immunization programmes
• national, sub-national and service delivery health managers from within the country and neighbouring
countries
their participation can be very helpful, and can have a long-lasting impact on the improvement of services in
their country
• international experts
they should be assigned to sub-teams with national team members who know the country and its health system,
and, if necessary, its language.
A successful team has a balance of national and international representation

so that different knowledge, experience, and perspectives can be considered.
What skills do Assessment Team members need?

All members of the Assessment Team need to have critical thinking and communication skills that will
help them to discuss the situation with people at each level and find the ‘issues behind the facts’.
The leader of the Assessment Team should have experience in:
• immunization programmes
• team leadership
• using this methodology.
How many team members should there be?

The number of team members will vary depending on the purpose of the assessment, the size of the
country, and the number and location of data collection sites.
No matter how many people there are on the Assessment Team,

you will need to assign some members to the national team and
some to the sub-national teams.

Suggested team sizes
National Sub-Team
Number of members At least five.
Comments Individual team members may go to:

• different offices in the Ministry of Health
• partner agencies
• NGOs
• private associations
• other ministries, for example, planning and finance
• health facilities in the capital area.
Booklet 3 includes a Guide for Data Collection which national team members
should use for this.
Sub-National and Service Delivery Sub-Teams

Number of members At least two for each district or sub-national level.
Comments After initially visiting the sub-national office, the team should divide again for
visits to health facilities. For example, in a country with regions and districts, the
whole sub-team of four would divide into teams of two to visit the selected
districts and health facilities within the districts.
Teams should visit public and private sector health facilities and meet with
relevant sub-national level officers, politicians and members of the community
and their leaders.
Is a full-time commitment needed?

Participating in the assessment means you will have to work full-time in preparation, data collection,
analysis, making recommendations, and reporting activities. Some Assessment Team members may also be
needed at the end of the assessment to:
• finalise cost estimates for alternative strategies
• incorporate assessment recommendations into the multi-year plan of action for immunization
• complete writing the Assessment Report

see Step 6.
Task 1.5 Identify members of the Planning Team
The Planning Team prepare for the assessment before the sub-teams go out into the field.
Planning Team members need:
• data collection skills
• analysis skills
• knowledge of the immunization programme and health system in the country
• access to key data and other key documents.
As well as this, at least one member of the Planning Team will need to be familiar with health system
assessment procedures and tools.
More information
There is a summary of Planning Team tasks on pages 30-32 of this booklet, and there are Data Collection
Guides and Discussion Guides for the Planning Team in Booklet 2.

How long will the Planning Team’s work take?
The Planning Team will take between four and six weeks to prepare for the assessment.
They may also continue to take part in the assessment as members of the sub-teams.
Task 1.6 Prepare an assessment schedule
An ideal schedule for a two-week assessment in a country that begins its working week on
Monday would be like this:
Suggested assessment schedule
Day Step Activity Notes
Week 1
Wednesday Step 3 planning
Thursday planning
Friday planning
Saturday planning, free day or travel
Sunday travel
Week 2
Monday Step 4 data collection
Tuesday data collection
Wednesday data collection
Thursday data collection
Friday data collection
Saturday travel
Sunday Step 5 sub-teams analyse
Week 3
Monday analysis and recommendations
Tuesday analysis and recommendations
Wednesday Step 6 debrief
Thursday Step 7 planning for implementation
Friday planning for implementation

The length of an assessment depends on its purpose and the size and nature of the geographical area
being assessed.
If the work of the Planning Team is not included, an assessment using this methodology can be
completed in between two and three weeks, including travel. You will probably spend between 60% and
70% of that time on fieldwork which can be split up so that:
• 25% of the time is for the team to plan for data collection – see Step 3, pages 33-37
• 50% of the time is for data collection, including interim analyses and meetings with stakeholders –
see Step 4, pages 38-42
• 25% of the time is for analysis, developing recommendations, and briefing government authorities
and other major stakeholders – see Steps 5 and 6, pages 43-48.
Schedule the assessment so that data collection starts on the first day of the working week, if possible.
Task 1.7 Plan support for the assessment
It is the job of the Assessment Secretariat to plan support for the assessment. This may include:
• helping to obtain government agreements for the assessment
• making sure information about the assessment is given to development partners
• coordinating invitations for Planning and Assessment Team members
• arranging for salaries, consultant fees, and daily wages for team members
• making hotel reservations
• coordinating transport
• reserving meeting space for Steps 3, 5, 6 and 7
• providing secretarial support and business equipment
• making sure there are adequate supplies of items like stationery
• making sure sub-national and service delivery sites are told about visits.

How many booklets are needed for the assessment?
Use the table to work out how many copies of each booklet you will need.
Booklet 1 Assessment Methodology

One copy for each member of the Assessment Team =
One copy for each member of the Planning Team =
15 extra copies = 15
Total number of Booklet 1 needed =
Booklet 2 Planning Team Assessment Instructions

One copy for each member of the Planning Team =
Booklet 3 National Sub-Team Assessment Instructions

One copy for each member of the National Sub-Team =
Booklet 4 Sub-National Sub-Team Assessment Instructions

One copy for each of the sub-national levels to be visited =
Booklet 5 Service Delivery Sub-Team Assessment Instructions

One copy for each service delivery level to be visited =
As well as this, every sub-national team should have:
• multiple copies of the Data Collection Guides
• one set of Data Collection Guides for each sub-national office and each health facility
they visit
• enough copies of the Assessment Summary sheets to allow them to give a written
summary to every level they visit.

What other documents will be needed?
Each sub-national team will also need a set of relevant documents. These may include:
• the national plan for the health system
• the national plan for immunization operations
• the health system budget
• the immunization budget
• national immunization policies
• operational guidelines
• reports of reviews and evaluations assessments of immunization operations conducted

in the last three years.
What supplies will be needed?

The list below gives you details of the supplies the team will need.
• Notepads
each Assessment Team member will need a notepad to record the information they
receive during field visits
• Flip chart paper

if this is expensive or difficult to find in the country, you can use newsprint instead.
Newsprint is the paper newspapers are printed on. You can buy it from newspaper
publishers for a small fee
• Index cards
approximately 4" x 6", but not smaller.
If index cards are not available, you can use A4 notebook paper cut in half instead
• Masking tape or adhesive clay

for example, Blu-Tac
• Paper, pens, and pencils
• Thick felt-tip marker pens

Task 1.8 Identify funding sources and mechanisms for all assessment activities
Development partners and internal sources may provide sources of funds.
What should be included in the budget for the assessment?

The budget may include:
• salaries and daily wages for Planning and Assessment Team members
• travel and hotels
• secretarial support
• communication costs
• hire of meeting rooms
• photocopying and printing costs
• supplies and equipment
• translation costs.

Step
2 Preparing for the assessment

The Planning Team is responsible for:
• collecting, compiling, reviewing, and collating material on immunization operations, the health
system, and the external environment
• carrying out a SWOT analysis to identify critical issues for immunization services and the health system
and their internal strengths and weaknesses and any external opportunities and threats they may face
• uncovering gaps in information
• identifying issues related to data quality.
Tasks for Step 2
Task 2.1 Collect, compile, and review available information on immunization operations,
the health system, and the external environment
Task 2.2 Identify critical issues for immunization and the health system by conducting
a SWOT analysis
Task 2.3 Compile key materials for the Assessment Team members
Task 2.4 Prepare to brief the entire Assessment Team
Task 2.5 If appropriate, select sub-national areas for visits
Task 2.1 Collect, compile, and review available information on immunization operations,
the health system, and the external environment
The Planning Team do not need to carry out any primary data collection, but do identify possible critical
issues using the data that is available.
You will need to work with the national immunization manager and members of the assessment to:
• review the Planning Team guidelines in Booklet 2
• consult with MOH staff and partners to find the most reliable sources of information
these could be people or documents with relevant information
• prepare a time schedule for Planning Team activities
• review information available at the national level.
More information
There are more details about the information the Planning Team needs to gather in Booklet 2 along with
tools to help summarise the information.

Task 2.2 Identify critical issues for immunization and the health system by conducting
a SWOT analysis
You will need to carry out a SWOT analysis to identify the strengths and weaknesses of immunization
services and the health system, and the external opportunities and threats they face.
More information
There is more information about carrying out a SWOT analysis in Annex 2, pages 59-61.
After you have carried out the SWOT analysis, you will need to prepare a summary of critical issues which
should include:
• any conclusions based on the SWOT analysis
• the possible implications of these conclusions on immunization services and the health system
• a brief description of any further assessment you think may be needed
• suggestions for where the Assessment Team could gather more information on the administrative
level or levels.
Special studies
The government may ask for an in-depth study of a particular aspect of immunization
services such as financing, the cold chain, vaccine procurement, laboratory capacity, or health
worker communication skills. In these cases, you will need to gather specific data which is
beyond the scope of these guidelines. However, national or international experts should be
able to give you advice.
Task 2.3 Compile key materials for the Assessment Team members
You should now prepare an assessment library of any documents the Assessment Team will need to
consult during the assessment process.
What types of documents should be included in the assessment library?

Consider including:
• national plans
• budgets
• policy documents
• standards
• guidelines for the health system and immunization services.
There is a list of suggested documents in Booklet 2.
Introducing new vaccines

If a new vaccine or other innovation is being assessed before being introduced, the
Assessment Team will need specific information on the requirements and guidance for its
introduction. This information is available from WHO or UNICEF.

Task 2.4 Prepare to brief the entire Assessment Team
You now need to brief the full Assessment Team on your findings and give them copies of the completed
forms and Data Collection Guides.
This briefing should highlight:
• the basic characteristics of the national immunization programme and the health system
• your preliminary conclusions about critical issues for immunization services and the health system, and
the external opportunities and threats that seem to be present
• any areas where there are gaps in the information or where the quality of the data may be in question
• your recommendations about issues that need further analysis.
Keep the presentation short – no more than 30 minutes – so that there’s time
for discussions and questions from the Assessment Team.
Task 2.5 If appropriate, select sub-national areas for visits
The MOH and ICC may ask you for advice on which sub-national areas to select for data collection.
There is more information about this in Task 3.6, page 36.

