JUSTIFICATION

I have selected the transformative investment of using information system to increase the vaccination coverage by ensuring availability of quality data. Performance of immunization programme is a key driving force to meet the Sustainable Development Goal 3. Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization (EPI). The programme gained momentum in 1985 and was expanded as Universal Immunization Programme (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90. India with one of the largest Universal Immunization Programme (UIP) in the world necessitates provisioning of quality data to act as evidence for effective decision making. The full immunization coverage (FIC) stands at 62% (NFHS 2, 2015-16) and the administrative data shows an FIC of 95.6% (HMSI 2017-18). This starkling disparity between the data could primarily be attributed to the data quality and synthesis. Hence, of the various constraints identified for effective programming of immunization programme in India, poor data management and analysis for evidence generation has been one of the key challenges.

Since the inception of UIP, India’s had set up a reporting mechanism from the health center to national level. In last few years, country has also introduced electronic data systems like HMIS and MCTS to improve reporting, analysis, monitoring and planning at all levels. However, there are big gaps in quality of data being reported, its analysis and use for decision making and thus leading to inadequate information to support NTAGI and UIP to design and implement strategies to improve immunization quality and coverage. Few case studies also reveal the issue of discordance between data sources, intrinsic data quality issues in the available data. It has also been pronounced that besides compilation of data, its methodology used in data collection should be maintained to ensure valid comparison between data generated from various sources

The key facets of data quality viz., availability, completeness, consistency and agreement of data needs to be cautiously maintained to ensure enhanced actionable strategies. It is of paramount importance that data is of the highest quality, hence use of information system will immensely useful to guide programme actions.

PRIORITIZATION

The process of prioritization of strategies emanates out from the need for multidimensional, accurate and timely information in order to address issues related to quality and equity in the immunization programme. The whole gamut of M&E system, ranging from data collection, collation, analysis and use of data quality needs careful assessment with a broader perspective, focusing on support mechanisms as well as on technicalities. Way back in 1983, Indian Journal of Public Health commented in the editorial on the need for HMIS in India. “A good health service superstructure can be built only on a solid base provided by the reliable health statistics collected through a well organised infrastructure”. The several inadequacies in the HMIS system make it very unreliable and undependable. The available research findings suggest that HMIS in many of the African and Asian countries is very weak and suffers the same limitations as India.

Evidently, the efficient use of health data for decisions and actions to improve the quality of health services and achieve performance goals is the vital ingredient of shared accountability. Hence the three strategies encompassing data collection to ensuring quality data (in terms of accuracy and reliability) and use as evidence for decision making have been carefully carved out to confer to the transformative investment of information system to increase the vaccination coverage by ensuring availability of quality data

Strategy 1: Use and interpret performance data to drive programmes

Data is crucial to demonstrate and evaluate the impact of an intervention, monitor progress towards a goal, determine barriers to care, and influence public policy. In India, data are collected in vast amounts but are mostly incomplete, unreliable and unused. Appropriate and timely analysis and use of health and health-related information for decision-making is an essential element in the process of transforming the health sector. Hence it is significantly important to ensure timely and effective use and interpretation of the performance data to lead programme in the right direction

Strategy 2: Improve administrative coverage data recording and collection

Administrative data can provide a strong basis from which to guide planning, review progress, and address gaps in areas with low-coverage or high drop-out rates; if accurate, timely reporting occurs at each level. Even general information is collected every time and reported afresh. Every month many things are entered afresh. Information declared once is not stored in to the formats. It has to be supplied every month increasing the sense scope for error. Using data as evidence to inform the development of health care has grown out of the use of science to choose the best decisions. It is based on data being collected in a methodical way. Harmonizing the data collection, standards, best practices, and other elements of a national health information system. Standardization enables economies of scale for training, hardware and software, and processes. To collect, collate, analyze, and communicate the necessary information in a timely and understandable fashion requires organized processes and procedures and a comprehensive data system

Strategy 3: Increase accuracy and reliability of data aggregation and feedback

Public health decision-makers are often overwhelmed with large quantities of data, evidence, reviews and summaries. As the volume of information increases, the need for trusted sources of synthesis becomes greater. There are issues of exhaustive information collected but hardly used. Systems Model is based on the core principle that input is processed into output and fed back to the input. It is a complete process where in each and every stage is important and contributes to the overall improvement of the system. But the information collected from the health facility is never fed back to them after processing. It is just supplied to the top tiers of administrative hierarchy.

Decisions at different levels of the health sector can only be effective if they are backed with accurate and reliable information

ACTIVITY PLANNING

Logical arguments have been advanced on the prioritized strategies and when supported with evidence of literature it will enrich the work.

Prior to activity planning, it is advised to do a good RI review basing on an available data anad identify bottlenecks/challenges. This will give direction of the other activities the will foll as the base wil be already built. The authr is advised to inlude something on thorough datadesk review BEFORE putting other activities.

Strategy 1: Use and interpret performance data to drive programmes

Strategy 2: Improve administrative coverage data recording and collection

M&E

Monitoring is an important tool for the porgram managers. It can help improve the quality of the immunization programme by ensuring:

1. all infants and pregnant women are immunized
2. vaccines and safe injections equipment are delivered in correct quantities and on time
3. staffs are well trained and adequately supervised
4. information on disease incidence and AEFI are collected and analysed
5. the community has confidence in the vaccine

Monitoring systems is key to measuring immunization implementation and surveillance of vaccine preventable diseases to be able to identify areas to leverage and areas for improvement. Ultimately this will lead to informed decision for program improvement and sustainability. The activities outlined to achieve the strategies will be measured using a robust mechanism by first identification of key indicators, numerator, denominator and visualization as illustrated in the matrix below. This will primarily include supporting improved data collection, analysis, building skills of the data handlers and works towards enhancing