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BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
ACKNOWLEDGEMENTS
These best practices documents for polio eradication have been developed from the contributions of many people from all over the world. The people concerned have themselves spent many years striving to eradicate polio, learning from successes and failures to understand what works best and what does not, and quickly making changes to suit the situation. In writing these best practices the aim has been to distil the collective experiences into pages that are easy to read and detailed enough to be adapted for other health programmes.
‘To strive, to seek, to find, and not to yield’
ACRONYMS iv
INTRODUCTION 1
THE PURPOSE OF THIS DOCUMENT 2
MICROPLANNING ELEMENTS 4
MICROPLAN RESOURCE ESTIMATE 8
COLD CHAIN AND LOGISTICS MICROPLAN 9
OPERATIONAL MICROPLAN 9
SUPERVISION MICROPLAN 23
RECORDING AND REPORTING TOOLS 28
MONITORING MICROPLAN 30
CONCLUSION 33
ANNEX 1 MICROPLAN RESOURCE ESTIMATE 34
ANNEX 2 COLD CHAIN AND SUPPLIES 39
ANNEX 3 CHECKLISTS 41
ANNEX 4 TALLY SHEET 46
SUPPLEMENTS TO THIS DOCUMENT (PROVIDED IN SEPARATE DOCUMENTS)
• BESTPRACTICESINMICROPLANNINGINAREASWITHPOORACCESS(INCLUDINGTHEKOSIRIVERAREAOFBIHAR,INDIA)
• BESTPRACTICESINMICROPLANNINGFORCHILDRENOUTOFTHEHOUSEHOLD:ANEXAMPLEFROMNORTHERNNIGERIA
• BESTPRACTICESININNOVATIONSINMICROPLANNINGFORPOLIOERADICATION
• BESTPRACTICESFORPLANNINGAVACCINATIONCAMPAIGNFORANENTIREPOPULATION
CONTENTS
iv BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
ACRONYMS
AEFI Adverseeventfollowingimmunization
AFP Acuteflaccidparalysis
GPEI GlobalPolioEradicationInitiative
HC Healthcentre
NGO Nongovernmentalorganization
OPV Oralpoliovaccine
RCM Rapidcampaignmonitoring
SIA Supplementaryimmunizationactivity
SOP Standardoperatingprocedure
1 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION (POLIO SUPPLEMENTARY IMMUNIZATION ACTIVITIES)
INTRODUCTION
DOCUMENTINGBESTPRACTICESFROMPOLIOERADICATIONObjective4ofthePolio Eradication & Endgame Strategic Plan 2013–2018callsfortheGlobalPolioEradicationInitiative(GPEI)toundertakeplanningto"ensurethattheinvestmentsmadetoeradicatepoliomyelitiscontributetofuturehealthgoals,throughaworkprogrammethatsystematicallydocumentsandtransitionstheGPEI'sknowledge,lessonslearntandassets".AsoutlinedinthePlan,thekeyelementsofthisbodyofworkinclude:
• ensuringthatfunctionsneededtomaintainapolio-freeworldaftereradicationaremainstreamedintoongoingpublichealthprogrammes(suchasimmunization,surveillance,communication,responseandcontainment);
• transitioningnon-essentialcapabilitiesandprocesses,wherefeasible,desirableandappropriate,tosupportotherhealthprioritiesandensuresustainabilityoftheglobalpolioprogramme;
• ensuring that the knowledge generated and lessons learnt from polio eradication activities are documented and shared with other health initiatives.
THE SCOPE OF DOCUMENTING BEST PRACTICESBest practice documents deal with technical aspects of polio eradication. The documents will include clear guidelines, case studies of effective programmes and processes, case studies of failures, and innovations developed at the national, regional and global levels, and will highlight areas where other programmes could benefit from the polio practices to achieve their health priorities. A series of technical subjects are being developed on:
• improvingmicroplanning
• ensuringqualityacuteflaccidparalysis(AFP)surveillance
• monitoringthequalityofsupplementaryimmunizationactivities(SIAs)
• securingaccessforImmunizationinsecurity-compromisedareas
• targetingandplanningforvaccinationofolderagegroupsduringpolioSIAs
• coordinatingcross-bordervaccinationcampaigns
• integratingotherantigensorotherinterventionsintopolioSIAs
• targeting and planning for the vaccination of nomadic populations during polio SIAs
• benefiting from other relevant technical areas where WHO country, regional and headquarter polio teams have significant expertise.
2 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
THE PURPOSE OF THIS DOCUMENT
THE RELEVANCE OF THIS DOCUMENT TO OTHER HEALTH INITIATIVESMany public health interventions are currently delivered through a campaign approach, which is likely to continue. This approach not only includes vaccines but other interventions for communicable diseases and nutrition, for children and, in certain circumstances, for an entire population, especially those facing emerging diseases.
THE SCOPE OF THIS DOCUMENTThis document describes best practices in microplanning for polio eradication campaigns, also known as supplementary immunization activities (SIAs) with oral polio vaccine (OPV). A microplan must aim to reach 100% of the target population, usually children aged under 5 years. Experience over the years has shown that the poliovirus can continue to circulate in quite small populations of unvaccinated children, thus requiring that the microplan be sufficiently detailed to reach every child with OPV.
The elements for making a microplan are described, along with the relevant best practices learnt over time. This document is a practical guide with working examples that can be adapted as needed. The best practices can serve as a guide for other public health programmes.
Over the last 25 years, microplanning for SIAs to eradicate polio has undergone changes and innovations. Errors were made and corrected, best practices were learnt through trial and error, without any textbook to follow. This document highlights what works best, but also indicates what does not work as well. The great strength of the polio eradication initiative is its flexibility and ability to identify problems rapidly in order to make significant changes, even at short notice.
This document does not replace the many guides, technical sheets and training materials already in existence; these published documents provide detailed information on strategies, principles, methods and operations. This document outlines the same strategies and elements, but gives advice on how the tried-and-tested practices can best be put into action. It does not include budget examples, which vary greatly from country to country.
