Annex 7a. Evaluation of routine second dose measles vaccination (health facility based implementation)

Transcription

1 Annexes Annex 7a. Evaluation of routine second dose measles vaccination (health facility based implementation) Appendix 1.1: Questionnaire Central/regional/district Date of interview.... Name of interviewer.... This questionnaire was conducted at: (insert name of country, region or district) Central level.... Regional level.... District level.... Name (s) and title (s) of person(s) interviewed during the same interview session. Please list all people that you interviewed during the same session. Please fill out a separate form for each interview. The EPI Manager/person responsible for vaccinations (or their deputy) should be interviewed. Name.... Title.... Name.... Title.... Name.... Title.... Contact details of most senior person: Telephone.... address.... 1

2 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Documents to ask for at beginning of interview (check appropriate boxes) Document/data Copy of national immunization schedule (central level only) Copy of policy on 2 nd dose measles vaccination Introduction Plan for 2 nd dose measles vaccine Training materials/reference documents utilized at 2 nd dose measles vaccine training Vaccine management guidelines Media campaign/social mobilization/education materials (brochures, posters, pamphlets, etc) for 2 nd dose measles vaccine Vaccine Stock Records Supervisors book/site visit reports (regional and district level only) Injection safety/waste management policy document Wastage reports AEFI protocol/reporting form AEFI logbook/registry Surveillance data/bulletin on measles National coverage and drop out rates (central level) Document received Document reported to exist but not available at time of interview Document does not exist 2

3 Annexes KEY TO ABBREVIATION FOR CATEGORY = Generic questions should be included in all evaluations -C = Questions to be asked at the central level only These questions are shaded in grey -C&R = Questions to be asked at the central and regional level only These questions are shaded in grey -D = Questions to be asked at the district level only These questions are shaded in grey Category Questions Comments BACKGROUND INFORMATION 1) Date routine 2 nd dose measles vaccine introduced nationally/ regionally/ district (DD/MM/YYYY)..../..../..../ -C -C -C Note: if interviewing at central level, put date for introduction nationally. If interviewing at regional or district level, put date for regional or district introduction, respectively. 2) Was 2 nd dose measles introduced nationally or phased? 3) What was the measles vaccine coverage rate in the year prior to introduction of 2 nd dose measles vaccination? 4) What factors influenced the decision for introduction of routine 2 nd dose measles vaccine? National introduction (all regions and districts at once) Phased introduction (explain) Coverage rate... Is this rate based on: (check best response) administrative data survey data combination of administrative and survey data Check all that apply Good coverage with 1 st dose measles vaccine. If yes to this response, was there a coverage threshold that was deemed necessary to meet prior to introducing 2 nd dose measles vaccine? Don t know If yes, what was the coverage target?... High coverage of 2 nd dose measles through SIAs, now wanting to strengthen delivery of 2 doses through routine services Based on disease surveillance data, please explain.... A shift in measles incidence to older children Serologic data showing low prevalence of immunity among older children WHO policy recommendations and/or position paper Policy recommendations from other organizations. If so, which organization(s)?... Part of a region-wide decision or directive Availability of funding support Other, please explain... 3

4 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments -C 5) What is the national immunization Copy of schedule received schedule? -C -C -C -C -C -C Note: Ask for a copy of the schedule for all EPI vaccines (central level only) 6) What is the schedule for 1 st and 2 nd dose measles? Is MCV, MR, or MMR used? Note: Insert age when dose 1 is given and age (or age range) or school grade level(s) for dose 2. 7) Are there any policies on the minimum and/or maximum ages for receipt of 1 st and 2 nd doses of measles vaccine? Prompt: min/max age for 1 st dose, min/max age for 2 nd dose 8) Was the schedule for any other vaccine (including measles dose 1) changed when 2 nd dose measles immunization was introduced? 9) What was the rational for the choice of age/age range for dose 2? If target age for 2 nd dose is school aged children, ask what was the rational for choice of health facility based vs. school based program. 10) Is there a policy about a required minimum interval between doses? 11) Do you have any policies on contraindications for vaccination with measles vaccine? Schedule: Dose 1....Dose Type of vaccine used: Dose 1 Measles MR MMR Dose 2 Measles MR MMR Don t know If yes, please specify: 1 st dose, minimum.... maximum nd dose, minimum....maximum.... Don t know If yes, reason changes were made... Rational:... Don t know Don t know If yes, length of interval... Don t know If yes, please specify:... 4