Step
3 Planning data collection

During Step 3 all members of the Assessment Team get together for the first time to:
• learn what the objectives of the assessment are
• review the information on immunization operations and the health system that the Planning Team
gathered during Step 2
• familiarise themselves with the methodology.
Tasks for Step 3
Task 3.1 Explain the assessment objectives
Task 3.2 Brief the Assessment Team on critical issues for country
immunization operations and the health system
Task 3.3 Provide an overview of the assessment methodology
Task 3.4 Reach a consensus on which critical issues to pursue
Task 3.5 Adapt data collection materials
Task 3.6 Reach a consensus on sub-national areas for assessment
Task 3.7 Review the data collection process
Task 3.8 Prepare sub-teams for data collection
Task 3.9 Review special issues
How long will Step 3 take?

You will need between two and three days to:
• learn what the objectives of the assessment are
• review the information
• familiarise yourselves with the assessment methodology
• make adaptations to the Data Collection Guides and other tools, if appropriate.

Suggested planning schedule
Day Activity
Day 1 Welcome and introductions
Explanation of the Terms of Reference and assessment objectives

carried out by Immunization Manager and Team Leader
Briefing on critical issues for country immunization operations

and the health system
carried out by Planning Team
Overview of the assessment methodology, including a briefing on the use of

the SWOT technique
carried out by Planning Team and Team Leader
Day 2 Identification of critical issues for sub-teams to follow up

carried out by technical work group
Adaptation of data collection materials

Selection of first level of sub-national areas, if the Planning Team have not
already done this
Day 3 Study of data collection process

carried out by group work and exercises
Preparation of sub-teams for data collection

carried out by sub-team
Travel preparations
carried out by sub-teams with support from the Secretariat
Task 3.1 Explain the assessment objectives
The National Immunization Manager and the Team Leader will present the Terms of Reference and
clearly explain:
• why the assessment is needed
• what questions it will try to answer
• how they will use the findings and conclusions from the assessment.

Task 3.2 Brief the Assessment Team on critical issues for country immunization
operations and the health system
Members of the Planning Team will brief you on their findings on critical issues for immunization
operations, the health system, and the external environment.
Task 3.3 Provide an overview of the assessment methodology
You now need to review the assessment methodology with the Planning Team to make sure everyone
understands the principles of the assessment, the health system approach, and how to carry out a SWOT
analysis.
Task 3.4 Reach a consensus on which critical issues to pursue
You now need to divide the whole Assessment Team into six technical work groups according to each
member’s expertise and interests. Each work group should represent the health system and each of the five
immunization services components.
The five immunization services components

• Immunization service delivery • Vaccine supply and quality
• Disease surveillance • Advocacy and communications
• Logistics
Once you have formed work groups, each group should:
• review any information provided by the Planning Team that applies to their technical area
• review the critical issues presented
• assess how adequate and reliable the data is
• identify gaps in the information and possible problem areas.
You should then present your findings to the whole Assessment Team which will decide:
• the strengths the data suggests
• the weaknesses the data suggests
• the issues that seem to be most important
• how these issues can be investigated further.
You may need to form some additional groups depending on the objectives
of the assessment, for example, if you are introducing a new vaccine or
intervention, you may want to form an additional group for this.

Task 3.5 Adapt data collection materials
Each technical group now needs to review the Data Collection Guides and Discussion Guides in
Booklets 3, 4 and 5 and focus on the sections that relate to their technical area. Each technical group
should consider the adaptations they need to make to the Data Collection Guides, taking into account
the critical issues they agreed to investigate and the characteristics of the country.
After each group has done this, they should present the adaptations they are suggesting to the full
Assessment Team and reach consensus.
Adapt the Data Collection Guides taking account of any critical issues.
Task 3.6 Reach a consensus on sub-national areas for assessment
You will need to select sub-national areas for assessment, if the Planning Team has not already done this.
Consider the objectives of the Terms of Reference and identify immunization services and health system
criteria to help you select sub-national areas for assessment. Also, think about things like the size of the
Assessment Team, the location of sub-national areas and the transport available.
Examples of criteria to use when you are selecting sub-national areas

Area for assessment Criteria
Immunization operations Access to immunization services

indicated by BCG or DPT1 coverage
Drop-out rate
indicated by BCG-measles and/or DPT1-measles and/or DPT1-DPT3
Quality of disease surveillance
indicated by AFP rate or completeness and timeliness of routine reporting
Progress towards disease control
indicated by incidence of a disease in the area compared to the national average
Health system Extent to which health sector reforms have been introduced
Number of hospitals, health centres, and health posts
Adequacy of staffing – the number and capability of staff
Funding level
Public/private mix
External support
External environment Percentage of urban vs. rural population

Special populations in area
Social-economic factors, for example, literacy, poverty level, and the
infrastructure
Extent of decentralization

Task 3.7 Review the data collection process
The Planning Team, Assessment Secretariat and the Team Leader now use group work exercises, role play,
and other suitable techniques to make sure all members of the Assessment Team are familiar with data
collection methods.
An alternative method
An alternative method for making sure Assessment Team members are familiar
with data collection methods is to organize a hands-on practice session in a health facility
that will not be used as part of the assessment.
This will give you the opportunity to use the guidelines and debrief one another,
and to compare techniques and calibrate interpretations of what you have seen and heard.
If you decide to do this, you may need to set aside an extra day for the practice session.
Task 3.8 Prepare sub-teams for data collection
You will now be allocated to a sub-team depending on your expertise. Sub-teams should meet separately
to decide how to conduct the assessment. This should include studying the Data Collection Guides and
Discussion Guides, so that you do not have to refer to them much when you are in the field.
You should also review the Assessment Summary Sheets in Booklets 3, 4 and 5 which you will fill in and
leave with unit staff after each visit.
Task 3.9 Review special issues
If the Planning Team has identified special issues, the full Assessment Team must decide how they will
investigate them and make any adaptations to the Data Collection Guides. There is more information
about this in Annexes 5, 6 and 7, pages 83-103.
Special issues that may have been identified for the assessment
include things like:
• assessing the capacity of the health system to add a new vaccine to the routine schedule
• identifying challenges in the introduction of auto-disable syringes
• capacity building
• financing sustainability.

Step
4 Collecting data

During Step 4 sub-teams visit the national level and the sub-national areas selected during Step 3 to
collect the data and select second level sub-national areas and service delivery level facilities for data
collection.
Timeline showing the sequence of what happens during Step 4
National level 1 7
Sub-national level 2 5 6
Service delivery level 3 4
1 Visit national level offices
Visit sub-national level offices to identify

2 health and service delivery facilities
3 Visit health and service delivery facilities and collect data
4 Debrief health and service delivery staff
Visit sub-national level offices to follow up questions from

5 health and service delivery facilities
6 Debrief sub-national level staff
7 Debrief national level staff
More information
• Booklets 3, 4 and 5 include guidance about the data the sub-teams need to collect.

Tasks for Step 4
Task 4.1 Visit the national, sub-national, and service delivery level facilities
Task 4.2 Collect data from the national, service delivery, and sub-national level facilities
Task 4.3 Debrief staff from the national, service delivery, and sub-national level facilities
Before you start Step 4, make sure all members of the team are familiar with SWOT methodology and the
Discussion Guides for the sub-national and service delivery level.
Task 4.1 Visit the national, sub-national, and service delivery level facilities
Visit the sub-national offices to identify health and service delivery facilities
When you arrive at a sub-national office, you will need to meet with relevant staff members to:
• brief them on the assessment objectives and methods
• obtain basic information
• find out if you need to pay a courtesy call to local leaders
• ask for knowledgeable members of staff to join the sub-team.
Staff members you may need to meet with include the Medical Officer and the Health Management Team.
After you have briefed staff about the purpose of the assessment, you will need to ask them to help you
identify second level sub-national areas such as districts or facilities for the assessment. You can do this
by applying the criteria in Step 3, pages 33-37, or by asking a few basic questions.
Examples of questions that may help you to select second level sub-national areas
• What was the area’s immunization coverage last year for DPT3, TT2+ and measles?
• Has immunization coverage in the area risen, fallen, or remained stable over the last three years?
Are there any places with more noticeable changes?
• Which areas have the highest performance for immunization services and health services?
Which are the lowest performing areas?
• Which areas have the most health resources? Which have the least?
• Is private provision of healthcare an important factor in this area? Where is it more prevalent?
Where is it less prevalent?
The number of sub-national levels you will need to visit will depend on the structure of the government.
If the country has more than one sub-national level – both regions and districts, for example – you will
need to agree which areas to include with staff at the sub-national level.
When you are choosing second level sub-national areas think about the distance you will need to travel to
them and the available transport. Include both high and low performing areas.
Considerations for selecting health facilities

When you are selecting health facilities try to:
• include facilities in both urban and rural locations
• only visit facilities with comparatively high populations in their catchment areas
• include facilities with comparatively high numbers of people who are not currently reached
• select peripheral facilities such as health centres for most of the visits
• include private facilities (both profit and non-profit) if a large percentage of them offer
immunization in the area

• include facilities offering both fixed and outreach sessions
• include underserved areas, for example, those where services are less frequent, where there are no
permanent health workers, or those that are not covered by outreach sessions.
Visit health and service delivery facilities

Before you begin collecting data:
• meet with the director of the facility and any other facility staff who can contribute to the assessment
• explain the objectives of the assessment to staff members.
Task 4.2 Collect data from the national, service delivery, and sub-national level facilities
Collect data from health and service delivery facilities

The ten steps below give you information about the best way to do this:
1 Talk to staff members about the facility’s immunization services and other services.
2 Observe health workers when they are preparing and giving immunizations.
If possible, go to outreach sessions with health workers.
3 Talk to clients to find out about their opinions and concerns about the services offered by the
facilities.
4 Talk to people in communities who do not use, or who do not have access to, the services to find out
what they think the barriers preventing them from using the services are.
5 Meet with relevant community leaders to find out their opinion on immunization services in the area.
6 Use the Discussion Guide in Booklet 3 for ideas on how to initiate discussions, and how to find the
‘issues behind the facts’.
7 Use the Data Collection Guides in Booklet 5 to record your findings. You don’t need to fill out every
line in the Data Collection Guides – only the information that will help you to clarify critical issues.
8 Use the SWOT technique described in Annex 2, pages 59-61, to identify the strengths and weaknesses
of immunization services and the health system, as well as any external opportunities and threats that
may have an impact on services. Summarize your conclusions on the forms provided.
9 Summarize what you think the critical issues for immunization services and the health system might
be. This summary should include:
• any conclusions you have made based on the SWOT analysis

• possible implications these conclusions have for immunization services and the health system
• a brief summary of draft recommendations including suggestions on the administrative level
or levels.
10 Meet with other sub-team members to:
• compare interpretations of what you have found and observed

• discuss problems implementing the assessment methodology
• modify planned visits, if appropriate.