DEFINITION OF A MICROPLANA microplan is a population-based set of components for delivering health-care interventions – in this case, supplementary polio vaccination for every child aged under 5 years. The microplan contains technical details and can be adapted as needed at every level, whether by national institutions, health-care workers or community participants. It is not a reference book but a dynamic set of tools that can be used and modified at any time to suit the demands of implementation according to the circumstances.
The microplan is divided into six sections:
• resourceestimate
• coldchainandlogistics
• operations
• supervision
• recordingandreportingtools
• monitoring
3 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
OBJECTIVE OF THE MICROPLANEvery person engaged in making and implementing the microplan must have a clear understanding of the objective: to achieve polio eradication through the systematic immunization of every child in the target population with polio vaccine.
Polio eradication microplans have adopted the innovative strategy of house-to-house vaccination over time. The health services in countries in which polio has been endemic did not reach everyone, and underserved communities had a greater burden of polio. Services were therefore brought to the community.
ENGAGING THE OPERATIONAL LEVEL IN MICROPLANNINGThe microplan must work with the health service at the operational level, usually the health centre.
• Microplansmustbevalidatedinthefieldandnotfromafaratahighlevelofcommand.
• Thedetailsoftheirimplementationmustconsidertherealsituationofthepeopleinfieldoperations.
• Standardsmustbesettoplanandsecuresuppliesandlogistics,butflexibilitytomakechangestosuitlocalconditionsmustbepossibleateverystep.
Important lessons learnt
The polio SIA microplan is not just a collection of spreadsheets and budgets, it is a flexible and evolving set of plans at each level of operation that can be adapted and corrected rapidly, even between each campaign round.
The microplan requires field validation; spreadsheets may not reflect the reality of operations at the field level where access is difficult and resources are scarce. Detailed plans must be made at the operational field level (health centre or an equivalent institution).
Assigning teams to vaccinate children in a certain number of households per day in a defined area is often more effective than designating a total number of children per day.
The microplan must be able to show the details of exactly where every person needs to be and when, as well as their duties and movements during the entire period of the SIA.
Coverage data alone are not a reliable way to measure the results of a microplan. It is better to triangulate data using a variety of sources, for example supervisory reports, independent monitoring and surveillance data, to understand whether a microplan is adequate or needs to be modified.
4 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
MICROPLANNING ELEMENTS
CAMPAIGN STRATEGY DECISIONThe campaign strategy must be decided and understood by the health service and community:the immunization of all children aged 0 to 59 months with OPV on an equitable basis regardless of prior immunization status, location and social condition in a defined wide area (country, province).
ESTABLISHING A COORDINATION STRUCTUREA structure that can oversee and coordinate the development and implementation of the microplan must be established. It must include national-level decision-makers and representatives at other levels involved in the area of the microplan’s operations. Imposing a plan at any one level should be avoided as full participation at every level is essential to make the plan work.
SETTING THE REQUIRED MICROPLANNING STANDARDSPlanning standards must be set for supplies, logistics, human resources, transport, equipment and the span of management control. The standards should be flexible enough to allow local variations.
ESTIMATING MICROPLAN RESOURCES• Makeaninitialpopulation-basedestimateofthetotalrequirementforsupplies,logistics,human
resources,transportandcold-chainequipmentatthehighestlevel.
• Usethesamepopulation-basedmethodtoestimaterequirementsforsupplies,logistics,humanresources,transportandequipmentateachlevel:province,district,subdistrict,healthcentre.
• Estimateresourcesaccordingtothelocalcharacteristics,suchastheextentofurbanandruralareas,astheyshouldnotbestandardized.
• Use simple form to estimate population distribution, supplies and human resource requirements at the district and health centre levels as conditions may vary greatly from place to place.
PLANNING THE COLD CHAIN AND LOGISTICS ELEMENTSThe microplan should include information pertaining to:
• theavailabilityanddeploymentofcold-chainequipment;
• a plan for transporting vaccine and supplies.
PLANNING THE OPERATIONAL ELEMENTSThe operational aspects of the microplan should include:
• managementprocedures;
• atrainingplan;
• ahealthcentresessionplan(seeFigure1);
• avaccinationteamdailylogisticschecklist;
• anindividualteammovementplan(seeFigure2);
• detailedoperationalmapsanditinerariesfortheteams,organizedbythenumberofhouseholdstovisitwithstartandendpoints;
5 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
• fixedsiteinformation;
• house-markinginformation;
• finger-markinginformation;
• aspecialteamdeploymentplanfortransitpoints,marketsandstreets;
• a community engagement plan.
PLANNING THE SUPERVISORY ELEMENTSThe microplan should describe the duties of supervisors in detail. At every stage in its development and implementation, supervisors are expected to observe operations and take corrective action where needed. Their duties include:
• fieldvalidation
• immunizationsupervisionandtraining
• teamplanningandscheduling
• responsibilityforoperationalmaps
• pre-andpost-implementationchecks
• checklistupdates.
USING RECORDING AND REPORTING TOOLSSimplefield-basedtoolsshouldbeusedtocollectandreportdataontheimplementationofthemicroplan.
MONITORING THE MICROPLANAplanfordeployingmonitorswhowillcheckthepreparationsandimplementationofthemicroplanmustbeputintoplace.
ESTABLISHING A COORDINATION STRUCTUREAcoordinationstructureshould includenational-leveldecision-makersandrepresentativesatotherlevelswhoareinvolvedintheareaofthemicroplan’soperations.OneinnovationhasbeentoestablishEmergencyOperationCentresworkingattheprovinceanddistrictlevelstocoordinatepoliooutbreakactivities,includingtheextentoftheSIA,thebudgetallocation,communicationandtrainingstrategies,monitoringplansandcross-borderactivities.
The coordination structure’s various committees and national and subnational committee members should ensure that:
• thesamestandardsareappliedeverywhere;
• correctandappropriatemessagesaredisseminatedeverywhere;
• allmicroplanningmaterialsandallresourcesareavailablewhenandwhereneeded.