5 Annexes Category Questions Comments -C 12) Are there any policies that require a child s immunization status to be checked prior to being allowed school entry? Yes, up to date vaccinations required for school enrolment and attendance Yes, records checked but child allowed to enroll and start school without up to date vaccinations No checking child s immunization status Don t know If yes to checking, How is this checked and who checks? What is done if the child s vaccinations are not up to date? Prompt: checking child vaccination card, vaccination register at health facility, parental verbal report/ recall, other records. -C 13) Is there a policy about screening the child s measles vaccine status prior to administering the measles vaccine at the target age for the 2 nd dose? 14) If yes, is the child s vaccination card used to screen vaccination status? 15) If yes to screening with child s vaccination card, what is the policy if: 1) The vaccination card is not available at the time of the immunization session and the child is in the age range for receipt of 2 nd dose measles vaccine (and no other records of the child s vaccination status are available)? 2) The vaccination card has no documentation of any previous measles vaccine. 3) The vaccination card indicates the child has already had 2 doses of measles vaccine. Prompt: Child/family is given a letter to take to health facility or health care provider for vaccinations, child/family is verbally instructed to go to health facility or health care provider for vaccinations, child is not allowed to enter school until vaccinations are up to date, varies from school to school no set policy Don t know If yes, what is the policy? Don t know Are registers or other records used to screen vaccination status if vaccination card is not available? Give measles vaccine and tell caregiver to have child return for another dose. Give measles vaccine without further follow-up. Do not vaccinate at this time if no immunization record available. Other, specify Give measles vaccine and tell caregiver to have child return for another dose. Give measles vaccine without further follow-up Other, specify... Give another dose of measles vaccine to ensure that a dose is given in the target age range. Do not vaccinate. Other, specify... 5

6 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments -C 16) Is there a policy about older children (i.e. outside of the target age for 2 nd dose measles vaccine) who have no previous measles vaccination history? Don t know If yes, what is the policy? Prompt: No policy on vaccinating outside the target age group, encourage screening vaccination history of older children (until what age?) and providing missing vaccines. 17) Are other services (e.g. deworming, vitamin A) and/or other immunizations offered at the same time as the 2 nd dose measles vaccine? 18) How do you reach the target age population for 2 nd dose measles vaccination? Does this vary by fixed health facility, outreach and mobile activities? What has been the most and least successful ways to reach this age group i.e. what are your lessons learned? Prompts: Reminding families at the 1 st measles vaccine contact, promotion messages to the community (ask specifically how), active seeking out of children in target age group (ask specifically how). 19) Have certain groups been harder to reach for 2 nd dose measles vaccination? If yes, which groups? If yes, are particular efforts being made to reach these groups? If so, what? Probe to see if low socioeconomic groups, certain ethnic or religious groups might have low 2 nd dose measles coverage rates. Yes, other immunizations. Please indicate what... Yes, other services. Please indicate what... No Don t know If yes, was 2 nd dose measles vaccine introduced at the same time as these other immunizations and/or services started prior to offering these other immunizations and/or services added to existing immunizations and/or services If yes, has offering multiple immunizations/ services been successful or problematic? Please explain:... Don t know If yes, which group(s)... Don t know If yes, please describe... 6

7 Annexes Category Questions Comments 20) Has the introduction of 2 nd dose measles immunization added to staff/ personnel existing workload? Yes, quite a lot Yes, a moderate or small amount No Don t know If yes, please describe 21) Has it been necessary to hire additional people to implement 2 nd dose measles immunization? 22) Have other activities been cut or diminished in order to accommodate this new immunization? If yes, what? Don t know If yes, please describe... Don t know If yes, please list... PRE-IMPLEMENTATION PLANNING AND VACCINE INTRODUCTION PROCESS 23) Do you have a central / regional / district 2 nd measles dose vaccine introduction plan/timeline for introduction activities? -C Note: For example if interviewing someone from the district they may only have a national plan so just check national plan. If they have a national and a district plan check both. Only ask if yes to question above 24) Did you receive technical support to develop your introduction plan? Yes, national plan/timeline Yes, regional plan/timeline Yes, district plan/timeline Interviewer please ask for a copy at time of interview. Review later to ensure essential components are included. No. If no why not?... Yes. If yes from whom?... No Don t know 7

8 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments TRAINING 25) Please describe staff training for 2 nd dose measles vaccine introduction if any. Type of training Cascade Region by Region Other (specify) None Was training conducted before 2 nd dose measles vaccine introduction If yes, how long before... Was training conducted after 2 nd dose measles vaccine introduction If yes, how long after... Was 2 nd dose measles training conducted as a separate training or incorporated into something else? Stand alone Incorporated into training on other topics. List topics... Other (specify)... 26) Was the training successful? Did it meet expectations? Please explain successes and problems. 27) How often is refresher training on measles vaccination offered (either as stand alone or as part of other training)? 28) How often do you think refresher training on measles vaccination should be offered? 29) What educational and reference materials were provided to participants at time of training? Ask for samples How long was the (measles component of the) training?... Who conducted the training at each level? Regions.... District... Health Facilities.... Other comments on training... Very successful Somewhat successful Not very successful Please describe... 8

9 Annexes Category Questions Comments VACCINE COVERAGE 30) What is the target age for 2 nd dose measles immunization? Note: question already asked for central level above, can confirm here. Target age: ) What formula do you use to calculate 1 st and 2 nd dose measles vaccine coverage? What are the sizes of the numerator (doses administered) and denominator (target population) in the last year in your country/region/ district? What are the sources of information for these numbers? 32) What was the coverage of 1 st and 2 nd dose measles vaccine in the last year? 33) What were 1 st and 2 nd dose measles coverage rates for each year since the introduction of 2 nd dose measles vaccine? And what was the coverage of 1 st dose measles in the year prior to the introduction of 2 nd dose measles? 34) What was the drop out rate between 1 st and 2 nd dose measles in the last year? 35) What were the drop out rates in the years since the introduction of 2 nd dose measles vaccine? Formula Numerator source for 1 st dose.... Denominator source for 1 st dose.... Numerator source for 2 nd dose.... Denominator source for 2 nd dose.... Interviewer: Correct formula used? Measles 1 st dose... Measles 2 nd dose.... in...(fill in year) Measles 1 st dose.... in....year (prior to introducing 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (1 st year of introduction of 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (2 nd year of introduction of 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (3 rd year of introduction of 2 nd dose)...etc. Drop out rate....in....year Drop out rate....in....year Drop out rate....in....year Drop out rate....in....year Drop out rate....in....year Interviewer: Calculate drop out rate as follows: MCV1-MCV2 x 100 = % MCV1 Is calculated drop out rate same as drop out rate provided? Don t know 9

