Missed opportunities for immunization

This will stress lowering barriers to immunization and increasing the certainty that every child who is immunized is protected. EPI managers have long been able to measure the level of coverage because of an easy and widely accepted survey method, the EPI 30-cluster survey. Fortunately, this survey tool also contains quality of service indicators to assess and monitor the quality of immunization. But it is complex and time-consuming to analyze the survey results for these indicators. A computer program, developed for the World Health Organization (WHO) by the Resources for Child Health (REACH) Project and the Institut Francais de Recherche Scientifique pour le Developpement en Cooperation, called Coverage Survey Analysis System (COSAS), can perform this analysis quickly and accurately. Using COSAS, a program manager has ready access to information on the age distribution of immunizations, dose intervals, dropout rates and other factors influencing the quality of the program. A sensitive indicator of the quality of EPI services is missed opportunities for immunization (MOI). MOIs occur when a child who is eligible for an immunization leaves a health center without receiving the needed antigens. Exit interviews to determine the level of MOIs in various developing countries have measured rates of MOIs from 17-76% with a median of 49%. This decreased likelihood of a child being immunized leads to higher costs, delayed or missed protection, and loss of confidence in the EPI system. COSAS is a good start for evaluating quality of care. While COSAS can identify the rate of MOIs, it cannot determine the cause. Other research and evaluation tools, such as observation checklists or exit interviews, can further define the causes of poor quality service identified by COSAS. They are frequently due to false contraindications, improper screening, lack of supplies, fear of giving multiple injections and poor clinic organization. The above combined evaluation methods provide a means for identifying causes of and monitoring progress toward improved quality of EPI service. (Author abstract)