6 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Table 1. Coordination structure committees
National committee is responsible for the overall monitoring of the planning, implementation and evaluation stages.
Technical subcommittee follows up on the technical aspects of the process, verifying the national work plan and its target population and age groups; and assesses the adequacy of the training modules for every level.
Logistics subcommittee ensures the availability of vaccines, adequate cold chain, transportation and supplies; and develops and implements the logistical distribution plan.
Social mobilization subcommittee
develops social mobilization materials and key messages, and plans their dissemination; and coordinates the recruitment of local social mobilization and community engagement focal points at the subdistrict level.
Finance subcommittee ensures the availability of funds and their timely release to all levels, as well as the post-campaign financial report.
SETTING THE REQUIRED STANDARDS FOR SUPPLIES, LOGISTICS, HUMAN RESOURCES, TRANSPORT AND COLD-CHAIN EQUIPMENT
BEST PRACTICE FOR SETTING MICROPLANNING STANDARDSPlanning standards should be set on realistic estimates, especially regarding the amount of work that vaccinators and supervisors must conduct in the time available. To keep an equitable workload throughout, it is necessary to vary the standards according to accessibility, distance and other local conditions including security. Regardless of their assigned workload, all vaccination teams are responsible for vaccinating children in their assigned area whether the children are in the house or out of the household.
ASSIGNING DAILY TARGETS OF TOTAL HOUSEHOLDS PER DAY OR TOTAL CHILDREN PER DAYIntheearlyyearsofpolioeradication,countrieswouldimplementtwoorthreeroundsofpolioimmunizationperyear,andmanychildrenweremissed.Oftenteamsweresettargetsofaround200childrenormoreperdaytovaccinate,andtheywouldstopworkwhentheyhadachievedthetargetnumber.Theywouldthenclaim100%coverage,eventhoughadditionalchildrenmayhavebeenintheassignedarea.Inlateryearsasoperationsintensified,somecountrieswouldholdasmanyas12campaignsperyearbut,asitbecamecriticalthatnochildbemissed,thestrategyofsettingtotalchildrenasatargethadtobemodified.Communitiesbecamereluctanttoacceptmanyvaccinationroundsandhadtobeconvincedoftheirpurpose.Moretimehadtobespentonengagingthecommunityandgainingitstrust.
House-to-house vaccination provided the opportunity to engage families and convince them of its benefits, but it proved more time-consuming and fewer children could be immunized per working day. Microplans were changed; in urban and semi-urban areas, it became more effective to assign each team to a certain number of households per day (approximately 50ะ75) than to designate a certain number of children.
• In urban areas,streetmapscanbeused,andvaccinationteamscanbeassignedacertainnumberofhouseholdstovisit.Ateam’sdailyworkcanbepreciselymapped,withidentifiedstartandendpoints.Thehousescanbenumberedandthevaccinationteamcanmarkthemaccordingtotheimmunizationstatusofthechildrenwithin.Supervisorsandmonitorscanmoreeasilyfollowupontheworkoftheteams.
• In rural areas,suchasvillageswherehousesmaynotbeorganizedonastreetpattern,settingthetargetofreachingeveryhouseholdandeverychildinavillageismoreeffective.However,simplemapsshowingdesignatedstartandendpointscanstillbeused,togetherwithhouse-marking.
7 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Table 2. Example of the standardization of resources (variable according to country and location)
Variable Standard
Population aged <5 years (0 to 59 months) Varies by country (approx. 13.5%)
Population aged <10 years <5 years population x 1.5
Population aged <15 years <5 years population x 2
Vaccinators per team 2 (minimum)
Support staff at post or in team 1–2
District refrigerator capacity 100 litres per refrigerator
Health centre refrigerator capacity Approx. 20 litres per refrigerator
Number of households to be visited for immunization per day
Average number of children aged 0 to 59 months per household
50–100 households
3 children
Number of children immunized per team per day 100–200 in urban areas
60–80 in rural areas
Number of teams per supervisor 4–5 in urban areas
2–3 in rural areas
2 in transit areas
Fuel consumption of a 4x4 vehicle 15 litres per 100 km on good roads
20 litres per 100 km off the road
Fuel consumption of a motorbike 4–5 litres per 100 km
Maximum daily distance for a national supervisor 150 km
Maximum daily distance for a team supervisor 100 km
Maximum daily distance for a vaccination team 30 km, if motorized
OPV wastage in 20-dose vials during SIA 15%; 1.2 wastage factor
Volume of a dose of 1.5 ml OPV 1000 doses per 1.5 litres cold storage volume
Capacity of 1 vaccine carrier with 4 ice packs Approx. 1–1.5 litres
Capacity of 1 ice-pack freezer Approx. 100 ice packs
Number of finger-marking pens needed per team 2 pens per team per day of work
8 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
MICROPLAN RESOURCE ESTIMATE (see Annex 1 for examples)
• Makeaninitialpopulation-basedestimateofthetotalrequirementforsupplies,logistics,humanresources,transportandcold-chainequipmentatthehighestlevel.
• Usethesamepopulation-basedmethodtoestimaterequirementsforsupplies,logistics,humanresources,transportandequipmentateachlevel:province,district,subdistrict,healthcentre.
• Estimateresourcesaccordingtothelocalcharacteristics,suchastheextentofurbanandruralareas,astheyshouldnotbestandardized.
• Use simple formats to estimate population distribution, supplies and human resource requirements at the district and health centre levels, as conditions may vary greatly from place to place.
BEST PRACTICE FOR ESTIMATING RESOURCES• Themicroplanmuststartwithanestimateoftotalresources,madeseveralmonthsinadvanceso
suppliescanbeorderedanddeliveredintime.
• Whenplanningacampaign,itisbesttoestimatethetotalresourcesneededinatimelymanner.
• Timewillbeneededtogathertheresources:vaccinemustoftenbeorderedfromoverseas,vehiclesdistributed,personneltrainedandsupervisorsassigned.Theextentofalltheseresourcesneedstobeknownwellinadvanceateverylevel.
