Question 1: Should Harmonia conduct an EPI survey early next year. What are your considerations?

No, better to delay. Based on the DHS data provided, Harmonia had DPT1-95%, DPT3-80% & MCV1-80% three years ago. There is good 'access' for the vaccines, but there seems to be 'demand side' issues leading to high dropouts. Even if the admin coverage is >100% due to old denominator data, the improvement is visible for DPT3% in admin data for the current year. Therefore, we can assume that things are moving on a right track.

PCV has been introducted three years back, but Rota is to be introduced this year. It will be wise to defer the EPI review till Rota is universally introduced and the beneficiary kids for Rota complete their vaccination schedule. This will provide GAVI an assurance for both, PCV & Rota vaccine coverage.

Secondly, by that time, fresh census data will also be available. The teams will have better representative sample for population in Rural/Urban areas. There is a great liklihood that the Urban areas would have expanded in these 15 years and many slums or weaker section of societies would have joined the urban population (Being GAVI eligible, it has to be a developing country, with sufficient health care challenges).

Question 2: The steering committee includes representatives from National Ministry of Health, National Statistics Office, WHO, UNICEF & a Donar. Given what you have already learnt about Harmonia, what do you think will be their primary question of interest for the survey (estimation, comparision, or classification)? Why

Following should be the primary question of interest for the survey:

1. Have they been able to reduce the dropout between DPT1 to DPT3 & MCV1 (assuming DPT1 is above 95%)

2. Has PCV & Rota vaccine coverage reached DPT1/DPT3 levels

3. Have they been able to reduce the disparity among various classes e.g. Geographic, Demographic, Social, Religious, etc (Equity issues)

4. What are the reasons for high dropouts / low coverage

5. It will be wise to include few questions around the occurrance of Vaccine Preventable Diseases during the survey (to know about the impact of vaccination)

6. Can measure the difference between the new admin coverage (as the new census data would be available) and the EPI survey coverage

7. Has there been an increase in retention of Immunization Cards, as compared to last DHS

Question 3: Who will comprise the target population and why?

1. All children aged 12-23 months should be the target population for the survey

2. Parents of those children should also be interviewed

3. It will be wise to increase the age range for children, as MCV2 is also part of their vacination schedule