Finding the ‘issues behind the facts’
The Discussion Guide in Booklet 3 gives you ideas to help you find ‘the issues behind the facts’.
However, you should not use the Discussion Guide as a questionnaire, and you do not need to ask all
the questions in the discussion points column.
Instead, focus on the critical issues you agreed with the rest of the Assessment Team during Step 1.
You will have more success gathering the information if you try to establish an open dialogue with
health staff and their stakeholders.
Local problems – local solutions

Local problems, such as immunization session scheduling, can often be solved at the local level.
You should discuss both the problem and the possible solution with health facility staff before leaving
the health facility.
You can then report the outcome of the discussion to people at the next level.
Before you leave the health facility, give a completed Assessment Summary sheet to the staff. This will
serve as a reminder of the discussions and will also be a benchmark for any future assessments.
Repeat tasks 4.2 and 4.3 until you have visited all the health facilities or areas selected for the assessment.
Use a separate Data Collection Guide and Assessment Summary for each one.
Collect data from the sub-national office

You now need to return to the sub-national office and collect data for that level. You should also follow
up on any questions or problems identified at the service delivery level.
Use the Discussion Guides and Data Collection Guides in Booklet 4 to help you with this.
Share findings with those who are most concerned with them,
and with those who can help to solve them.
Task 4.3 Debrief staff from the national, service delivery, and sub-national level facilities
Debrief health and service delivery staff

When you have finished collecting data, meet with health facility staff to discuss your findings and
possible solutions for the problems identified. Consider including community leaders or key community
representatives in the debriefing.
Before the meeting, write your findings on the strengths and weaknesses on flip chart paper or newsprint
and stick it on the wall. Make sure that you allow local staff members and partners to take part fully in
the meeting. It should take between 45 minutes and an hour.

Suggested debriefing meeting agenda
Review and discussion of findings Describe the strengths and weaknesses you have observed in
immunization services and health system functions. Ask staff if
they agree with the findings, and invite them to make suggestions
or add information that will help you understand the situation.
Consensus on recommendations Ask staff what recommendations they suggest for solving problems
identified.
Discuss suggested responsibilities for implementing

recommendations. For example, health facility staff can agree to
check all their vaccines and remove any whose expiry date has
passed, but they probably cannot solve a vaccine supply problem
without involving other levels.
Conclusions Review what health facility staff have suggested they will do
themselves, and what you have agreed to bring to the attention of
staff at the next levels.
Debriefing sub-national level staff

Now meet with members of the Health Management Team and other staff members and stakeholders.
Use this meeting to:
• report on findings at second level sub-national areas and the service delivery level
• reach agreement on the possible causes of the critical issues in these areas
• identify health system and external opportunities and threats that may affect immunization services
• agree on what second level sub-national and health facility staff can do
• agree on what the Assessment Team needs to discuss at the next level.
Before leaving the sub-national office, give staff a copy of the Assessment Summary for each health facility
visited, and the summary for their sub-national level.
Why is the debriefing meeting important?

Debriefing sessions at the sub-national level are of great practical benefit as they allow sub-national staff
to advise you on your findings, and give you feedback that can be included in the final conclusions and
recommendations.
Remember to congratulate health facility staff on any positive findings,

and to explore options for solving problems which respect existing lines
of authority and responsibility.

Step
5 Analysing findings

When the data has been collected, all members of the Assessment Team meet again at the national level
to review regional findings, agree on conclusions and recommendations, and to set priorities for actions.
At this stage, technical staff from key stakeholders or partner agencies may join the Assessment Team as
they can contribute to accomplishing the proposed tasks.
Tasks for Step 5
Task 5.1 Analyse information by sub-national area
Task 5.2 Analyse information by technical area
Task 5.3 Prepare the main conclusions of the assessment
Task 5.4 Develop main recommendations of the assessment
Task 5.5 Compile information and prepare the first draft of the Assessment Report
Task 5.6 Prepare for debriefing
In health planning there are three important Here ...
questions to ask: ... is where we are now

1 Where are we now? ... ‘here’
the current status of the health system
2 How do we get from ‘here’ to ‘there’? Strategies and activities
strategies and activities that have to be organized,
and the management support that is needed to
organize them
There ...
3 Where do we want to be in the future? ... ‘there’
the country’s goals and objectives ... is where we want to be
Task 5.1 Analyse information by sub-national area
Your sub-team should spend between half a day and a day organizing notes and completing the report on
the sub-national level they visited. You will also need to analyse your findings, prepare conclusions based
on the SWOT analysis, and write preliminary recommendations.
Each sub-team should prepare a 10 to 15 minute presentation to the whole Assessment Team describing:
• their main conclusions about critical issues for immunization services and the health system in
their area
• their main conclusions about immunization services and the health system in their area
• their recommendations.

Task 5.2 Analyse information by technical area
At this stage the assessment changes from analysis by sub-national area to analysis by immunization
services components and health system functions.
Copies of each sub-team’s reports showing findings, conclusions, and recommendations should be
distributed to the technical work groups formed in Task 3.4.
Each technical group should analyse the data and then summarise their findings on the Data Collection
Guides in Annex 3, pages 63-65. Each group should then make a ten minute presentation to the full
Assessment Team explaining their analysis. You can summarize any conclusions or recommendations
on a large index card and stick it on the wall.
Immunization services work groups

Each of the five immunization services work groups should analyse its component and reach
agreement on:
• progress and achievements made
• the most important conclusions for each component
• recommendations related to each conclusion
• any possible implications these recommendations may have for the health system.
Health system work group

If the health system technical group has extensive data to analyse, it may be helpful to allocate more
people to this group and divide them into four smaller groups to analyse each function separately.
The health system work group uses the health system information gathered by each sub-team to analyse
information on health system functions for each of the three levels. It should reach agreement on:
• progress and achievements made
• the most important conclusions for each function of the health system
• recommendations related to each conclusion
• any possible implications these recommendations may have for immunization services.
Service delivery problems may need health system solutions

Some problems may involve other parts of the health system, so it is important to consider
that solutions to these problems may be system wide.
Preparing conclusions on special issues

If a special issue was included in the assessment, one of the technical work groups will need to review
the proposed indicators to assess this special issue and draw conclusions. It is also important to make
sure that the recommendations and activities you propose in Steps 6 and 7, pages 48-50, also address
these issues.
Examples of special issues include things like the introduction of new vaccines or AD syringes, capacity
building, and financing sustainability.

Task 5.3 Prepare the main conclusions of the assessment
Before beginning this task, you should remind yourself of the country’s current immunization targets,
goals, and objectives.
Aims for Task 5.3

The aims of this task are to report on:
• the immunization programme’s strengths and weaknesses
• its efficiency and effectiveness
• its impact on disease burden
• its capacity to adapt to new demands – both those generated by health sector reform and those
that arise in response to the population’s need for access to vaccines.
You should then identify:
• the progress and achievements made
• your main conclusions about critical issues for immunization services and the health system
in the country
• your main conclusions about immunization services and the health system in the country.
There are several methods you could use to achieve this task. But whatever method you choose, it is
important to make sure that it:
• promotes ownership by all key stakeholders in the assessment
• allows the different sub-teams and technical groups to give their input
• helps identify priority conclusions and recommendations.
Identifying priority conclusions and recommendations using index cards

When all the technical groups have made their presentations, you will have a large
number of conclusions and recommendations.
1 Ask each technical group to summarize their report including the main achievements, conclusions,
and suggested recommendations on a large index card.
2 Stick all the cards on the wall – there will probably be between 20 and 30.
3 Discuss each conclusion on the cards and consolidate them where possible by:
• moving the cards around so that you group all the cards relating to the same
problem together
• comparing the health system and immunization services cards and putting together
those that have a direct impact on each other
• deciding which conclusions are most important and then putting those cards
together and removing the others.

Task 5.4 Develop main recommendations of the assessment
You should now come to an agreement on the main assessment recommendations. You can achieve this
by following an approach similar to the one you used to select priority conclusions and
recommendations.
You do not need to make recommendations for each of the immunization services components and
health system functions. For example, it is possible that most of the recommendations for solving
immunization coverage will involve the health system in the areas of planning, training, and supervision
only.
Some problems may need more study

You may not have been able to find enough information about some issues.
These may need more investigation, so you should recommend this in your final report.
How can you tell if the recommendations are relevant?

To check if your recommendations are relevant, answer the questions below:
• Are the strategies consistent with the country’s objectives, policies, strategies, and plans for
immunization services?
• Are they consistent with the country’s health sector development goals and the national health plan?
• Are they consistent with the universal goals of equity, public participation, and accountability?
• Are they feasible?
• Are they affordable?
• Will these recommendations be viewed as collaborative or competitive by non-governmental

organizations, UN organizations, and other stakeholders in the country?
• Are these recommendations consistent with national and partner’s criteria for obtaining, giving, using,
and accounting for financial support?
How can you identify the ways in which immunization services may provide an opportunity
for strengthening health systems?
You may find it helpful to ask:
• What are the critical health systems functions that will allow immunization services to perform better?
• How can these be improved in a sustainable way which will benefit other services and not damage
them?
• What are the critical health systems issues if new technologies or vaccines are introduced?
• How can these be improved in a sustainable way which will benefit other services and not damage
them?
• Are they coherent with health sector development priorities?
Preparing recommendations on special issues

If a special issue was included in the assessment, it is important to make sure that the
recommendations and activities you propose address this issue.
Examples of special issues include things like the introduction of new vaccines or AD syringes,
capacity building, and financing sustainability.