• Earlyplanningestimatesarealsoessentialbecauseashortageofresourcesismorelikelyatthedistrictlevel.
• Accurateresourceestimatesarecalculatedfrompopulationestimates,butthelattermayvaryaccordingtotheinformationsource.Planningestimatesshouldbemadefromthebottom-up,usingthesameframeworkdespitevaryingpopulationtotals(i.e.usingthesametypeoflogisticalplanwithstandardizedvariablesbutwithvaluesthatmaychangefromvillagetohealthcentretodistrictduetothemanydifferentpopulationestimatesateachlevel).
• It is always best to slightly overestimate the population to ensure sufficient vaccines and other resources are available.
9 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
COLD CHAIN AND LOGISTICS MICROPLAN (seeAnnex2forexamples)
The microplan should include information pertaining to:
• theavailabilityanddeploymentofcold-chainequipment
• a plan for the transport of vaccine and supplies.
BEST PRACTICE FOR PLANNING THE COLD CHAIN AND LOGISTICS• Everyprovinceshouldestimateitscold-chainequipmentsituationearlyon.Duringacampaign,
thedemandforrefrigerators,coldboxestocarryvaccineandfreezerspaceishigh.
• Alldistrictsshouldmanagetheircold-chainresourcesaccordinglyandwellinadvance.
• Adistrictthathasashortfallincold-chainequipmentcanreceiveassistancethroughthedeploymentofequipmentfromtheprovinceleveloraneighbouringdistrict.
• Ifdistrictcentresarenotfarfromeachother,poolingfreezercapacityforicepacksmaybepossibleatasharedlocation.
• Vaccineshouldbedistributedfromtheprovincetothedistrictnolaterthanonemonthfromthestartofthecampaign.Equipmentcanalsobetransportedinadvanceincaseofashortfall.
• The province and district should regularly update their lists of equipment according to local transport information and the cold-chain equipment plan.
OPERATIONAL MICROPLAN
The operational aspects of the microplan should include:
• managementprocedures;
• atrainingplan;
• ahealthcentresessionplan(seeFigure1);
• avaccinationteamdailylogisticschecklist;
• anindividualteammovementplan(seeFigure2);
• detailedoperationalmapsanditinerariesfortheteams,organizedbythenumberofhouseholdstovisitwithstartandendpoints;
• fixedsiteinformation;
• house-markinginformation;
• finger-markinginformation;
• aspecialteamdeploymentplanfortransitpoints,marketsandstreets;
• a community engagement plan.
10 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
OPERATIONAL MICROPLAN FOR THE HEALTH CENTRE• Afterthemicroplanresourceestimateshavebeenmade,detailedoperationalplanswillbe
required.Theoperationalmicroplanislikeaworkplan:itdescribesthedatesandplaceswhereteams,communityrepresentatives,volunteersandsupervisorswillneedtobelocatedoneachday.
• Thedetailsoutlinedintheoperationalmicroplandependonanassessmentofthelocalsituationandcannotbestandardized.
BEST PRACTICE FOR MANAGING OPERATIONAL MICROPLANS
1. Send a simple message to all participantsThe goal is to vaccinate all target-age children in a given geographical area. Teams are assigned to specific areas and must visit every household in that area to ensure vaccination.Supervisors will check that teams have visited every household and that no child has been missed.
2. Divide the operational area into three categories of accessThenumberofchildrenorhouseholdstobereachedwilldependonaccessandthetimetheteamshavetowork.Operationalareascanbemapped,andvaccinationteamsandsupervisorscanbeassignedaccordingly.
Table 3. Three categories of access
1. Easy access: households can be reached on foot each day 50–80 households per day or 200 children
2. Intermediate access: transport is needed between areas, but households can be reached on foot
30–50 households per day or 100 children
3. Difficult access: areas include geographical obstacles, such as rivers, hills or bush tracks with poor road conditions
30–50 households per day or 100 children
3. Pay special attention to high-risk areasHigh-risk areas require the best vaccinators and supervisors suited to the areas. Community mobilizers and influencers must be identified in advance to accompany teams.
High-risk areas can include those with:
• recentcirculation
• lowperformancesinpreviousrounds
• lowroutinecoverage
• lowsurveillanceperformance
• settlementsofurbanpoor
• newandinformalsettlements
• remoteruralpopulations
• minoritypopulations
• highlymobilepopulations
• nomads.
11 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
4. Select the best vaccinators• LargenumbersofvaccinatorsareneededtodeliverOPVdrops.Ifpossible,selectvaccinators
fromthecommunitybyengagingcommunityleaders.Thismaybemoreeffectivethanrecruitingvaccinatorsthroughhealthserviceofficials.
• Vaccinatorsshouldbefromthesameethnicgroupasthetargetpopulation,befamiliarwiththelocationandspeakthesamelanguage.Previousexperienceisdesirable.
• Sufficientfemalevaccinatorsshouldbeavailable,giventheneedtoengagemotherswithyoungchildren.
• Nursingstudents,otheruniversitystudentsandnongovernmentalorganization(NGO)staffoftenworkwellasvaccinators.
• Supervisors may be health service staff, teachers, NGO staff and other people with knowledge of the community.
BEST PRACTICE FOR TRAINING VACCINATORS• Allvaccinatorsandsupervisorsmustbetrainedpreferablyinsmallgroupsbyexperiencedsenior
staffandpartners.
• Thelocationoftrainingisimportant.Itshouldbelocal,andtheparticipantsshouldbeabletohearclearlyandinteractwithtrainerswithnooutsidedistractions.
• The vaccinator’s basic job is to administer vaccine, tally, and mark the finger and the house. The vaccination team should not be overloaded with other jobs unless they are essential to the plan.
Vaccinator training• Thetrainingofvaccinatorsshouldnotbelefttonewlytrainedsupervisors;itshouldbeundertaken
bythemostexperiencedprofessionals.
• Thetrainingsiteshouldbeneartheareawheretheteamswillwork(suchasschools),withenoughroomforparticipantstobeseated.