10 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments 36) Do you use coverage wall charts at the central / regional / district to monitor coverage and drop out levels? Note: Ask about level of interview (i.e. use at central level for central interviews, etc. Central Don t know Region Don t know District Don t know If wall charts are used, are they used to monitor 2 nd dose measles coverage? 37) What is the policy on what recording forms are to be used to record doses of 2 nd dose measles vaccination that are administered? 38) Were forms revised upon introduction of 2 nd dose measles vaccine? If so, which ones? Ask for samples of the forms 39) Do you have a system for tracking whether a measles vaccine administered to a child in the age range for the 2 nd dose is actually a 1 st dose vs. a 2 nd dose? 40) If yes, in the past year how many/ what percent of children in the target age range for 2 nd dose measles vaccine who received measles vaccination were actually receiving their 1 st dose of measles vaccine Don t know Check all that apply: tally sheets register of recipients child vaccination cards other, specify Don t know If yes, please describe how they were modified Don t know If yes, describe...# of children in the target age range for 2 nd dose measles vaccine who received measles vaccine in the past year that were actually receiving 1 st dose of measles vaccine...% of children in the target age range for 2 nd dose measles vaccine who received measles vaccine in the past year that were actually receiving 1 st dose of measles vaccine Interviewer: Do the recording forms allow for differentiation of whether the child is receiving a 1 st or 2 nd dose of measles and at what age? For example, if a child in the target age group for 2 nd dose measles vaccine had no previous documentation of measles vaccination and this was presumably the 1 st dose of measles vaccine, do the forms allow for clarification that the dose is a 1 st dose and not a 2 nd dose despite the age of the child? Tally sheets: tally sheets not used tally sheets used but n/a Register of recipients: register not used register used but n/a Child vaccination cards: cards not used cards used but n/a Other, specify: form used but n/a 10

11 Annexes Category Questions Comments MEASLES VACCINE SUPPLY 41) How are measles vaccine supply needs calculated? What formula do you use? Is the supply need based on target population, previous vaccine consumption, size of immunization sessions, or other factors? 42) Has the way you calculate measles vaccine supply needs changed since introduction of second dose measles vaccine? Formula: Comments: Basis of projections: target population previous vaccine consumption size of immunization sessions other, describe Don t know If yes, describe 43) Have you had any difficulty accurately predicting measles vaccine supply needs since introduction of 2 nd dose measles vaccine? Please explain. 44) How did the estimated needs change with introduction of 2 nd dose measles vaccine? 45) Did the frequency of vaccine deliveries from your level to the next* change with introduction of 2 nd dose measles vaccine? If yes, by how much? *i.e. depending on who you are interviewing, from central to regional, regional to district, district to health facility 46) Was there any other impact on the distribution schedule? 47) Did you have any stock-outs of any vaccines or vaccine related supplies in the past 6 months? 48) If yes to above, Have stock-outs increased since introduction of 2 nd dose measles vaccine? What was the reason? Note: Probe for the real reason for the stock out. Shortage of vaccine or management problems. 49) Have you had any measles vaccine with VVM in stage III or IV in the last 6 months? If yes, what did you do with these vaccines? 50) Did you have to expand/ make changes to your waste disposal system to accommodate introduction of 2 nd dose measles vaccine? If yes explain. Don t know If yes, describe Don t know If yes, Frequency of delivery before introduction...times/year Frequency of delivery after introduction...times/year Reason for change? Yes, specify No Don t know Yes vaccines (specify)... Yes vaccine supplies (specify)... No If yes, how many weeks.... If yes, reason for stock out.... Yes No If yes, reason.... If yes, action taken.... If yes, describe..../... 11

12 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments MEASLES WASTAGE 51) What formula is used to calculate vaccine wastage and what is the source of the data? Vaccine wastage not calculated Formula: Ask for wastage report Data source, numerator.... Data source, denominator ) What was the measles vaccine wastage rate in the year prior to the introduction of 2 nd dose measles vaccine? 53) What was the measles vaccine wastage rate last year? What were the measles vaccine wastage rates for each year since introduction of 2 nd dose measles vaccine? 54) Did you change anything about the way vaccines are administered to reduce wastage related to the 2 nd dose of measles vaccine? 55) Has vaccine wastage been a concern with the introduction of 2 nd dose measles vaccine? If so, how? Is provided formula correct? Source of data: Stock books Summary sheets Other Measles vaccine wastage rate prior to introduction of 2 nd dose measles vaccine:...% in...year Measles vaccine wastage rate in most recent year:....% Measles vaccine wastage rate each year since introduction of 2 nd dose measles vaccine:...% in....year...% in....year...% in....year...% in....year If yes, what?.... If yes, how?.... COLD CHAIN 56) Discuss any changes you had to make in the cold chain before introduction of the 2 nd dose measles vaccine e.g. expansion? 57) Did you do an assessment of adding 2 nd dose measles vaccination on the cold chain? Yes, explain No Don t know 58) What effect did the adding 2 nd dose measles vaccine have on cold storage space requirements? Note: Try and separate cold chain expansion/replacement of equipment that is part of normal cold chain rehabilitation versus changes specifically for the new vaccine. 12

