Title: Planning immunisation program
Course: Level 3 - Immunization > Section: Plan and monitor an immunisation program

Planning for routine immunisation is a continuous process of analysing data, evaluating progress and constraints and making decisions about reaching program objectives.

An effective immunisation plan for any health information needs collection of some basic information like:

- The total population of your local area (kebele) and target population for immunisation.
- Kebele map showing important features in your local area.
- Details of infrastructure in the area and energy sources of the community.
- Partners in the kebele who may assist you, for example. associations, NGOs, etc.

Steps in Planning

There are six basic steps in planning process (in this case planning immunisation program). These are:

1. Need assessment: is identifying and understanding the health needs of your community in relation to immunisation services. It also includes identification of any problems and their possible causes that make it harder to meet those needs. For example, possible problems that may need to be addressed to increase your immunisation coverage in your local kebele may include: Road access to the health post, immunisation only given on certain days, low vaccine supply, high dropout rates etc.
2. Prioritise problems: it means, after identifying problems, ranking them in their order of importance or urgency. It is impossible to solve all problems at once because there are always many resource constraints. In order to select your priority activities in this case, with the aim of reducing vaccine-preventable diseases through delivery of an effective immunisation program, you may prioritise the identified problems based on the following criteria.
  - Magnitude of the problem: what percentage of the population is at high risk of developing the disease, or is already affected by it?.
  - The severity of the problem: how serious is the disease in question, regarding its impact on health and the risk of death?.
  - Socioeconomic impact of solving the problem: how will the social and economic circumstances of individuals, families and the community benefit if immunisation coverage increases?.
  - Feasibility of tackling the problem: do solutions exist, and is it realistic to increase immunisation coverage with the available technical resources, personnel and organisational capabilities?
  - Affordability of tackling the problem: is the financial support adequate for an improved immunisation program?.
  - Acceptability to the beneficiaries of tackling the problem in the ways suggested: does it meet community and government concerns?.
3. Setting goals and objectives: after prioritising the identified problems, the next step you should do is setting SMART (S-Specific, M-Measurable, A-Achievable, R-Relevant and T-Time bound) objectives for each problem you prioritised in order to progress towards your overall goal. For example, one possible objective of an improved immunisation program might be: To achieve 90% coverage of all eligible children in the catchment area with the third dose of PCV10 by the end of the year.
4. Developing a strategy: Developing the strategy for the stated objectives means working out the methods you will use and the activities you will undertake, and writing a clearly stated action plan. The action plan should include every activity to be performed during the year, the time when that activity is to be done, who will do it, how that person (or people) will do it, and what resources will be needed. In developing your action plan, you should ensure that your strategy and activities are relevant to resolving the identified problems, and that they are technically feasible, financially affordable and acceptable to the community.
5. Implementation of the action plan: Before implementing your action plan, you need to communicate to all stakeholders at community level, your supervisor and the woreda health office. You should arrange a meeting with local government administration officials, community leaders and community volunteers to discuss your plan and gain their approval and support. Once approved, it is your responsibility to implement the plan. You have to keep all stakeholders well informed about progress during the year, so that you can agree on a solution to any problems you encounter during the implementation period.
Fig 8.1. Approval for your action plans from local officials and community leaders.

6. Monitoring and Evaluation: Monitoring is the systematic and routine collection of information beginning in the planning stage of a project or program. Monitoring allows results, processes and experiences to be documented and used as a basis to steer decision-making and learning processes. Monitoring is checking progress against plans. Evaluation is assessing, as systematically and objectively as possible, a completed project or program (or a phase of an ongoing project or program that has been completed). Evaluations appraise data and information that inform strategic decisions, thus improving the project or program in the future. The main EPI indicators of progress that are commonly used to monitor and evaluate immunisation program are:
  - Immunisation coverage rate for each vaccine, i.e. the percentage of all eligible children who have received all doses of a vaccine under one year of age, according to the EPI schedule.
  - Percentage of fully immunised children aged under one year, who have received all recommended doses of all vaccines (including measles vaccine at age 9 to 11 months), according to the EPI schedule.
  - Percentage of pregnant women with adequate TT doses, defined as receiving any of TT3, TT4 or TT5. This indicator is often abbreviated to TT2+ (because more than two doses of TT vaccine have been given).
  - Percentage of children protected at birth (PAB) from neonatal tetanus, because their mother received a valid dose of TT2+ vaccination at least two weeks before delivery.
  - Dropout rates: the percentage of children and mothers not completing all the scheduled EPI immunisations.