• Thevaccinators’attentionshouldbegainedthroughinteractivetraininginanumberofsmallgroups(around20persons)ratherthaninlargegroups.
• Thetrainingcourseshouldtakeoneday,withhalfofthedayspentonhands-ontrainingandroleplayingwithsimulatedvaccinationactivities.
• Thetrainingshouldbecompletedaroundfivedaysbeforethecampaignstarts.
• An additional 5–10% more vaccinators should be trained in case of absentees on the campaign days.
Simple but clear vaccinator training content• Vaccinatorsmustknowthecampaign’spurposeandobjective.
• Everyteamandsupervisormustuseamapduringeachdayofthecampaign.
• Mapsshowingtheboundarieswhereeachteamwillworkcanbemadeduringtrainingorprovidedbysupervisors.
• Themapsforvaccinatorsmustshowlandmarkswheretheyshouldstartandfinisheachday’swork,andtherouteeachteamshouldtaketomovefromhousetohouseeachday.
• Everyteamandsupervisormustprovidetheirmobilephonenumberstofacilitatesupervisionandreportproblems.
• House-to-housevaccinationshouldfollowtheassignedrouteshownonthemap,withvaccinatorsmarkinghousesandfingersastheygo.
• Vaccinatorsshouldcommunicatepolitelywithfamilies,eventhosethatrefusethevaccination.
12 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
• Trainingshouldincludeanswerstofrequentlyaskedquestions.
• Teamsshouldknowhowtosystematicallyrecordhouseholdstoberevisitedorabsentchildren,notingthenamesofabsentchildren,lockedhousesandfamilyrefusalsonthebackofthetallysheet.
• Follow-up of absent children should be conducted before the end of the day.
Key questions for vaccinators to avoid missing children• Atthehouseholddoor:“Howmanymothersareinthishouse?”
• Thenaskeachmother:“Howmanychildrendoyouhave?”
• Tomakesureallchildren,especiallyyounginfants,areincluded,askeachmother:
– “Do you have an infant?” – “Do you have any sick children?” – “Do you have any visiting children?” – “Are any children sleeping?”
Vaccine distribution plan for vaccinators and supervisors• Everyvaccinatorshouldknowwheretopickupvaccineandreplenishit.
• Healthcentresshouldsetupcoldboxesand/orrefrigeratorswhereteamscanconvenientlypickupvaccineandicepacksbeforestartingtheday’swork.
• Supervisors should have vaccine carriers with vaccine to replenish teams when needed.
13 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
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espe
cial
ly if
ther
e is
vac
cine
hes
itanc
y. It
may
be
poss
ible
to s
plit
the
wor
k in
one
are
a ov
er m
ore
than
one
day
, but
mor
e di
stan
t ar
eas
may
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e to
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plet
ed in
one
day
, due
to tr
ansp
ort c
onst
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ts. R
emot
e ar
eas
may
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uire
an
over
nigh
t sta
y. S
tayi
ng in
com
mun
icat
ion
by m
obile
ph
one
is e
ssen
tial.
14 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figu
re 2
. Ind
ivid
ual t
eam
mov
emen
t pla
n
Heal
th C
entr
eSu
perv
isor
Nam
e an
d Ph
one#
Te
am N
umbe
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ne#
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oute
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quir
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Vacc
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Tall
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pick
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cify
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Day
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00 h
ouse
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Star
t at 0
8:00
with
firs
t hou
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end
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kat
hea
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llage
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ppro
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useh
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Ta
ke b
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then
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k in
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and
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lds
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loca
l bus
and
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at b
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ost
Day
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Day
4
BEST
PRA
CTIC
E IN
INDI
VIDU
AL T
EAM
MOV
EMEN
T PL
ANS
Each
team
has
an
indi
vidu
al p
lan
to s
how
exa
ctly
whe
re it
mus
t go
each
day
. The
hea
lth
cent
re a
ssig
ns te
ams
to e
ach
area
but
, in
the
assi
gned
are
a, th
e te
am
mus
t fol
low
an
assi
gned
rou
te, v
isit
all t
he a
ssig
ned
hous
ehol
ds a
nd v
acci
nate
all
child
ren
aged
0 to
59
mon
ths
in th
ose
hous
ehol
ds. T
he te
am m
ovem
ent
plan
mus
t be
base
d on
the
loca
l situ
atio
n; in
som
e co
mm
uniti
es, h
ouse
hold
s w
ill n
ot o
pen
the
door
unt
il la
te in
the
mor
ning
whi
le, i
n ot
hers
, mot
hers
and
ch
ildre
n le
ave
the
hous
e ve
ry e
arly
to g
o to
the
mar
ket.
Each
team
’s s
impl
e m
ap s
how
s ho
w it
mus
t mov
e fr
om h
ouse
hold
to h
ouse
hold
with
ass
igne
d st
art
and
end
poin
ts. E
ach
hous
ehol
d sh
ould
be
mar
ked
by th
e vi
sitin
g te
am to
sho
w th
e ho
use
has
been
vis
ited
and
the
stat
us o
f the
chi
ldre
n w
ithin
.
15 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
OPERATIONAL MAP FOR TEAMS
BEST PRACTICE IN OPERATIONAL MAPPING (see also the separate section on GIS mapping)
Each team should have its own map to show exactly where the team will work each day according to the team movement plan.
The image on the left shows a large town map on which team areas have been shaded: Day 1, Day2, Day 3.
Hand-drawn maps are also useful when they show:
• streetsandlandmarkswithineachsettlementandcity;
• housesandhamletslyingoutsidethemainroads;
• majorlandmarks(suchasrivers,bridges,healthcentres,schools,markets,nurseries,train/busstation,policecheckpoints,etc.);
• roadsandtracks;
• the limits of the team’s catchment area (the border of their working area).
The location where each team works can be shown as in the example below.
BEST PRACTICE IN HOUSE-MARKING
House-marking is evidence that a team has visited a house. It informs teams, supervisors, monitors and evaluators about whether a household was visited, all children were immunized or the house needs to be revisited.