13 Annexes Category Questions Comments MONITORING AND SUPERVISION 59) Is there a schedule for how often and when immunization supervisory visits should be made to the regional/district/ health facility level? 60) How often do you think immunization supervisory visits should be made to the regional/district/health facility level? 61) Have you or a member of your staff or a partner organization made supervisory visits, to the districts/ health facilities since 2 nd dose measles introduction? If so, how often and by whom? Don t know If yes, how often Regional level.... District level.... Health facility level.... Regional level... District level... Health facility level... Don t know If yes, how often Regional level... District level... Health facility level... By whom:.... -D If yes to previous question 62) Were issues or problems specific to 2 nd dose measles vaccine identified during the site visits? 63) How do supervisors give feedback to sites visited? 64) Are follow up visits conducted with poorly performing sites? 65) Have you received a supervisory visit? If yes, when and by whom? 66) If yes, was the visit helpful in identifying or working out 2 nd dose measles vaccination issues or problems? If no, why? No problems, visits found sites to be on track Generally on track, minor problems or issues identified. Explain:... Some major issues or problems were identified. Explain:... Written Supervisory log book Supervisory checklist Send site visit report Other (specify)... Oral Discussion with staff Other (specify)... When:.... By whom:.... Ask to see a copy of the visit report. Explain:

14 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments ADVERESE EVENTS FOLLING IMMUNIZATION (AEFI) 67) Do you have a system and written protocol for monitoring and reporting AEFIs for all vaccines? Please describe the procedure. If no, why not:.... Ask for a copy of the AEFI protocol and reporting form 68) How many AEFI events were reported in relation measles vaccine in the last 12 months? Please provide the # by age group if possible. Note: Verify using AEFI log book/registry if available 69) How many AEFI events were reported in relation measles vaccine in the year prior to introduction of 2 nd dose measles vaccine? Please provide the # by age group if possible. # in past 12 months total... # among <1 year olds... # among 1 4 year olds... # among >4 year olds... What were the AEFIs?.... How were they handled?.... Able to verify in AEFI log book Not able to verify in AEFI log book AEFI log book not available...# in....year prior to measles vaccine introduction # among <1 year olds... # among 1-4 year olds... # among >4 year olds... What were the AEFIs?.... FINANCING -C 70) Is there a budget line item for immunization in the national budget? Don t know -C 71) If yes, did the budget line change with the introduction of 2 nd dose measles vaccination? 72) Has 2 nd dose measles vaccine been incorporated into your Comprehensive Multi-Year Plan (cmyp)? 73) If no, do you plan to incorporate 2 nd dose measles vaccine into your cmyp? If yes, when? 74) How were start-up costs for 2 nd dose measles immunization financed? Did you receive any additional funds to cover the start-up costs of 2 nd dose measles vaccine? Don t know Don t know Don t know If yes, when.... Don t know If yes, specify from where did the additional funds come from?

15 Annexes Category Questions Comments 75) Were there financial implications of introducing and sustaining the implementation of 2 nd dose of measles vaccine for each of the following areas? Ask about the financial implications of each of the following: Measles vaccine and vaccine-related supplies If yes, specify:.... Cold chain/storage If yes, specify:.... Vaccine transport If yes, specify:.... Transportation of health personnel to outreach sites If yes, specify:.... Wastage If yes, specify:.... Communication materials/media If yes, specify:.... Training If yes, specify:.... Monitoring and Supervision If yes, specify:.... Revision of child health cards, tally sheets, vaccine registries, other related forms If yes, specify:.... -C -C 76) What were the financing sources for measles vaccine prior to introduction of 2 nd dose measles vaccine? Note: List all sources that pay for the vaccine 77) What have been the financing sources for measles vaccine since introduction of 2 nd dose measles vaccine? Note: List all sources that pay for the vaccine Other costs? If yes, specify:

16 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Category Questions Comments SURVEILLANCE AND IMPACT -C&R 78) Do you have measles surveillance? Please describe. Note: Include the number of sites, date started Don t know If yes, describe.... -C&R -C&R Ask for a copies of the surveillance data/ bulletins that date back to before and after 2 nd dose measles vaccine was implemented 79) Have there been any problems with the surveillance? Please describe. 80) Do you plan to conduct a vaccine impact assessment i.e. a study to determine if the 2 nd dose measles vaccine is reducing measles disease burden. Don t know If yes, describe... Don t know If yes, give details... If no, why not?... ADVOCACY & COMMUNICATION 81) Did you use any media outlets or other communication channels to inform/education the community about immunization among the new target age group (for 2 nd dose measles vaccine) and the need for 2 doses of measles vaccine for full protection? Check all that apply and then if checked, please note if interviewee feels use of these outlets were helpful in promoting 2 nd dose measles vaccine. Radio very helpful somewhat helpful not helpful Television very helpful somewhat helpful not helpful Community groups very helpful somewhat helpful not helpful Community leaders very helpful somewhat helpful not helpful Town crier very helpful somewhat helpful not helpful Celebrity very helpful somewhat helpful not helpful Government officials very helpful somewhat helpful not helpful Other (specify).... very helpful somewhat helpful not helpful 82) Did you prepare or distribute any health education material for the community about immunization among the new target age group (for 2 nd dose measles vaccine) and about the need for a 2 nd dose of measles vaccine? Note: Please ask for copies of any materials Main messages.... Tick all that apply and then if checked, please note if interviewee feels use of these outlets were helpful in promoting 2 nd dose measles vaccine. Posters very helpful somewhat helpful not helpful Brochures very helpful somewhat helpful not helpful Flyers very helpful somewhat helpful not helpful Clothing (t-shirts, hats etc.) very helpful somewhat helpful not helpful Other (specify).... very helpful somewhat helpful not helpful 16 Main messages....

17 Annexes Category Questions Comments 83) What has been most and least helpful/ successful for advocacy for 2 nd dose measles vaccine and immunization of children in the target age group for 2 nd dose measles within the community? What advice would you offer regarding promotion messaging, materials and channels to other countries planning on introducing 2 nd dose measles vaccination? Most helpful... Least helpful... Advice to others... ERAL IMPRESSIONS 84) How well has 2 nd dose of measles vaccine been accepted? If there were any issues please comment for each group. Prompts: Was considered to be a safe and effective and needed vaccine New vaccine well accepted Healthcare workers Professional societies Community/public Parents Government Media 85) What effect has the expansion of the immunization schedule to include the target age group for the 2 nd dose measles and the introduction of a 2 nd dose of measles vaccine had on your EPI program? 86) In your opinion has the expansion of the immunization schedule to include the target age group for the 2 nd dose measles and the introduction of a 2 nd dose of measles vaccine been a smooth process or problematic? 87) Other countries will be introducing 2 nd dose measles vaccines soon. What have you learned from this experience and what advice do you have for other countries to ensure a smooth introduction? What have been the main challenges and main lessons learned? Discuss any problems... Please check one that best describes the introduction: Improved the EPI program Please explain... Made the EPI program worse Please explain.... No effect Please explain... Please check one that best describes the introduction: Very smooth, no problems Smooth, minor problems Please explain.... Somewhat smooth, some major problems Please explain.... Not smooth at all, some major problems Please explain.... NOTES AND COMMENTS Record any interesting positive or negative anecdotes or comments by immunization staff. Please note that such information is often most helpful in documenting problems or successes! 17

18 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Appendix 1.2: Questionnaire Health facility Date of interview.... Name of interviewer.... This questionnaire was conducted at: (insert name of country, region or district) Region.... District.... Health facility name.... Type of health facility (check one): Health centre/clinic Health post/outpost Other (specify.... Name (s) and title (s) of person(s) interviewed during the same interview session. Please list all people that you interviewed during the same session. Please fill out a separate form for each interview. EPI Senior Nurse/Healthcare Worker responsible for vaccinations (or their deputy) should be interviewed. Name.... Title.... Name.... Title.... Name.... Title.... Contact details of most senior person: Telephone.... address

19 Annexes Documents to ask for at beginning of interview (check appropriate boxes) Document/data Introduction Plan for 2 nd dose measles vaccine Training materials/reference documents utilized at 2 nd dose measles training Vaccine management guidelines Media campaign/social mobilization/education materials (brochures, posters, pamphlets, etc) Vaccine stock records Supervisors book / site visit reports Injection safety / waste management policy document Wastage reports AEFI protocol / reporting form AEFI logbook/registry Sample child health card/immunization card Immunization logbooks, monitoring forms, tally sheets, vaccine registries Surveillance data/bulletin on measles National coverage and drop out rates (central level) Document received Document reported to exist but not available at time of interview Document unavailable 19

20 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions PRE-IMPLEMENTATATION PLANNING 1) Were you (interviewee) working at this health facility at the time that 2 nd dose measles vaccine was introduced? 2) When was 2 nd dose measles vaccine first administered at this health facility? Comments Interviewer, if no, try and get a staff member who was present when the new vaccine was introduced to participate. If not possible continue with interview but it may not be possible to answer all questions. (MM/YYYY).../.... Don t know TRAINING 3) Please describe health facility staff training for the 2 nd dose measles vaccine introduction if any. How many people from this health facility were trained?... How long was the training for health facility staff?... Did the person from this health facility who was trained train others in the health facility? Don t know Was training conducted before vaccine introduction? If yes, how long before.... Was training conducted after vaccine introduction? If yes, how long after.... 4) Who conducted the training? Where did the training take place? 5) Were 2 nd dose measles vaccine educational and reference materials provided at the time of the training? If yes, are they available? Ask to see samples Other comments on training.... Don t know 20

