Rapid assessment to evaluate the defaulter tracing program for under five children immunization services in Rumphi district
Abstract
EXECUTIVE SUMMARY
Type of Study:Amixed methods study where retrospective data will be used and prospective data will be collected as well.Mixed quantitative and qualitative methods will be used.Secondary analysis of Ministry of Health(MOH)routineExpanded Programme on Immunisation
(EPI)administrative datawill be conducted.
Background:The MOHwith funding fromUNICEF has been implementing acommunity-based defaulter tracing program in Rumphi districtto improveequity and effectiveness of the immunization program.Thedefaulterprogramhas two approaches, one usingmother care group volunteers(MCGs)andthe other one usesreligious institutionsin the communities.It is anticipated that the defaulter program willincreaseproportionof fully immunized children and vaccination coverage in under-five childrenin the district. However,after implementing the program since August 2019,there is need to systematically evaluate theperformanceof the defaulter programin the districtregardingits impactand toinformtheimplementersand policy makerson areas requiring improvementsand strengthening.
Main Objective:Evaluatethe performanceand impactof theMOH community-baseddefaulter programfor routine immunization in under-five childrenbeingimplemented byMCGs volunteers and religious institutionsinRumphidistrict.
Methods:Wepropose toconductsecondary analysis of MOH routine EPIquantitative administrative data from 2018 to date toestablishthe immunization coverage trendsin the
districtbefore and after the defaulter tracing program.We will also conductcross-sectional quantitative and qualitativeevaluation assessments.Theassessmentswill be conductedin4 randomly sampled health facilities, 2 from each of the implementation approaches(MCGs and religious institutions).Based on vaccination coverage performance,2 health facilities(one best EPI performing and one poor EPI performing health facility)will be randomly chosen from the listof facilitiesfor each approach.For the quantitative component, we willconduct exit interviews with child caregivers.We willenrol30 participants using simple randomsampling from each of the 4 selected facilities.For the qualitative component, we will conduct10focus group discussions (FGDs).The FGDs will be conducted as follows: a)Twowill be with child caregivers of under-immunised children attending therandomly sampled2low performing facilities, one from each approach b) Two will be with child caregivers of under-immunised children from communities of the 2low performing facilities, one from each approach c) One will be with MCGs who will be randomly sampled from a list of MCG volunteers d) One will be with religious volunteers who will be randomly sampled from a list of religious groups volunteersand e) Four will be with health workers from each of the 4 sampled health facilities.Each FGD will be comprised of 6-8participants.Wealso propose to conduct 8in-depth interviews (IDIs)with key informantsselectedpurposively.These will includedistrict EPI and community health coordinators,DEHO orAEHOs,health facility EPI focal personsor seniorHSAs. The exit interviews,FGDs and IDIs with key informants will be employed toobtain information ondefaulter program includingknowledge of the program,it’sstructure and systems, best practices,lessonslearnt, implementation strengths, challenges and recommendations.All qualitative interviews will be digitally-recorded and transcribed verbatim, coded and thematic analysis will beconducted.Quantitative data will be analysed using statistical software packages.
Expectedfindings and dissemination: Weexpect thisevaluationtoprovide information on vaccinationcoveragetrends before and after the defaulter tracing program for immunization in Rumphi district to assess impact. In addition, the evaluation will document andprovide information on the currentimplementationstructuresand systems, best practices,lessons learnt, strengths and challenges of the defaulter tracing program. Theinformationwillguide implementers and policy makerson the areas requiringstrengthening andimprovementforthe program.It is planned that the findingswill be shared with College of Medicine Research and Ethics Committee, MOHand presented at college, national and/or international research dissemination conferences and will be publishedin peer-reviewed journals.