The definition of a household should be applied flexibly: a household can be the smallest family unit or a compound. It can include temporary settlements, boat people or nomads. Each household should be marked. In compounds where several households share the same entrance, each household as well as the main entrance should be marked.
Houses should be marked with a crayon, or any other locally accepted product, but never with ink markers. The mark should be placed on, beside or above the door. If that is not possible, any other immobile object (a rock, tree, fence, etc.) should be chosen. The location of the mark should preferably be protected from rain. Houses can be marked in many ways; the marking has not been standardized in all countries.
16 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Examples of simple basic house-markingT15 H23 29/6 4/4
Interpretation: Team 15 visited (√) household number 23 on 29 June and immunized all four children. (The tick mark is circled.)
T18 H74 29/6 2/3 +1
Interpretation: Team 18 visited (√) household number 74 on 29 June, two out of three children were vaccinated. but some children were missed and the household needs to be revisited (no circle). When the team revisits, it adds +1 to the house-marking.
Some houses may be locked and empty. Houses should be marked for revisiting only when individuals in the target age group are absent and can be immunized by a revisit during the campaign. A list of houses to be revisited should be made on the back of the tally sheet and each team should submit it to the supervisor at the end of each day.
The marking on the wall indicates that all 10 children in the household were vaccinated on 2 March 2010.
17 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
BEST PRACTICE IN FIXED SITE CAMPAIGN IMMUNIZATIONMany years of experience have shown that a successful campaign cannot be conducted with fixed sites alone. A combination of fixed site and door-to-door vaccination is sometimes used, often on the first day of the campaign, after which the campaign becomes focused on door-to-door visits.
• Thefixedsitesshouldbeinprominentandconvenientplacesintheshadewithenoughspaceformothersandchildrentowait.
• Thesiteisfixed,butthepersonnelarenot.Vaccinators,volunteersandsocialmobilizersshouldallmovearoundthesitetolookforchildrentovaccinate.
• Healthcentresandhospitalscanremainopenandfunctionasfixedsitepostsforthedurationofthecampaign.
• Theexteriorofschools,placesofworship,busstationsandotherlocationscanbevaccinationareasforacertainnumberofdaysbutshouldnotreplacedoor-to-doorvisits.
• Banners and posters should draw attention to the site.
Each fixed site should have at least two vaccinators to immunize children and record doses administered, and two support staff to help manage the flow of waiting clients and to mobilize mothers and children in the area.
Each child of eligible age is tallied on the tally sheets and gets a finger-mark. There is no need to record addresses or other information.
BEST PRACTICE IN FINGER-MARKINGFinger-marking during SIAs allows teams, supervisors, monitors and evaluators to know whether a child has actually been immunized. Fingers should preferably be marked with indelible ink markers, rather than with gentian violet or other products that usually do not stay visible sufficiently long. Fingers marked the correct way and with quality markers, stored and handled appropriately, will normally remain visible for the duration of the campaign and a few days thereafter. It is important that teams strictly follow the recommended method for finger-marking. Always cap the finger-marker pen after use to prevent it from drying out.
Finger-marking process:• Thefingershouldbemarkedafteradministering
theOPVandnotbefore.
• Beforemarking,theteamshouldproperlycleanthechild’snailusingapieceofcloth/cotton.
• Onlythechild’s left little finger shouldbemarked–NOotherplace.
• Theinkshouldbeappliedonthe nail and nail bed.Markingthenailbedisimportantbecausethestainwillremainlonger.
• The ink should be allowed to dry for 30 seconds.
BEST PRACTICE IN TEAM MANAGEMENT AT TRANSIT POINTSThe locations of common transit points include:
• railwaystations
• busterminalsandmajorroadcrossings
• highwaycheckpoints
18 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
• tollboothsonhighways
• majorriverbridges
• ferrycrossings
• airports
• children’sparks
• religious and social community event venues.
Vaccinationteamsassignedtoworkattransitpointsneedspecialtrainingandcarefulsupervision.Inmanycountries,thousandsofchildrenmoveinandoutoftransitpointseveryday.Theywouldbemissedbyteamsthatonlyvisithouseholds.Animportantfactorisengagingthecooperationofthepeoplewhoareintransitwiththeirchildren,althoughtheyareofteninahurryandmayresentthepresenceofvaccinators.Itmaybehelpfultoengageyouthgroups,tosteerparentswithchildrentowardsthevaccinators.Localauthoritiesandpolicemustapprovethevaccinationworkattransitpoints.
Planning steps• Everyimportanttransitpointshouldbeidentifiedandmapped.
• Trainedvaccinatorsshouldbedeployedatthetransitpointsdependingonthesizeoftheareaandthemovementoftrafficandpublicatvarioustimesoftheday.
• TransitteamsshouldbedeployedforalltheSIAdays.Thismayrequiretwoshiftstocovertrafficmovingfromearlymorningtolateevening.
• Vaccinationteamsshouldbedeployedatallexit/entrypointsinbigtransitareaswithmultipleentriesandexits.
• Asupervisorshouldbedeployedforevery2–3transitteams.
Microplanning steps• Visitthetransitpointtoestimatethelikelyworkload.
• Estimatethenumberoftargetchildrenpassingthroughthetransitpointandthenumberofentryandexitpoints.
• Takeintoconsiderationvariationsintrafficloadinthemorningsandevenings.
• Judge the most appropriate location for placing vaccination teams.
Transit team vaccinator trainingTransit team vaccinators need dedicated training because their work is different from that of house-to-house teams. Some transit teams are static, working at major crossings to vaccinate children as they pass by. Others are mobile, entering buses or trains and vaccinating children inside them.
Transit team vaccinators need to know:
• thebasicsaboutpolioeradicationandhowtohandlevaccineandvaccinate;
• howtonegotiateentrytocrossingpoints,busesandtrains;
• howtoapproachparentspolitelyincrowdedcircumstances;
• howtocheckforvaccinatedandunvaccinatedchildrenbyfinger-mark;
• howtoconvinceparentsreluctanttoacceptvaccination;
• the importance of actively seeking children.
