Monitoring and supervision

Monitoring

A good microplan includes procedures for monitoring and supervision, to ensure that regular visits are made to immunization sites to quickly identify and correct problems. Work plan and monitoring forms for routine immunizations in the WHO publication Microplanning for Immunization Service Delivery Using the Reaching Every District (RED) Strategy can be adapted for HPV vaccination programs.

Vaccine Introduction Guidelines from WHO includes an annex entitled “Checklist for post-introduction evaluation,” which offers suggestions for reviewing records and forms, vaccination coverage, and vaccine wastage through routine reporting systems. It also provides advice for supervisors when they make field visits, such as monitoring the use of syringe safety boxes, making sure that safe injection practices are followed, and assessing community acceptance of vaccination.

WHO recommends a more formalized evaluation of new vaccine introduction programs and recently published a tool for this purpose, the New Vaccine Post-Introduction Evaluation (PIE) Tool. Its purpose is to assist immunization managers in countries that have introduced a new vaccine by providing a systematic method for evaluating the implementation of the introduction and its impact on the existing immunization system in the country.

Another source of information and sample forms for monitoring is Immunization in Practice Module 7: Monitoring and Using Your Data from WHO.

Supportive supervision

A comprehensive monitoring and supportive supervision plan should be developed (ideally during training and microplanning activities) and implemented under the direction of the district health authorities. Monitoring and supportive supervision strengthens the capacities of health workers and improves performance; visits can be used to provide feedback, update health staff on HPV and other vaccinations, enhance motivation, and identify training needs.

According to the Guidelines for Implementing Supportive Supervision (developed by PATH with information from WHO, UNICEF, the Pan American Health Organization, and USAID), “A cornerstone of supportive supervision is working with health staff to establish goals, monitor performance, identify and correct problems, and proactively improve the quality of service. Together, the supervisor and health workers identify and address weaknesses on the spot, thus preventing poor practices from becoming routine. Supervisory visits are also an opportunity to recognize good practices and help health workers to maintain their high level of performance.” Managers can refer to this document, national EPI guidelines, and WHO’s Vaccine Introduction Guidelines to develop effective supervisory programs.

Photo: David Jacobs