Task 5.5 Compile information and prepare the first draft of the Assessment Report
Once you have developed your recommendations, you should start to consolidate the information the
sub-teams and Planning Team gathered into the first draft of the final Assessment Report. You will use this
first draft to debrief high level officials and partners during Step 6.
Suggested table of contents for the final Assessment Report

1 Objectives of the assessment
2 Assessment methodology – a brief description of the process, including the number of sites
visited and people interviewed
3 The context – a brief discussion of the political, economic and other critical issues in the
external environment that have an impact on health status, immunization services, and the
health system
4 Conclusions and recommendations relating to immunization services and the health system
5 Conclusions and recommendations on the feasibility of introducing a new vaccine or another

innovation in the country, if applicable
6 Next steps – for example, incorporating the recommendations into the current national plan,
preparing cost estimates and a financing plan, further in-depth study, or monitoring a
particular area
Annexes Country fact sheet

Data Collection Guides including conclusions and recommendations
Copies of each sub-national team’s reports
Task 5.6 Prepare for debriefing
You should now prepare a summary description of the assessment process, and of your conclusions and
recommendations which you will present to the government and stakeholders.

Step
6 Debriefing

The Assessment Team, or a sub-group of its members, gives a debriefing about the assessment and their
major recommendations.
Tasks for Step 6
Task 6.1 Debriefing
Task 6.2 Complete the final draft of the Assessment Report
Why is the debriefing meeting important?

The debriefing gives you the opportunity to:
• make sure that proposed changes are consistent with government policies and goals
• obtain high-level political commitment for implementing the recommendations
• promote intra-sector and inter-sector support for proposed changes
• discuss resource and funding needs.
Task 6.1 Debriefing
You now need to give a debriefing based on the conclusions and recommendations compiled in Step 5 to:
• high-level national officials and policy-makers

Minister of Health, local government, and finance
• ICC members
• NGOs
• other partners.
You may also need to provide an executive summary of the preliminary report. You can prepare the full
final report later.
Task 6.2 Complete the final draft of the Assessment Report
During Task 6.1 you will have presented your draft conclusions and recommendations but it is unlikely
that you will have finished the final draft of the report.
You should now complete this report so that it is available before the Assessment Team separates.
If possible, you should submit it to the MOH no more than one month after the assessment.
Remember to include in the report any input that senior MOH staff and
key stakeholders give you during the debriefing.

Step
7 Planning for implementation
and monitoring

The Assessment Team proposes the implementation phases and outlines the key steps for monitoring.
Tasks for Step 7
Task 7.1 Incorporate recommendations into a draft multi-year national plan
Task 7.2 Prepare a draft budget and financing plan
Task 7.3 Plan how implementation will be monitored
Completing the planning process

When you are planning for implementation, you will need to:
• contrast your findings with current goals and targets
• establish specific objectives
• select indicators to evaluate progress
• make plans to determine what priorities need to be tackled, what strategies and activities have
to be implemented, and what management support is needed.
Task 7.1 Incorporate recommendations into a draft multi-year national plan
Selected Assessment Team members, MOH planners, immunization managers, finance staff, and technical
staff from key partners will need to work together on this task.
Assessment recommendations need to be integrated into the national plan. This will help to make sure
that they are supported by decision-makers and implemented by national and sub-national staff.
The process described in Annex 4, pages 67-69, should help you with this task.
You may not be able to complete this task in the time available, but it is important to initiate it and take
part in preparing an initial draft. The immunization manager and partners should prepare a clear timeline
for completing the draft.
If you cannot complete it in time, some members of the Assessment Team could stay behind to help
finalize it.

Task 7.2 Prepare a draft budget and financing plan
Estimates of the costs of current and future activities are important for financing immunization services.
Cost analysis may include the total estimated costs, programme specific costs, and recurrent, variable,
non-personnel costs. See Annex 4, pages 67-69, for more information.
You will need to clearly identify the source of financing for each component of the immunization
programme. You can use information about estimated costs and financing information to identify
financing gaps. You should also assess any financial gaps both with, and without, the planned changes
and new activities.
You will need to estimate the cost of delivering new antigens, interventions and technologies before you
can budget or find support for their introduction.
Task 7.3 Plan how implementation will be monitored
It is essential to develop a mechanism that will help you to monitor progress and evaluate it in the three
to five years after the assessment.
Everyone who was involved in the assessment and subsequent revisions of the national plan will want
to know what the impact of new strategies is on performance. If there is not currently a system for
monitoring plan activities, you should encourage the MOH to develop a system that includes:
• appointing someone in the MOH to monitor the implementation of the plan
• preparing progress reports for the ICC, development partners, and other key stakeholders
• following up progress in sub-national offices

people from sub-national offices who were also on the Assessment Team can do this.
Evaluating implementation
You can evaluate implementation of the multi-year plan in two ways:
1 By assessing which activities have been implemented compared to what was proposed
in the multi-year plan of action or annual work plan.
2 By assessing if the indicators show that the vaccine-preventable disease burden has been
reduced.

Annex
1
Key indicators
Indicators are essential for analysing the current situation, for expressing specific targets, and for assessing
if these targets are being met.
This annex shows the key indicators you will need to consider for the five immunization services
components and the health system.
The tables show indicators for the three levels – national, sub-national, and service delivery.
The Discussion Guides in Booklets 3, 4 and 5 are based on these indicators.
Service delivery: Immunization services key indicator – 1
National level Sub-national level Service delivery level
Coverage level for each vaccine Coverage level for each vaccine Coverage level for each vaccine
during the last three years during the last three years during the last three years
National drop-out rate Sub-national area drop-out rate Health facility drop-out rate
Completeness and timeliness of Completeness and timeliness of Completeness and timeliness of

routine coverage reporting from routine coverage reporting from routine coverage reporting to the
the sub-national levels the catchment area sub-national level
Proportion of sub-national units Proportion of catchment areas by Effective outreach schedule

by coverage level for each vaccine coverage level for each vaccine
(e.g. <50%, 50-79%, >80%)
Existence of a national plan for Proportion of facilities offering

immunization vaccinations
Completion of a standardized Supervision system for injection Use of one sterile needle and one
immunization injection safety safety sterile syringe for each injection
assessment
Existence of a policy, plan, and Distribution and maintenance Collection of sharps in puncture-
budget for injection safety system for supplies of safe proof containers
injections
Appropriate disposal of injection
equipment
System for detecting, System for detecting, Knowledge of what should be

investigating, and reporting investigating, and reporting AEFIs reported as an AEFI
adverse events following
immunization (AEFIs)

Disease surveillance: Immunization services key indicator – 2
Vaccine-preventable disease Vaccine-preventable disease Vaccine-preventable disease

incidence incidence incidence
Non-polio AFP rate Non-polio AFP rate Non-polio AFP rate
% of measles outbreaks % of measles outbreaks % of measles outbreaks

investigated investigated investigated
% of measles cases with % of measles cases with % of measles cases with

information on age and information on age and information on age and
vaccination status vaccination status vaccination status
Completeness and timeliness of Completeness and timeliness of Completeness and timeliness of

routine reporting routine reporting routine reporting
Logistics: Immunization services key indicator – 3
Existence of guidelines on:

• vaccine management
• transport management
• cold chain
• disposal and destruction
Supplies, equipment and Supplies, equipment and Good quality supplies,

consumables are available where consumables are available where equipment, and consumables are
they are needed and in the they are needed and in the available in the amount needed
amount needed amount needed
Cold-chain equipment operating Cold-chain equipment operating Cold-chain equipment operating

and in good repair and in good repair and in good repair
Staff monitor status and stock Staff monitor status and stock
of supplies, equipment, and of supplies, equipment, and
consumables when visiting consumables when visiting
sub-national and service delivery service delivery areas
areas
Staff have an emergency plan for Staff have an emergency plan for
sub-national area health facility

Vaccine supply and quality: Immunization services key indicator – 4
Supply Supply Supply
• vaccine forecasting • vaccine forecasting • vaccine forecasting
• vaccine utilization and wastage • vaccine utilization and wastage • vaccine utilization and wastage
monitoring monitoring monitoring
Quality Quality
• an assessment of quality • vaccine stored and handled

performed by a fully functional properly
regulatory authority (NRA), or
other independent assessment • quality and expiry date of
of quality performed vaccine checked before use
• manufacturer viable or vaccines

procured from prequalified
sources
Source and finance
• system for selection of sources
• sustainable financing
mechanism
Advocacy and communications: Immunization services key indicator – 5
Active support of routine Active support of routine Knowledge of public, including

immunizations: immunizations by political leaders parents, about immunizations
and other influential people and
• by political leaders groups in the area
• by development partners
Active public promotion of Active public promotion of Active attempts to reach the
immunizations immunizations by units unreached, defaulters, and
non-users
Health staff communicate

effectively with clients
Community involvement in
planning and monitoring of
health services

Stewardship: Health system key indicator – 1
Policy-making and Policy-making and Policy-making and

standard-setting standard-setting standard-setting
National health policies: Sub-national policies and plans: The health facility’s schedule:
• address the needs of the • address the needs of the • addresses the needs of the
unserved and under-served unserved and under-served unserved and under-served
• assure equity of access to • assure equity of access to • assures equity of access

health services health services
• includes health interventions
• address health interventions • address health interventions that are priorities for the
that are priorities for the that are priorities for the country and the area
country country and the area
As well as governing the public

sector, policies and regulations
govern the activities of multi-
and bilateral agencies, non-
governmental organizations, and
the private health sector
Planning Planning Planning
Existence of a multi-year national Existence of a plan for each unit Existence of a health facility plan
health plan and budget as well as in the sub-national level and a and a budget for the current year
a plan and budget for the current budget for the current year
year
Adaptability of staff to change

plans and adjust budgets based
on current events such as sector
reforms
Information management Information management Information management
Staff at all levels receive timely Staff receive timely information Staff receive timely information
information on new policies and on new policies and guidelines on new policies and guidelines
guidelines
Staff at all levels receive reports Staff receive reports on national Staff receive reports on national
on national progress towards progress towards meeting disease progress towards meeting disease
meeting disease reduction and reduction and other health goals reduction and other health goals
other health goals
Staff use information to plan and Staff get feedback on reports Staff get feedback on reports
to make adjustments in strategies submitted submitted
National statistics are submitted Staff use information to plan and Staff use information to plan and
to WHO regional and global to make adjustments in strategies to make adjustments in strategies
offices on time