19 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Vaccine and the cold chain• Transitteamsshouldbegivenenoughvaccinevialsfortheestimatednumberofchildrenpassing
throughthesite.Ateammayneedasmanyas1000dosesofOPV(50x20-dosevials)formajortransitpoints,suchaslargerailwaystations.
• All vials (empty, full or partial) should be returned to the cold store at the end of each day. Every vaccination team and supervisor should have a vaccine carrier to store the daily vaccine requirements.
Information, education and communication/mobilization• Postersandbannersshouldhelpindicateandmakevisiblewheretransitteamsareoperating.
• Teeshirts,capsandidentificationbadgesshouldbewornsoparentscaneasilyidentifytheteammembers.
• Radioandtelevisionmessagingshouldbedevelopedandsharedthroughappropriatechannelstoensureparentsaresensitizedtotransitteamsoperatingintheirareas.
• Thecontrollingauthority(e.g.railwayorbusterminusauthorities)shouldensureendorsementsandannouncementsatthetransitpoint.
• Religious leaders should make announcements at places of worship.
Supervision• Atleastonesupervisorshouldoverseeevery2–3transitteams.
• Iftransitteamsaredeployedinshifts,everyshiftshouldhaveseparatesupervisors.
• Supervisors should move around to check vaccinators’ activities carefully.
Working at transit points• Vaccinatorsmustidentifyparentsandcaretakerswithtargetchildrenattransitpointsandpolitely
asktocheckthechildren’svaccinationstatus.
• Ifunimmunizedchildrenarepresent,vaccinatorsshouldimmunizethemandmarkthefinger.
• Vaccinatorsmustobtainconsentfromparentsbeforevaccinatingchildren.Ifachildisalone,vaccinatorsshouldtrytolocatethechild’sparentsorcaretakerstoaskpermissiontovaccinatethechild.
• Ifparentsrefusevaccination,vaccinatorsshouldpolitelytrytoconvincethemtoacceptOPV.Ifparentsrefuse,vaccinatorsshouldnotwastetimetryingtopersuadethem.
• Vaccinatorsshouldcheckallchildrenforfinger-markings,evenwhenparentsclaimchildrenhavebeenimmunized.
• Every vaccinator deployed must be independent and should carry vaccine, marker pens and tally sheets.
Recording and reportingThe tally sheet should record:
• date,placeandtimingofactivity
• numberofchildrencheckedforvaccinationstatus
• numberofchildrenvaccinated
• number of vaccine vials received, spent and returned.
20 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figure 3. Transit team management form
Location for transit team
Team number
Names of vaccinators
Name of supervisor and mobile phone number Hours of work
Figure 4. Form for community engagement activities in high-risk communities
Location of community
Names of vaccinators
Name of person selected for community
engagement and mobile phone
number
Name of supervisor and mobile phone
number
Dates of engagement
21 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
BEST PRACTICE IN COMMUNITY ENGAGEMENT IN HIGH-RISK COMMUNITIES
High-risk communitiesHigh-risk communities are defined as areas with:
• recentcirculation
• lowperformancesinpreviousrounds
• lowroutinecoverage
• lowsurveillanceperformance
• settlementsofurbanpoor
• newandinformalsettlements
• remoteruralpopulations
• minoritypopulations
• highlymobilepopulations
• nomads.
High-risk communities need careful microplanning to make sure the community is visited by the best possible teams, best supervisors and persons from the local community who can engage and influence the community.
Certain high-risk communities may be reluctant to accept vaccination and other interventions. In these circumstances, it is necessary to engage the community through a person it knows well and trusts. Such a person may be a religious or other leader who is well informed and able to explain why vaccination is needed and its benefits to the community.
Community engagementCommunitiescanbeengagedthroughteamworkinvolvingavisit fromatrustedcommunityperson,asupervisorandthevaccinationteamallworkingtogether.
1. During local planning
• Identifyinfluentialpeopleinthecommunitybyvisitingitandaskingtheadviceofthecommunity.
• Brieftheidentifiedinfluentialpeopleonpolioeradication:describewhatthehealthserviceistryingtoachievewithpolioeradication,anddescribehowimportantitisthateverychildinthetargetagegroupbevaccinated.
• Wheninthecommunity,identifyvolunteerswhocanhelptomobilizethecommunitywiththeinfluentialpersons.
• Aimtofindlocalpeoplewhoarewell-knownandarewelcomeinanyhouseinthecommunity.
• Be prepared to pay volunteers and community influencers for their work. It is better to have a formal engagement with an agreed allowance than to depend on voluntary assistance, especially in poverty areas.
22 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
2. During house-to-house campaign visits
• Makesurealleligiblechildreninahouseholdareidentifiedandvaccinated.
• Getacommunityvolunteertohelpbyenteringthehouseandspeakingtomothers.
• Ifthecommunityisknowntobehesitantaboutvaccination,asktheinfluentialpersonpresenttoanswerquestionsandconvincethecommunitytoallowthechildrentobevaccinated.
• Note any households that refuse immunization on the back of the tally sheet, with some indication of why the refusal occurred. Refusals can be addressed by different people according to the reason for refusal.
23 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
SUPERVISION MICROPLAN (see Annex 3 for examples)
The duties of supervisors include:
• fieldvalidation
• immunizationsupervisionandtraining
• teamplanningandscheduling
• responsibilityforoperationalmaps
• pre-andpost-implementationchecks
• checklist updates.
DIFFERENCES BETWEEN SUPERVISING AND MONITORING POLIO ERADICATION SIAs• Supervisorssupportteamsduringtraining,preparationandoperations.Theyaremobile,observe
theworkandtakecorrectiveactionoftenonthespot,andreporttheirfindingsatfeedbackmeetings.
– Supervisors should not be burdened with long checklists to complete when they are observing intra-campaign house-to-house team operations. They should devote their time to visiting teams and taking corrective action. They may carry vaccine to vaccinate missed children.