21 Annexes Questions 6) Overall were you satisfied with the information and skills that the training content provided? Were there any problems with the training? Comments Very satisfied Somewhat satisfied Not very satisfied Please describe... Prompts: Were topics adequately covered? Were all staff in the facility trained? Was enough time allotted? Was it too time intensive? 7) Did the training allow you to confidently administer 2 nd dose measles vaccine to the target population? Yes Somewhat No Please describe.... 8) Do you have any suggestions for other countries that might be introducing 2 nd dose measles vaccine about training or training materials? 9) How often is refresher training on measles vaccination offered (either as stand alone or as part of other training)? 10) How often do you think training updates on measles vaccination should be offered? MONITORING AND SUPERVISION 11) How many times in the past 6 months were you supposed to have you received a vaccination-related supervisory visit from district or regional level or from a partner agency? 12) How many times did you receive a supervisory visit?... One or more visits? Number of visits.... Is there a written copy of the visit? 13) If yes, who visited, and what were the problems identified? Ask to see the supervisory book, copy of last report. Who visited... (job title)... Problems identified.... VACCINE COVERAGE 14) What is the targeted age/age range for 2 nd dose measles immunization? 15) What is the size of the target age population for in this health facility? Target age.... Population of target group.... Source of data ) What is the source of this data? 21

22 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions 17) What formula do you use to calculate 1 st and 2 nd dose measles vaccine coverage? Include the source of the numerator (doses administered) and denominator (target population) 18) What was the coverage of 1 st and 2 nd dose measles vaccine in the last year? 19) What were 1 st and 2 nd dose measles coverage rates for each year since the introduction of 2 nd dose measles vaccine? And what was the coverage of 1 st dose measles in the year prior to the introduction of 2 nd dose measles? Comments Formula Numerator source for 1 st dose.... Denominator source for 1 st dose.... Numerator source for 2 nd dose.... Denominator source for 2 nd dose.... Interviewer: Correct formula used? Measles 1 st dose... Measles 2 nd dose... in...(fill in year) Measles 1 st dose.... in....year (prior to introducing 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (1 st year of introduction of 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (2 nd year of introduction of 2 nd dose) Measles 1 st dose.... Measles 2 nd dose.... in....year (3 rd year of introduction of 2 nd dose) 20) Can you provide coverage of 1 st and 2 nd dose measles vaccine for fixed facility vs. outreach services in the past year? 21) What was the drop out rate between 1 st and 2 nd dose measles in the last year? 22) What were the drop out rates in the years since the introduction of 2 nd dose measles vaccine?...etc. Measles 1 st dose... Measles 2 nd dose... through fixed facility services Measles 1 st dose... Measles 2 nd dose... through outreach services Drop out rate....in....year Don t know Drop out rate....in....year Drop out rate....in....year Drop out rate....in....year Drop out rate....in....year Don t know Interviewer: Calculate drop out rate as follows: MCV1-MCV2 x 100 = % MCV1 Is calculated drop out rate same as drop out rate provided? Don t know 22

23 Annexes Questions 23) Do you use coverage wall charts to monitor coverage and drop out levels? If wall charts are used, are they used to monitor 2 nd dose measles coverage? Comments Don t know If no, why not? If yes, ask to see wall chart. Is data on wall chart complete/up to date? Don t know If no, why not? VACCINE WASTAGE 24) What vial size of measles vaccine do you use? How many doses are contained in the measles vaccine vials that you use? If yes to 10 or 20 dose vials, ask 25) What do you do with open multi-dose vials? Prompt: How long do you store the vial once opened before disposing? 26) What formula is used to calculate vaccine wastage and what is the source of the data? Ask for wastage report Check all that apply 1 dose 10 doses 20 doses Vaccine wastage not calculated Formula: Data source, numerator.... Data source, denominator.... Is provided formula correct? Source of data: Stock books Summary sheets Other 27) What was the measles vaccine wastage rate in the last year? 28) Did you change anything about the way you administer vaccines, to reduce wastage related to the 2 nd dose of measles vaccine? 29) Has vaccine wastage been a concern with the introduction of 2 nd dose measles vaccine? If so, how? 30) Do you ever not administer the vaccine (2 nd dose measles) because of concerns of wastage (for example, not wanting to open a vial for 1 or 2 administrations only)? Wastage report on site? Measles vaccine wastage (most recent year)... If yes, what?.... If yes, how?...., never If yes, how frequently? very infrequently sometimes often 23