Stewardship: Health system key indicator – 1 continued
Coordination among Coordination among Coordination among

healthcare providers healthcare providers healthcare providers
Staff coordinate planning, Staff coordinate planning, Staff coordinate planning,

implementation, and monitoring implementation, and monitoring implementation, and monitoring
among representatives of private among representatives of private among representatives of private
and public healthcare providers and public healthcare providers and public healthcare providers
Staff keep all representatives of Staff keep all representatives of Staff keep all representatives of
healthcare providers informed of healthcare providers informed of healthcare providers informed of
new policies, guidelines, and new policies, guidelines, and new policies, guidelines, and
changes in public health changes in public health changes in public health
administration administration administration
Cooperation Cooperation Cooperation
Staff coordinate support provided Staff coordinate support provided Staff coordinate support provided
by partners by partners by partners (not usually applicable
at the service delivery level)
Staff keep partners and others Staff keep partners and others
informed of activities and informed of activities and
changes changes
Evaluation Evaluation Evaluation
Staff periodically evaluate Staff periodically evaluate Staff periodically evaluate

progress towards the progress towards the progress towards the
achievement of national goals achievement of the sub-national achievement of the unit’s goals
and objectives, and the impact level goals and objectives and objectives
of strategies on the health of
the nation

Human resource development: Health system key indicator – 2
Staffing Staffing Staffing
Personnel in all locations meet Personnel in all locations meet Personnel in all locations meet
national staffing levels and national staffing levels and national staffing levels and
standards standards standards
There are enough staff with the There are enough staff with the There are enough staff with the
appropriate skills to meet the appropriate skills to meet the appropriate skills to meet the
needs in all locations needs in all locations needs in all locations
Staff receive adequate salaries on Staff receive adequate salaries on Staff receive adequate salaries on
a regular basis a regular basis a regular basis
Working conditions are adequate Working conditions are adequate Working conditions are adequate
Staff job performance is regularly Staff job performance is regularly Staff job performance is regularly
evaluated and feedback is evaluated and feedback is evaluated and feedback is
provided provided provided
Training Training Training
All staff have the knowledge and All staff have the knowledge and All staff have the knowledge and
skills they need to do their jobs skills they need to do their jobs skills they need to do their jobs
Supervision Supervision Supervision
Guidelines for supervisors of Staff provide supervision and the Staff receive the supervision and
health workers and other administrative and technical technical and administrative
personnel in the system have support needed at the service support they need
been issued delivery level
Supervisors are able to provide

the administrative and technical
support needed

Finance: Health system key indicator – 3
Budgets are consistent with plans Budgets are consistent with plans
Available funding meets the Available funding meets the Staff members are aware of the
needs of the healthcare system needs of the healthcare system cost of services, sources of
and immunization services and immunization services financing, and the need for
described in the national plan described in the national plan efficiency in the use of resources
and budget and budget
Funds approved are allocated Funds approved are allocated
Funds allocated are spent Funds allocated are spent

according to plan according to plan
Generally accepted accounting Generally accepted accounting

practices are followed practices are followed

Annex
2
Conducting a SWOT analysis
SWOT stands for strengths, weaknesses, opportunities, and threats*. When you are assessing
immunization services, you will need to use a SWOT analysis to study the strengths and weaknesses of
immunization services and the health system at each level. You will also need to identify opportunities
and threats from outside immunization services and the health system that may have an effect on them.
S W
Strengths Weaknesses
Study the internal strengths
and weaknesses of immunization
services and the health system
at each level.
O T
Identify opportunities and
threats from outside
immunization services and the
health system that may have
an effect on them.
Opportunities Threats
Carrying out the analysis

1 Make lists of the internal strengths and weaknesses of immunization services and the health system,
and the external opportunities and threats they face. Enter them in the appropriate quadrants of the
Summary SWOT analysis.
2 Compare, discuss, and analyse the possible implications of the items in the list.
3 Formulate strategies and recommendations based on the analysis.
Discussion and analysis are just as important as listing the strengths,

weaknesses, opportunities, and threats.
* John M. Bryson, Strategic Planning for Public and Nonprofit Organizations: A guide to strengthening and sustaining
organizational achievement. Revised edition. 1995. San Francisco, Jossey-Bass Publishers.

What to look for under each component of the SWOT analysis
Strengths
Factors that contribute to good system performance and that can be built on to achieve new objectives.
Examples of internal strengths might include an effective cold chain, or public acceptance of the need
for immunization.
Weaknesses
Factors in the system that hinder the achievement of objectives.
Examples of weaknesses include frequent occurrence of adverse events following immunization, or staff
dissatisfaction with salaries.
Opportunities
Factors outside the health system that you can take advantage of when planning change.
Usually fit into one of the following categories:
• political, economic, social, and technological trends
• stakeholders who control resources
• actual or potential collaborators or competitors.
Examples of opportunities include the appointment of a new key decision-maker who supports
immunizations, or public demand for injection safety.
Threats
Factors outside the health system that have a negative effect on it. Examples include a general decrease in
government revenue, or an extensive turnover or transfer of staff.

S W Country ..........................................................................................................................................................................................................................................
Strengths Weaknesses Summary of
Date ....................................................................................................................................................................................................................................................
O T SWOT analysis a Photocopy this form for each Summary SWOT analysis.
Strengths Weaknesses
61
There is an MS Word version of this form on the CD. If you need to, you can edit or amend it for the country you are assessing. a Look for Form 1.1
Annex
3
Data Collection Guides
for analysing data
During Step 5 of the methodology, you will use the forms in this section to summarize your conclusions
and recommendations.
1 Fill in one form for each of the immunization services components.
2 Fill in one form for each of the health system functions.

DATA COLLECTION GUIDE Immunization service delivery Vaccine supply and quality Country ........................................................................................
Immunization services Disease surveillance Advocacy and communications Date ..................................................................................................
Logistics a Photocopy this form for each immunization services component. Tick whichever applies.
64
Achievements
Conclusions – Implications for immunization services Conclusions – Implications for health system
Recommendations
DATA COLLECTION GUIDE Stewardship Service provision Country ........................................................................................
Health system Human resource development Finance Date ..................................................................................................
a Photocopy this form for each health system function. Tick whichever applies.
Achievements
Conclusions – Implications for immunization services Conclusions – Implications for health system
Please include information for each of the sub-functions, e.g. policy-making, planning etc Please include information for each of the sub-functions, e.g. policy-making, planning etc
Recommendations
65
Annex
4
Incorporating the assessment
recommendations into the national plan
Assessment recommendations need to be integrated into the national plan. This will help to make sure
that they are supported by decision-makers and implemented by national and sub-national staff.
Planning is a dynamic process that does not always take place in a purely logical way. However, the steps
below give a useful sequence for developing a plan of action.
1 Review the goals for immunization services and the health system
in the multi-year plan
• Ask if the plan’s targets and goals are achievable, or if they are too ambitious or too restricted,
given the current health system and external environment.
• Ask if the plan’s targets and goals are consistent with the Assessment Team’s recommendations.
• Resolve any difficulties.
• Make the necessary adjustments to the national plan.
2 Write the interim objectives or milestones

• These must be met if goals are to be achieved.
3 Review current and planned strategies

Review the strategies that are currently in the plan and compare them to the Assessment Team’s
recommendations. Choose or plan strategies that are:
• relevant
they are most likely to contribute to the achievement of interim objectives or milestones
• sustainable
they are most likely to have a lasting impact on immunization coverage and disease incidence,
and contribute to health systems development
• effective
they are most likely to have a positive impact on the health system
• feasible
given existing or projected financial and human resources
• acceptable
to decision-makers and the public.
There may be several ways to achieve objectives, but as planning proceeds, any practical
constraints should become clearer and you may have to revise original strategies.

4 Identify the necessary indicators to monitor progress
Indicators are essential for analysing the current situation, for expressing specific targets, and for
assessing if these targets are being met.
Also identify:
• the level each indicator should be monitored at
• the source of the information
• the frequency of collection
• the staff responsible for consolidating and analysing the information.
If you are proposing any new indicators, assess the benefits of collecting additional information
against the benefits of improving the quality and completeness of existing indicators.
5 Review the activities described in the national plan

Identify all necessary activities and tasks and determine if they will contribute to achieving the new
objectives and strategies, and how they will combine with them.
You will also need to:
• work out the implications for staffing, facilities, supplies, and transport budgets.
6 Estimate the cost of planned activities

Categorize the activities on the basis of whether they can be implemented:
• at minimal additional cost
• at additional cost where funds are available
• at additional cost where new funds are needed.
Often there will not be enough resources to implement all the recommendations, so decision-makers
may ask planners and finance specialists for a variety of ‘what if’ scenarios so that they can study the
cost implications of different strategies and combinations of strategies.
7 Schedule activities and assign responsibility

When you have selected the activities that will reach the objectives most effectively, you will need to
schedule them and assign responsibility for their implementation. You will also need to estimate how
long activities will take and then fix realistic starting and completion dates. You may find summary
tables like those in Annex 4a helpful.
8 Re-estimate costs and prepare budgets for the next three to five years
Allocate funds that you know are available, or are pledged, and estimate any potential funding gaps.
You may find the forms in Annex 4b helpful for this.

Incorporating the assessment recommendations into the national plan

Annex
4a
Identifying activities needed
to achieve targets and objectives
The forms on the following pages will help you to identify the activities that need to be achieved
to meet established targets and specific objectives.
1 Fill in one form for each of the immunization services components and one for each of the
health system functions.
2 Identify marginal costs of adding new vaccines or interventions.

