Trap, Rete (1,2); Trap, Birna (3,2); Hansen, Torsten Wind (2); Hansen, Ebba Holme (4)

1. Is Performance-Based Reward the Strategy of the Future for Strengthening the Quality of Reporting and Immunization Systems?—Experiences from GAVI Trap, Rete (1,2); Trap, Birna (3,2); Hansen, Torsten Wind (2); Hansen, Ebba Holme (4) 1: Aabenraa University Hospital, Denmark; 2: Euro Health Group, Denmark; 3: Management Sciences for Health, SURE Program, Kampala, Uganda; 4: Faculty of Pharmaceutical Sciences, Department of Pharmacology and Pharmacotherapy, University of Copenhagen

2. Background and objectives • Global DTP3 immunization coverage 80% in 1990 • GAVI Immunization Service Support • 75 countries • Performance-based financial rewarding • Country specific recommendation and implementation-support. • To assess the effectiveness of the combined GAVI ISS ICIUM 2011/RT

3. Data Quality Audit (DQA) • WHO validated, standardized survey • Sentinel indicators • National, district (4) and health unit (24) • Assessing the quality of national immunization system • REPORTING QUALITY : • Consistency and accuracy of EPI reporting system • Measured by Verification Factor (VF) • SYSTEM SET-UP: • Efficiency, security and usefulness • Measured by quality score (QS) ICIUM 2011/RT

4. Managerial • Vaccination guidelines /STG • National Reporting Guidelines Medicines management Economic • Performance based reward scheme Regulatory • Inspection/ DQA • VF with pass or fail GAVI ISS Intervention strategies Educational • On-site mentoring during DQA • Implementation support

5. Methods • Retrospective study • National immunization data collected at DQA in the period 2002-2005 • Study population are nine developing countries having had two consecutive DQA’s ( pre - post) • Interventions: GAVI ISS • Outcome measure(s): • Reporting quality (verification factor) • System set-up quality (quality scores). ICIUM 2011/RT

6. National Verification Factor versus the Combined Quality Score at National, District and Health Unit levels in nine countries with pre and post data quality audits. Pre data quality audit (DQA1): symbolised by  Post data quality audit (DQA2): symbolised by  ICIUM 2011/RT

7. Changes in Combined Quality Score between pre and post data quality audits by country at National, District and Health Unit levels. ICIUM 2011/RT

8. Verification Factor and Immunization Coverage (DTP3) in the nine countries with pre and post data quality audits. ICIUM 2011/RT

9. Lesson learned • The combined GAVI ISS performance-based reward intervention strategy is effective • resulting in increased immunization coverage • improved reporting quality • improved quality of the immunizations system set-up at all levels of health care. • The positive correlation between increased reporting quality and immunization coverage indicates that: • high-quality reporting with accurate and consistent data is instrumental in targeting and focusing immunization management toward increased coverage. ICIUM 2011/RT

10. Recommendation • Repeated assessments are recommended to ensure sustainable immunization system improvements ICIUM 2011/RT

11. Policy Implications & Conclusions • The applicability of the performance-based reward system to other areas of supply chain and medicines management needs to be explored. ICIUM 2011/RT