24 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions ADMINISTRATION AND DOCUMENTATION 31) Prior to immunizing children in the target age group for 2 nd dose measles vaccine, do you screen measles vaccination status? i.e. do you check to see if the child has received any previous doses of measles vaccine in the past? If yes to above, 32) What do you do if a child in the target age group for 2 nd dose measles vaccine has no child health card? 33) What do you do if a child in the target age group for 2 nd dose measles vaccine has no documented previous measles vaccine on his/her child health card? 34) What do you do if a child in the target age group for 2 nd dose measles vaccine has 2 documented previous measles vaccines on child card? Please describe what you would do in the following scenario: 35) A child outside the target age group presents and the mother and his/her records show that s/he has never been vaccinated against measles. Would you administer measles vaccine? 36) Would you administer measles vaccine to the child above if you had to open a new vial of measles vaccine for only one dose? Comments Yes. If yes, how do you check? Check all that apply child s vaccination card vaccine register caregiver verbal report other, describe No. If no, reason Defer measles vaccine until caretaker can show card Interviewer: If yes to defer measles vaccine, ask are caretakers told when to come back with card. Give measles vaccine Interviewer: If yes ask following 2 questions: Is a new child health card given to the caretaker? Is the caretaker instructed to bring the child back for another dose of measles vaccine? Check vaccine register or other documents kept at the health facility. If so, please indicate what you would do if there is no record of child having had previous measles vaccine Ask caretaker if child had previously received measles vaccine and rely on that information. Give measles vaccine without further follow-up Give measles vaccine and advise return for another dose of measles vaccine Check vaccine register or other documents kept at the health facility. If so, please indicate what you would do if there is no record of child having had previous measles vaccine. Ask caretaker if child had previously received measles vaccine and rely on that information. (For ex, if the mother indicates that child previously received 1 dose of measles vaccine, give the 2 nd dose and document as 2 nd dose.) Do not give measles vaccine Give measles vaccine Do not give measles vaccine Yes, document as 1 st dose on recording form for district Yes, document as 2 nd dose on recording form for district Yes, document as 1 st dose on recording form for district No If no, give reason

25 Annexes Questions If yes to above, 37) Do you check immunization status of sick children who come for treatment services? 38) How do you record or document the doses of measles that are administered? For each of the forms that you use to record measles vaccination administration, please comment on whether or not you are able to indicate if the dose administered to a child is his/her 1 st dose or 2 nd dose. 39) Have immunization registries, child cards, etc. been updated to include dose 2 of measles vaccine and the target age group for this vaccine? Ask to see registries, log books, tally sheets, parent record etc 40) How do you record and report immunization coverage/administration of vaccines? Prompt: How do you summarize this information for your reports? Ask to see a logbooks and monitoring forms. 41) How often do you report immunization data to the district? Ask to see a report Do you receive feedback on these reports? 42) How do you encourage the target age group for 2 nd dose measles vaccine to attend fixed health facility for measles immunization services? What strategies have been successful and not so successful in reaching the target age group with measles vaccine through fixed health facility services? 43) How many days a week does your site perform outreach immunization sessions i.e. immunization sessions not conducted at the health facility? Comments If yes, up until what age do you check vaccination status?... If yes, do you administer measles vaccine if: Child is in target age range for measles vaccine Child is older than target age for measles vaccine Child has a fever You have to open a new vial of measles vaccine and will only use the one dose for this child Check all that apply: tally sheets if checked, does form allow for specification of 1 st vs 2 nd dose? register of recipients if checked does form allow for specification of 1 st vs 2 nd dose? child vaccination cards if checked do cards allow for specification of 1 st vs 2 nd dose? other, specify.... If checked, does form allow for specification of 1 st vs 2 nd dose? Ask for copies of applicable forms. Check box if updated Vaccine registry/logbook Child health card Tally sheets/district reporting forms Vaccine stock forms Other (specify)... Most successful.... Least successful.... Note: Assess whether outreach data is recorded separately 25

26 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions 44) Do you include 2 nd dose measles vaccine in the outreach immunization sessions? Do you include the target age group for 2 nd dose measles vaccine in the outreach immunization sessions? Comments Yes No If no, reason.... If no, why not? Prompts: Not enough staff, unable to reach target age group, not enough capacity to carry additional vaccine and supplies required. 45) If yes to 2 nd dose measles through outreach services, what changes did you have to make to outreach sessions when you introduced the 2 nd dose measles vaccine? Prompt: More vaccine carriers? More sessions/trips to collect vaccine from health facility? Add staff on existing outreach immunization sessions? Add additional outreach session days? 46) If yes to 2 nd dose measles through outreach services, how do you mobilize the target age group for 2 nd dose measles vaccine in outreach immunization services? What strategies have been successful and not so successful in reaching the target age group with measles vaccine through outreach services? Prompt: House-to-house mobilization 47) Have certain groups been harder to reach for 2 nd dose measles vaccination? (either through fixed or outreach services) 48) If yes, are particular efforts being made to reach these groups? If so, what? Probe to see if low SES, certain ethnic or religious groups 49) Has the introduction of 2 nd dose measles immunization added to staff/personnel existing workload? 50) Has it been necessary to hire additional people to implement 2 nd dose measles immunization? 51) Have other activities been cut or diminished in order to accommodate this new immunization? If yes, what? Don t know If yes, which group(s).... Don t know If yes, please describe.... Yes, quite a lot Yes, a moderate or small amount No Don t know If yes, please describe.... Don t know If yes, please describe.... Don t know If yes, please list