SUMMARY TABLE Immunization service delivery Vaccine supply and quality Country ........................................................................................
Immunization services Disease surveillance Advocacy and communications Date ..................................................................................................
activities Logistics a Photocopy this form for each immunization services component. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Indicator Target Achieved to Main Activities Timeline Office and Estimated Source of
date/status constraint level cost funds
Year 1 Year 2 responsible Capital Recurrent
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 US$ US$
SUMMARY TABLE Stewardship Service provision Country ........................................................................................
Health system Human resource development Finance Date ..................................................................................................
activities a Photocopy this form for each health system function. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Indicator Target Achieved to Main Activities Timeline Office and Estimated Source of
date/status constraint level cost funds
Year 1 Year 2 responsible Capital Recurrent
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 US$ US$
Annex
4b
Estimating costs and funding sources
The forms on the following pages will help you to identify the estimated costs and funding sources
that are needed to achieve established targets and specific objectives.
1 Fill in one form for each of the immunization services components and one for each of the
health system functions.
2 Identify marginal costs of adding new vaccines or interventions.

ESTIMATED COSTS AND Immunization service delivery Vaccine supply and quality Country ........................................................................................
FUNDING SOURCES Disease surveillance Advocacy and communications Date ..................................................................................................
Immunization services Logistics a Photocopy this form for each immunization services component. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Type of cost Domestic source External source Total funding Shortfall

Central Local Health Other Grants Loans Other available
government government insurance
Capital costs
• Building space
• Vehicles
• Equipment
• Other
Capital costs subtotal
Recurrent costs
• Personnel
• Vaccines
• Supplies
• Transport
• Surveillance and monitoring
• Training
• Communication, including health
promotion, etc.
• Maintenance and overheads
• Other
Recurrent costs subtotal
Total
Percentage of total
ESTIMATED COSTS AND Stewardship Service provision Country ........................................................................................
FUNDING SOURCES Human resource development Finance Date ..................................................................................................
Health system a Photocopy this form for each health system function. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Type of cost Domestic source External source Total funding Shortfall

Central Local Health Other Grants Loans Other available
government government insurance
Capital costs
• Building space
• Vehicles
• Equipment
• Other
Recurrent costs
• Personnel
• Vaccines
• Supplies
• Transport
• Surveillance and monitoring
• Training
• Communication, including health
promotion, etc.
• Maintenance and overheads
• Other
Total
Percentage of total
Annex
4c
Summarizing projected costs
of the immunization programme
over the five year period
The forms on the following pages will help you to summarise the projected costs of achieving established
targets and specific objectives.
1 Fill in one form for each of the immunization services components.
2 Fill in one form for each of the health system functions.

SUMMARY OF PROJECTED Immunization service delivery Vaccine supply and quality Country ........................................................................................
COSTS (FIVE YEAR PERIOD) Disease surveillance Advocacy and communications Date ..................................................................................................
Immunization services Logistics a Photocopy this form for each immunization services component. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Component and Estimated Domestic source External source Total funding Shortfall
type of cost cost for available
five year Central Local Health Other Grants Loans Other
period government government insurance
Capital cost
Service delivery
Recurrent cost
Capital cost
Disease surveillance
Recurrent cost
Capital cost
Logistics
Recurrent cost
Capital cost
Vaccine supply and
quality Recurrent cost
Capital cost
Advocacy and
communications Recurrent cost
Capital cost
Health system
mgmt functions Recurrent cost
Grand total
SUMMARY OF PROJECTED Stewardship Service provision Country ........................................................................................
COSTS (FIVE YEAR PERIOD) Human resource development Finance Date ..................................................................................................
Health system a Photocopy this form for each health system function. Tick whichever applies.
Objective ...................................................................................................................................................................................................................................................................................................................................................................................................................................
Component and Estimated Domestic source External source Total funding Shortfall
type of cost cost for available
five year Central Local Health Other Grants Loans Other
period government government insurance
Capital cost
Service delivery
Recurrent cost
Capital cost
Recurrent cost
Capital cost
Logistics
Recurrent cost
Capital cost
Vaccine supply and
quality Recurrent cost
Capital cost
Advocacy and
communications Recurrent cost
Capital cost
Health system
mgmt functions Recurrent cost
Grand total
Annex
5
Assessing capacity building
Definition of capacity building (CB)

In the context of strengthening immunization services, capacity building means significantly enhancing
the ability of the national immunization programme to:
• increase and maintain access to immunization services
• decrease the burden of vaccine-preventable diseases
• expand the use of safe and cost-effective vaccines.
In capacity building, special attention is given to:
• safety and quality
• consistency with national health sector goals
• identifying funding shortfalls
• progressing towards self-reliance in identifying and generating resources
• managing knowledge so that work experience can be retained and expertise disseminated throughout
the organization.
How does this definition fit in with GAVI milestones?

1 By 2010 or sooner, all countries will have routine immunization coverage at 90% nationally with at least
80% coverage in every district.
2 By 2002, 80% of all countries with adequate delivery systems will have introduced hepatitis B vaccine.
By 2007, all countries.
3 By 2005, 50% of the poorest countries with high disease burdens and adequate delivery systems will have
introduced Hib vaccine.
4 By 2005, the world will be certified polio-free.
5 By 2005, the vaccine efficacy and burden of disease will be known for all regions for rotavirus and
pneumococcal vaccine, and mechanisms identified to make the vaccines available to the poorest countries.

Capacity building must maintain and develop existing abilities
As well as developing new abilities, the capacity building process must maintain and develop existing
abilities. It must be based on a methodology which can:
• assess the current situation
• define future goals
• plot a way of reaching goals.
Any capacity building strategy must also address three levels:
• the individual
• the institutions
• the overall health system.
Capacity building indicators

Countries should identify their own indicators to measure progress in addressing each of the health
system functions. The GAVI Inter-Taskforce Sub-group on Capacity Building has also suggested indicators
for each function which are consistent with global targets.
Capacity building indicators help countries to:
• carry out needs assessments
• develop plans that address gaps
• monitor implementation.
Many capacity building indicators overlap with the critical indicators included in the CAT.
The information below gives details of capacity building indicators and tells you if they are also included
in the CAT.
Finance – proposed CB indicators
CB indicators
The most recent indicators are summarized in Annex 6, section 6
CAT indicator that may overlap with the CB indicators

See Annex 6, section 6
Management – proposed CB indicators
CB indicators
Timeliness and completeness of reports, reflecting institutional capacity to monitor its performance

Completeness and timeliness of routine coverage reporting from sub-national levels
see Immunization services – immunization service delivery
Completeness and timeliness of routine surveillance reports

see Immunization services – disease surveillance
Staff at all levels receive timely information on new policies and guidelines
see Health system – stewardship
National statistics are submitted to WHO regional and global offices on time

CB indicators
Provision of adequate immunization supplies as reflected by lack of stock-outs

Supplies, equipment, consumables are available where they are needed and in the amount needed
see Immunization services – logistics
Staff monitor status and stock of supplies, equipment, and consumables when visiting sub-national,
service delivery areas
see Immunization services – logistics
Vaccine forecasting
see Immunization services – vaccine supply and quality
Vaccine utilization and wastage monitoring

see Immunization services – vaccine supply and quality
CB indicators
Number of days spent by national management team members in districts – proxy for assessing
supervision of sub-national level activities and district micro-planning

Guidelines for supervisors of health workers and other personnel in the system have been issued
see Health system – human resource development
Supervisors are able to provide the administrative and technical support needed
Strengthening human and institutional resources – proposed CB indicators
CB indicators
Percentage of total staff at each level that have received training in past two years, including the specifics
of those training activities

All staff have the knowledge and skills they need to do their jobs
CB indicators
National training plan developed, funded, implemented

Existence of a multi-year national health plan and budget for the current year
CB indicators
Adequacy of staffing (country to define specific levels), as defined by the rate of staff turnover at all
relevant levels

Personnel in all locations meet national staffing needs and standards
There are enough staff with the appropriate skills to meet needs in all locations

Immunization services operations/service provision – proposed CB indicators
CB indicators
Suggest using indicators included in the CAT for the five components of service delivery

All indicators overlap
see Immunization services

Annex
6
Financial Sustainability
Diagnostic Tool (FSDT)
This annex is adapted from the "Guidelines for preparing a National Immunization Program Financial
Sustainability Plan" prepared by the GAVI Financing Task Force (FTF), and includes information on the
Financial Sustainability Diagnostic Tool (FSDT), developed by the Access to Technologies Team (ATT).
Introduction to the FSDT
Countries receiving funding from GAVI through the Vaccine Fund are required to prepare financial
sustainability plans at the end of the second year. The Financial Sustainability Diagnostic Tool (FSDT) is
designed to facilitate the process of preparing Financial Sustainability Plans.
Countries could use the FSDT to diagnose their current situation in the areas defined in the Financial
Sustainability Plan guidelines, and thus guide the development and implementation of the Financial
Sustainability Plan.
The FSDT is a qualitative tool, based on possible key benchmarks for financial sustainability of
immunization programmes. From the results of the assessment, countries should be able to: identify the
strengths of the current financing of immunization programmes, highlight areas for further improvement,
and identify what type of capacity building is required to prepare and implement viable Financial
Sustainability Plans.
Objectives of the FSDT

This tool is intended to:
• assess the current level of financial sustainability of countries to monitor progress toward financial
sustainability and better management of national immunization programmes within health sector
development, using simple qualitative indicators
• assess the country capacity to formulate and implement a Financial Sustainability Plan using the
framework provided by the guidelines for Financial Sustainability Plan preparation developed by
the GAVI FTF
• help identify the strengths of countries current immunization programmes and highlight areas
for further improvement in achieving financial sustainability, prior to submission of Financial
Sustainability Plans
• provide guidance and information on technical assistance and training needed to support and
develop current immunization financing systems, structures, staffing and strategies.

Methodology of the FSDT
The FSDT is linked to the Financial Sustainability Plan guidelines and the overall objectives of the key
components. The FSDT appears as an annex to the Financial Sustainability Plan guidelines.
The tool should be used as best suited to country needs. For many countries, this might mean a jointly
conducted diagnosis at the outset of the financial sustainability plan development process with external
experts, as well as the internal core expert team. Other countries might opt to use the tool as a self-
assessment tool.
The FSDT is formulated as a questionnaire, including guiding criteria and possible sources of information.
All questions lead in to straight “Yes” or “No” answers. Following the completion of the FSDT, conclusions
and recommendations should be drawn, summarizing the country’s strengths, the areas susceptible to
improvement and indicating possible needs for capacity building and/or technical assistance where
required.
The FSDT would be completed through a series of interviews with all relevant stakeholders both at
national, sub-national and operational level. These stakeholders include, amongst others, Ministry of
Health (national immunization staff, planning department within the Ministry of Health), Ministry of
Finance (departments responsible for planning, budgeting, expense control, HIPC/PRSP), Ministry of
Planning, ICC members and other partners. The answers should be validated where possible. Sources of
validation could be the national budget, minutes of meetings of the ICC, public expenditure reviews,
immunization costing and financing studies.
A maximum of one week should be estimated to complete the FSDT, including the drawing up of
conclusions, recommendations and a work plan for developing the Financial Sustainability Plan.

Acronyms
EPI Expanded Programme on Immunization
FIC Fully Immunized Child
GDP Gross Domestic Product
Hep B Hepatitis B Vaccine
Hib Haemophiylus Influenzae Type B Vaccine
HIPC II/PRSP Heavily Indebted Poor Countries II / Poverty Reduction Strategy Paper
HIV/AIDS Human Immunodeficiency Virus / Auto-Immune Deficiency Syndrome
ICC Interagency Coordinating Committee
MoF Ministry of Finance
MoH Ministry of Health
NIDs National Immunization Days
NIP National Immunization Programme
SWAP Sector Wide Approach
TB Tuberculosis
VVM Vaccine Vial Monitor

Financial Sustainability Country ........................... Assessment performed by ...........................
Diagnostic Tool (FSDT)
90
Date of assessment ........................... Points of contact ...........................
1.00 Country and health system context

What are the current conditions and planned changes in the public sector organization and financing that are likely to
have an important effect on the the financial sustainability of the immunization programme?
Contributors to this section should include: Ministry of Finance, Ministry of Health and Leading Donor Agencies
Questions Answers Guiding criteria Remarks
1.01 Is immunization coverage a major development indicator ■ Yes

within the current health system? ■ No
1.02 Has a multi-year plan been developed for the health ■ Yes
sector? ■ No
1.03 Does the government budget contain vaccine and/or ■ Yes

other immunization line items? ■ No
1.04 Have potential health sector programme priorities that ■ Yes – HIV/AIDS
could impact funds for the NIP been foreseen in the ■ No – TB
budget allocation process? – Malaria
– Curative healthcare
– Others
1.05 Has the potential impact of public/health system ■ Yes – Decentralization

organization on the funding of the NIP been taken into ■ No – Integration
account by the national immunization manager in – Contracting with the
budgeting and funding of the programme? private sector
– Others
There is an MS Word version of this form on the CD. If you need to, you can edit or amend it for the country you are assessing. a Look for Form FSDT
1.06 Are there any planned public/health reforms under way ■ Yes – SWAps
in how priorities are set within national or financing ■ No – Public/private partnerships
partner budgets that would have important implications – Others
for the immunization programme?
1.07 Are there any planned changes in the financing strategy ■ Yes – Social insurance
or financing mechanisms to fund the health system that ■ No – Private insurance
are likely to have a positive impact on the funding of – Community financing
the NIP? – Payroll taxes
– Others
1.08 Are there any macroeconomic issues facing the country ■ Yes – Economic growth
that are expected to positively affect the future funding ■ No – Debt relief
of the NIP? – Inflation
– Other
1.09 Is there an adequate remuneration system in place to ■ Yes * When due: depending on
ensure motivation of health staff so that salary, perdiem, ■ No contractual agreements
and travel allowances are paid when due*? e.g. weekly, monthly
1.10 Have the full-time national immunization manager and ■ Yes

full-time national cold store manager been in place for ■ No
at least a year?
91
2.00 Financial management
What constraints do budgeting, financial management, disbursement and procurement systems place on the financial
92
sustainability of the immunization programme?
Contributors to this section should include: Ministry of Health Finance Department and/or Ministry of Finance
2.01 Are accounting policies and account code classifications ■ Yes

published and applied? ■ No
2.02 Is the national budget approved within 3 months of the ■ Yes

start of the financial year? ■ No
2.03 Is the requested budget consistent with the allocated ■ Yes

budget to the level of at least 75%? ■ No
2.04 Is immunization expenditure tracking carried out within ■ Yes

3 months after close of the quarter? ■ No
2.05 Are all donor funds released within 3 months after ■ Yes
request? ■ No
2.06 Are government funds released within 3 months after ■ Yes

request? ■ No
2.07 Are requested funds available at health delivery level ■ Yes

within 3 months of due date? ■ No
3.00 Programme characteristics, objectives and strategies
What are the programme objectives that form the basis for the financing requirements of the immunization programme
over the coming five to seven years?
Contributors to this section should include: Ministry of Health National Immunization Programme
3.01 Are there specific plans to introduce new antigens to ■ Yes – Hep B
the NIP over the next 5–7 years? ■ No – Hib
– Yellow Fever
– Other
3.02 Are there specific plans to introduce different ■ Yes – Quadravalent

formulations of standard antigens over the next 5–7 ■ No – Pentavalent
years? – Other
3.03 Are there any planned programme improvements to the ■ Yes – Cold chain improvements
NIP over the next 5–7 years? ■ No and expansion
– Reducing wastage
– Using auto destruct or
Uniject syringes
3.04 Are there any specific plans to increase immunization ■ Yes

coverage in hard to reach areas and/or specific ■ No
population sub-groups?
3.05 Are there any pending changes in the range of ■ Yes – Donors
development partners that are likely to increase financial ■ No – Private sector
participation? – Technical cooperation agencies
– Bilateral agencies
– Multilateral agencies
– Other
93
3.06 Are all planned changes to the NIP, their budget ■ Yes
implications and potential funding sources approved by ■ No
national authorities and partners prior to inclusion in the
multi-year plan?
4.00 Baseline and current programme costs and financing
Can the country provide a detailed picture of programme specific current funding requirements for the
94
immunization programme?
Contributors to this section should include: Ministry of Health National Immunization Programme, Ministry of Health Planning
Department, Ministry of Finance
4.01 Are the costing and budgeting requirements of all ■ Yes – Routine immunization
immunization strategies included in the current NIP? ■ No – NIDs
– Mop ups
4.02 Does the current immunization budget include a ■ Yes – Vaccines

recurrent (operational) cost breakdown? ■ No – Injection supplies
– Personnel
– Cold chain maintenance
– Transport
– Social mobilization
– Short-term training
– Surveillance and monitoring
4.03 Does the current immunization budget include a capital ■ Yes – Transport
cost breakdown? ■ No – Cold chain equipment
– Building space
– Long-term training
– Other
4.04 Does the current immunization budget include a cost ■ Yes – Recruitment costs
breakdown of immunization health staff? ■ No – Salaries
– Perdiems
– Incentives
4.05 Is the total current funding for the NIP known by ■ Yes – National government
funding source? ■ No – Sub-national government
– Lenders
– Donors
– Other
4.06 Is there an annual review of the immunization ■ Yes – MoH

programme funding and expenditures by those ■ No – MoF
responsible for the planning, budgeting and resource – ICC
mobilization process within the health sector? – Other
4.07 Is the immunization budget formulated using recent ■ Yes – Transport operating costs
costing data and/or formulas? ■ No – Vaccines
– Injection supplies
95
5.00 Future resource requirements and programme financing
Given resource requirements and funding probabilities, what is the likelihood of the funding gap being filled?
96
Department, Ministry of Finance, ICC partners
5.01 Have costing and budgeting calculations been made for ■ Yes – Routine immunization
improving immunization strategies of the NIP over the ■ No – NIDs
next 5 years? – Mop ups
5.02 Has a 5 year immunization budget been developed ■ Yes – Vaccines

including a recurrent (operational) cost breakdown? ■ No – Injection supplies
– Personnel
– Cold chain maintenance
– Transport
– Social mobilization
– Short-term training
– Surveillance and monitoring
5.03 Has a breakdown of the immunization programme ■ Yes – Transport

capital cost requirements been calculated for the next ■ No – Cold chain equipment
5 years? – Building space
– Long-term training
– Other
5.04 Have costing and budgeting calculations been made for ■ Yes – Cold chain improvements and
improving the efficiency of the NIP over the next 5 years? ■ No expansion
– Reducing wastage
– Using auto destruct or Uniject
syringes
– Other
5.05 Have costing and budgeting calculations been made for ■ Yes – Hep B
adding new antigens to the NIP over the next 5 years? ■ No – Hib
– Yellow Fever
– Other
5.06 Have costing and budgeting estimates been made for ■ Yes – Outreach costs
increasing immunization coverage of population groups or ■ No – Staff incentives
geographic areas that are below the national average? – Perdiems
– Other
5.07 Have costing and budgeting estimates for health staff ■ Yes – Recruitment costs
been made in line with increasing coverage targets over ■ No – Salaries
the next 5 years? – Perdiems
– Incentives
5.08 Is the total funding requirement for the immunization ■ Yes – National government
programme by funding source known for the next 5 years? ■ No – Sub-national government
– Lenders
– Donors
– Other
5.09 Are government funds for the immunization programme ■ Yes

predictable for up to 5 years? ■ No
5.10 Are donor funds for the immunization programme ■ Yes

predictable for up to 5 years? ■ No
5.11 Is there an estimate for the potential funding gap for ■ Yes
immunization for the next 5 years? ■ No
97
98
5.12 Is there any indication of changes in funding priorities of ■ Yes
national or external funding partners that are likely to ■ No
have positive affect on the funding of the immunization
programme?
5.13 Are new sources and mechanisms of internal and ■ Yes – HIPC II/PRSP
external funding being considered for future funding of ■ No – New donors
the immunization programme? – Vaccine independence initiative
– Revolving funds
– Health insurance
– Other
6.00 Sustainable financing strategic plan and indicators
What are the main issues and problems impeding financial sustainability, actions that will be taken to address the issues
and problems, and the indicators and targets that will be used to monitor and evaluate the actions?
Department, Ministry of Finance, ICC partners
6.01 Has a formal plan been developed and endorsed by the ■ Yes
MoF detailing an increase in the government’s share of ■ No
funding for the NIP?
6.02 Are there any contingency plans or immunization ■ Yes – Prioritization of activities
reserve mechanisms in place to deal with possible ■ No – Limited introduction of
resource constraints? new antigens
– Other
6.03 Has a long-term (5–10 years) capital financing plan ■ Yes