27 Annexes Questions 52) Are other services (e.g. deworming, vitamin A) and/or other immunizations offered at the same time as the 2 nd dose measles vaccine? Comments Yes, other immunizations Please indicate what.... Yes, other services Please indicate what.... No Don t know If yes, was 2 nd dose measles vaccine introduced at the same time as these other immunizations and/or services started prior to offering these other immunizations and/or services added to existing immunizations and/or services 53) Among children in the target age group for 2 nd dose measles vaccine, do caretakers tend to bring the children specifically for measles vaccination? Or do they tend to come for other services and are offered measles vaccine as well? If yes, has offering multiple immunizations/services been successful or problematic? Please explain:... Children often brought specifically for measles vaccine. Children often brought for other preventative services and are offered measles vaccine as well. Please describe these other services (e.g., deworming, vitamin A, other vaccines, bednets).... Children often brought for sick visits and are offered measles vaccine as well. 54) What information do you provide to parents before and after measles vaccination? Tick if mentioned don t prompt but can tell afterwards Vaccine schedule/when to return/child s vaccine schedule is complete Normal side effects What side effects they should return for Bring vaccination card Other health messages (specify) HEALTH CARE WORKER KNOWLEDGE: Ask HCW, not head of health facility 55) What is the immunization schedule for Stated schedule... measles? Is there a required minimum interval between doses? 56) Are there children who should not receive measles vaccine? Prompt: Age restrictions: min/max age, lack of documentation of vaccine status/ not wanting to give too many doses if possibly already immunized, HIV status 57) What is the purpose of administering a second dose of measles vaccine to the target age group? Are there any ill effects? Don t know Don t prompt but can discuss afterwards. Interviewer: Quote exact response given... 27

28 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions Comments VACCINE AND COLD CHAIN MANAGEMENT, STORAGE & LOGISTICS 58) Do you have written guidelines for vaccine management that includes measles vaccine? Ask to see a copy 59) Have you had any measles vaccines with VVM in stage III or IV in the last 6 months? If yes, what did you do with these vaccines? 60) Have you had stock outs of measles vaccine or any other vaccine, syringe or safety box in the last 6 months? If yes, what and how long did it last? 61) Were there problems or implications (including financial) of introducing the 2 nd dose of measles vaccine for each of the following areas? If yes, action taken.... Yes, vaccines Specify.... Yes, vaccine supplies Specify.... If yes, how many weeks.... If yes, reason for stock out.... Ask about the implications of each of the following: Measles vaccine and vaccine-related supplies If yes, specify.... Cold chain/storage If yes, specify.... Vaccine transport If yes, specify.... Transportation of health personnel to outreach sites If yes, specify.... Wastage If yes, specify.... Communication materials/media If yes, specify.... Training If yes, specify.... Monitoring and Supervision If yes, specify.... Updated forms such as cards, registries, logs, tally sheets If yes, specify.... Other If yes, specify

29 Annexes Questions Comments ADVERESE EVENTS FOLLOWING IMMUNIZATION 62) Do you have a system for tracking AEFI AEFI procedure in place? for all vaccines? Please describe the procedure. If no, why not? Ask for a copy of the AEFI reporting form. 63) Have you had any reported cases of AEFI for measles vaccine in the target age group for 2 nd dose? Note: Verify using AEFI log book/registry if one Don t know If yes, How many.... Over what period of time.... What were the AEFIs.... How were they handled.... ADVOCACY, COMMUNICATION & ACCEPTANCE 64) Did this health facility provide any health education messages or materials to the community about the new target age group for 2 nd dose measles vaccine or about the need for 2 doses of measles vaccine? Check all that apply None provided Posters Brochures Health education sessions Public meetings Other (specify) Ask to see copies of materials 65) Do you remember any media focus (e.g. on radio or television or newspapers) If yes, describe... about immunizing the target age group or about 2 nd dose measles vaccination? 66) Were any health education materials or messages or media messages particularly helpful in promoting measles immunization among the target age group for 2 nd dose measles vaccine? Any lessons learned about promoting routine 2 nd dose measles vaccine to share with other countries that will be introducing 2 nd dose measles vaccine to the same target age group? 67) What types of questions did you/do you get asked by parents or others in the community about immunizing the target age group and about 2 nd dose measles vaccine and did you feel confident answering them? 68) Has 2 nd dose measles vaccine and the Generally well accepted with little resistance vaccination of the target age group been generally well accepted by parents Accepted with some resistance. and others in the community? Did you Describe.... experience any resistance regarding 2 nd dose measles vaccine and/or immunizing There has been a lot of resistance. children in the target age group? If yes, Describe.... please describe. 29

30 A guide to introducing a 2 nd dose of measles vaccine into routine immunization schedules Questions ERAL IMPRESSIONS 69) What effect has the introduction of 2 nd dose measles vaccine had on your EPI program? Comments Please check one that best describes the introduction: Improved the EPI program Please explain.... Made the EPI program worse Please explain ) In your opinion was the introduction of 2 nd dose measles vaccine a smooth process or problematic? Please explain No effect Please explain... Please check one that best describes the introduction: Very smooth no problems Smooth, minor problems Please explain.... Somewhat smooth, some major problems Please explain ) Other countries are considering introducing 2 nd dose measles vaccine soon. What have you learned from this experience and what advice do you have for other health facilities to ensure a smooth introduction? Not smooth at all, some major problems Please explain... Main lessons learned:... Advice to others:... NOTES AND COMMENTS Record any interesting positive or negative anecdotes or comments by immunization staff. Please note that such information is often most helpful in documenting problems or successes! 30