including all funding sources for the NIP been developed ■ No
and endorsed by the ICC?
6.04 Has a formal plan for the purchase of vaccines and AD ■ Yes
syringes been developed and endorsed by the ICC for ■ No
the period of post vaccine fund support?
6.05 Has a formal plan been developed and endorsed by the ■ Yes * Polio funds are often used to
ICC addressing possible funding shortfalls as a result of ■ No simultaneously strengthen
completion of the polio eradication programme*? the routine programme
6.06 Has a multi-year plan for resource mobilization been ■ Yes

developed and endorsed by the ICC? ■ No
99
100
6.07 Does the multi-year plan include cost saving measures to ■ Yes – Reducing wastage
optimize the use of vaccines and immunization- related ■ No – Using VVM
supplies? – Rationalizing sessions
– Stock control
– Preventive maintenance
– Other
6.08 Does the multi-year plan include indicators to measure ■ Yes – Cost per FIC
the efficient use of resources? ■ No – Other
6.09 Were at least 75% of the recommendations of the last ■ Yes

national review of the NIP on efficiency and financing ■ No
implemented?
6.10 Are there selected indicators to monitor progress made ■ Yes – % increase in national
in terms of sustainable financing? ■ No expenditure on NIP as a
share of GDP after
adjustment for debt service
over the next 5 years
programme specific costs
– Depreciation schedule for
replacing capital items
– % increase in secured
funding for the NIP
– % decrease in the NIP
funding gap
– Other
7.00 Stakeholder comments
Is the Financial Sustainability Plan consistent with the ICC members’ perspectives?
Contributors to this section should include: Ministry of Health – Finance and/or Planning Department, Ministry of Finance,
other ICC partners
7.01 Are the major stakeholders of the NIP represented in the ■ Yes – MoF, MoP, MoH
ICC? ■ No – Donors
– Development banks
– International agencies
– Other
7.02 Has the current immunization work plan been approved ■ Yes
by the ICC? ■ No
7.03 Is the ICC operational, with a least 2 meetings a year for ■ Yes
which meeting notes are available and Terms of ■ No
Reference exist?
7.04 Are the roles and responsibilities of the ICC and ■ Yes – Monitor NIP progress
individual members, in the planned implementation of ■ No – Approve annual work plans
the Financial Sustainability Plan, appropriate and well – Approve multi-year plan
defined? – Advocacy for funding
– Addressing financial
sustainability of the NIP
– Other
7.05 Is the tracking of resources for the NIP organized by both ■ Yes
ICC members, as well as staff from the MoH and MoF? ■ No
101
102
7.06 Are the funding priorities of ICC member institutions ■ Yes
consistent with the Financial Sustainability Plan? ■ No
7.07 Is there a comprehensive list of actions to be taken by ■ Yes

the government and by ICC members to move toward ■ No
the achievement of the FS?
7.08 Are diagnoses of financial sustainability issues and the ■ Yes

strategies to address constraints and opportunities in ■ No
the Financial Sustainability Plan considered by the ICC to
be appropriate and realistic?
Annex
7
New Vaccine Discussion Guide
Use this Data Collection Guide if you have been asked to assess the feasibility of introducing a new
vaccine into the national immunization programme. Talk with epidemiologists and health managers in
the Ministry of Health to get information from a national perspective.
Checklists for new vaccine introduction, guidelines for new vaccine disease burden assessment, and
guidelines for planning the introduction of new vaccines are available from WHO and UNICEF.
To further assess the capacity of the system to introduce and sustain the new vaccine, you will also need
to consider data on the immunization services components and the health system.
?
Question: What is known about the disease?
Discussion points
Ask clinicians whether they have ever seen the disease and whether they think
it’s an important public health problem.
?
Question: What are the disease burden estimates?
Discussion points
Ask for a copy of any disease burden studies for this disease that have been
made in the country.
?
Question: Do staff members believe it to be important to public health?
Discussion points
Ask managers what they know about the disease – is it a public health
problem?
?
Question: What is known about the new vaccine? Is it seen as beneficial?
Discussion points
Ask epidemiologists what they think the benefits and shortcomings of the new
vaccine are.

Annex
8
Glossary and abbreviations
Several definitions have been adapted from WHO’s Health Promotion Glossary and Family Planning
Management Terms, Management Sciences for Health, 1996.
Advocacy
individual and social actions designed to gain political commitment, social acceptance, and organizational
and system support for a particular health goal or programme
Capacity
the ability of individuals, organizations, and systems to perform effectively and efficiently. Also, their
potential to perform
Communication
informing the public about health concerns and keeping important health issues on the public agenda.
Includes health promotion, health education, and social mobilization
Components
the five parts of the immunization services. These are:
• immunization service delivery
• disease surveillance
• logistics
• vaccine supply and quality
• advocacy and communications
Development partners
private and public, national and multinational organizations that offer technical, management, and
financial support to developing countries
monitoring disease incidence, record keeping, reporting, and laboratory testing
Equity
fairness – all people have an equal opportunity to develop and maintain their health
External environment
the political, economic, social, and technological forces, trends, and stakeholders that have an impact
on services

Functions
the actions a system is intended to perform. In this assessment methodology, the health system functions
examined are:
• stewardship
• human resource development
• finance
• service provision
Immunization service delivery

the strategies and activities involved in providing vaccinations to clients
Indicator
a quantitative or qualitative statement that provides a basis for measuring progress towards objectives
Innovation
a new vaccine or technology introduced or considered for introduction into immunization operations,
for example, injection equipment
Logistics
• the delivery of vaccines and other equipment in good condition to the place of use
• transport
• maintenance of the cold chain
• communications
• vaccine management
• waste disposal
Stakeholder
any person, group, or organization with an interest in an activity or service. Stakeholders include clients,
health workers, the public, politicians, and development partners
Stewardship
the careful and responsible management of the public’s health, and of the individuals and organizations
that provide health services
SWOT analysis
strengths, weaknesses, opportunities, and threats – an analysis technique that involves specifying the
strengths and weaknesses of an organization’s performance and the external opportunities and threats
that may have an impact on it
Sustainability
the ability of an organization to:
• provide quality services to its clients
• increase or maintain demand for services
• expand services to reach people who are not currently reached
• generate financial resources

Vaccine supply and quality
stock management, wastage monitoring, and the procurement of vaccines from manufacturers
Abbreviations
AEFI Adverse events following immunization
CB Capacity building
EPI Expanded Programme on Immunization
FIC Fully Immunized Child
FSDT Financial Sustainability Diagnostic Tool
GAVI Global Alliance for Vaccines and Immunization
GDP Gross Domestic Product
Hep B Hepatitis B vaccine
Hib Haemophilus Influenzae Type B vaccine
HIPC/PRSP Heavily indebted poor countries II/Poverty reduction strategy paper
HIV/AIDS Human Immunodeficiency Virus / Auto-Immune Deficiency Syndrome
ICC Interagency Coordinating Committee
MoF Ministry of Finance
MOH Ministry of Health
NGO Non-governmental organization
NIDs National immunization days
NIP National immunization programme
NRA National Regulatory Authority
SWAPS Sector Wide Approach Processes
SWOT Strengths, Weaknesses, Opportunities, Threats
TB Tuberculosis
VVM Vaccine vial monitor


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WHO/IVB/04.

World Health Organization

The Common Assessment Tool

This document was jointly produced by the

This document is available on the Internet at:

Copies may be requested from:

Fax: +41 22 791 4227 Email: vaccines@who.int

© World Health Organization 2002

The mention of specific companies or of certain manufacturers’ products does not

About this booklet 5

Forms in this booklet 6

1 The Common Assessment Tool (CAT) for Immunization Services 7

What is the CAT for? 7

Using the methodology for planning 7

Who is the CAT for? 7

Why do we need the new CAT? 8

2 The assessment approach 11

Comparing the new methodology with earlier approaches 12

Why take a health system approach? 14

The three elements of the assessment 17

3 The assessment process 19

Step 1 Initiating the assessment 22

Step 2 Preparing for the assessment 30

Step 3 Planning data collection 33

Step 4 Collecting data 38

Step 5 Analysing findings and developing recommendations 43

Step 7 Planning for implementation and monitoring 49

Annex 1 Key indicators 51

Annex 2 Conducting a SWOT analysis 59

What to look for under each component of the SWOT analysis 60

Annex 4 Incorporating the assessment recommendations into the national plan 67

Annex 4a Identifying activities needed to achieve targets and objectives 71

Annex 4b Estimating costs and funding sources 75

Annex 4c Summarizing projected costs of the immunization programme

Common Assessment Tool for Immunization Services

Capacity building must maintain and develop existing abilities 84

Capacity building indicators 84

Annex 6 Financial Sustainability Diagnostic Tool (FSDT) 87

Objectives of the FSDT 87

Methodology of the FSDT 88

Annex 7 New Vaccine Discussion Guide 103

Annex 8 Glossary and abbreviations 105

Common Assessment Tool for Immunization Services

• details of why it’s important to take account of health system functions

• detailed instructions for carrying out an assessment using the Common

• detailed instructions for analysing the data you collect

• detailed instructions for making recommendations on how immunization

Common Assessment Tool for Immunization Services

Form title Form reference Page

Summary of SWOT analysis Form 1.1 61

Data Collection Guide

Data Collection Guide

Estimated costs and funding sources

Estimated costs and funding sources

Summary of projected costs (five year period)

Summary of projected costs (five year period)

Financial Sustainability Diagnostic Tool

Common Assessment Tool for Immunization Services

What is the CAT?

What is the CAT for?

Development partners are public and private, national and

Using the methodology for planning

• improve the quality of immunization services