• Monitors observeoperationsandtakenoteofthequalityofoperations,butdonottakecorrectiveaction.Theirreportsarecompiled,discussedatfeedbackmeetingsandusedtotakecorrectiveactionthroughthesupervisors.
– Monitors have more time to complete checklists and to consolidate and report their findings. They do not usually carry vaccine.
BEST PRACTICE FOR MANAGING SUPERVISORSSupervisorsshouldunderstandtheirrolesclearly.Theyneedhands-ontraining,andthequalityoftheirworkismonitored.Districtandhealthcentresupervisorsshouldmonitorteamsupervisors.
Field validation of the microplanSupervisorsmustcheckthedetailsoftheoperationalmicroplansinadvance.
24 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Table 4.The roles of supervisors
Pre-implementation
(see checklist under Annex 3)
District and health centre supervisors Team supervisors•Overseeandfollowupmicroplandevelopment
•UsecheckliststoreviewSIAreadinessandtaketimelycorrectivemeasures
•Reviewandvalidatesupervisoryplansandmaps
• Ensure all teams have supplies, equipment, maps, plans and transport and take corrective action where needed
• Check details on team maps and movement plans and ensure team boundaries are clear
• Make sure all team members have been trained and no untrained people on the team are used as substitutes
Table 5. Implementation observation and corrective action
During implementation
(see checklist under Annex 3)
District and health centre supervisors Team supervisors
•Checkandcorrectmanpowerdeployment,accessandsupplyproblems
•Monitortheworkofteamsupervisors
•Participateinrapidcampaignmonitoringwithexternalsupervisors
•Followandmanagevaccinationteamactivitiesandtakecorrectiveaction
•Overseeteamstravellinghouse-to-house
•Overseerevisitsandthevaccinationofmissedchildren
•Carryvaccineinthevaccinecarriertorestockteams
•Collectandconsolidatereportsfromalllevels
•Providedailyfeedbackateveningmeetingstosolveproblems
Selection of team supervisorsSupervisors should be selected from among people who have some responsibility and respect inthecommunity,suchasschoolteachersandNGOstaff,amongothers.Retaininggoodsupervisorsisessentialbecausetheymakeanimportantcontribution.
TrainingAll supervisors must preferably be trained in small groups by experienced senior staff and partners. They should be trained by the most experienced professionals, which often includes external supervisors. The training course usually lasts two days. It should cover everything in the vaccinator training, plus hands-on field work training on the second day:
• Beforethestartofthecampaign,supervisorsshouldvisitlocationswherethepopulationisknowntobemobiletoupdatetheirmapswithnewsettlements.
• Mapsshouldshowwhereeachteamisworkingsosupervisorscanvisitthemandobservetheirworkclosely.
• Supervisorsshouldbefamiliarwiththehigh-riskareasandknowthenamesofthecommunityleaderswhocanactasinfluencers.
• Supervisorsshouldsolveproblemsandespeciallydealpolitelywithrefusals,requestingthesupportofpeoplewhocanengagewiththecommunity.
• Supervisorsshouldusesimplechecklistsanddebriefwithteamsattheendoftheday,advisingoncorrectiveaction.
• Supervisors should attend evening meetings with external supervisors to report their daily findings.
25 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Mobility• Supervisorsmustbemobileduringthedayandvisiteveryteamassignedtothem.
• Allsupervisorsmusthaveadailyplanandmaptomanagetheirmovements.
• Supervisorsshouldencourageandsupportteamsbymakingregularvisitstothevaccinatorteamsthroughouttheday.
• Supervisors may use some form of transport to move from team to team, but must walk with each assigned house-to-house team.
Evening supervisor meetings• Eveningmeetingsforsupervisorsshouldbechairedbythedistrictadministratororapersonof
equivalentlevelinthepresenceofteamsupervisorsandexternalsupervisors.
• Theagendashouldbeaction-orientedandfocusoncorrectiveaction,includingstrengthsandweaknesses,andtheactiontotakethenextday.Afullaccountoftheday’sproceduresisnotneeded.
• External supervisors can take the opportunity to review tally-sheet samples (a tally-sheet audit).
Figure 5. Overall district or health centre supervisory campaign plan
Health centre name Supervisor 1 (name)
Supervisor 2 (name)
Supervisor 3 (name)
Supervisor 4 (name)
Team # Team # Team # Team #
Day 1 (date) Teams
1, 2, 3, 4, 5
Teams
6, 7, 8, 9, 10
Teams
11, 12, 13, 14, 15
Teams
16, 17, 18, 19, 20
Day 2 (date)
Day 3 (date)
Day 4 (date)
Day 5 (date)
Figure 6. District or health centre daily supervisory plan
Health Centre Name Date
Supervisor name
Mobile phone number
Team number for supervision
Location of villages for house-to-house vaccination
Location of high-risk areas for rapid campaign monitoring
Mode of transport
A 1, 2, 3, 4, 5 Town South Side marketplace and bus station
motorbike
B
C
26 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
SUPERVISORY MAP
EXAMPLE OF BEST PRACTICE IN SUPERVISORY MAP USEThis supervisory map shows the location of each team to be supervised on each day (Day 1, Day 2, Day 3).
27 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figure 7. Daily schedule of supervisory visits
Health Centre Date
SUPERVISOR NAME AND PHONE NUMBER
TIME
LOCATION
TIME
LOCATION
TIME
LOCATION
TIME
LOCATION
TIME
LOCATION
18:00
AT HEALTH CENTRE
SUPERVISOR 1 TEAM NUMBER
14
TEAM NUMBER
15
TEAM NUMBER
16
TEAM NUMBER
17
TEAM NUMBER
18
09:00
AT BUS STATION
11:00
AT STREET BESIDE
MARKET
13:00
STREET 45
15:00
STREET NEXT
TO HIGH SCHOOL
17:00
MAIN ROAD
SUPERVISOR 2 TEAM NUMBER
19
TEAM NUMBER
20
TEAM NUMBER
21
TEAM NUMBER
22
TEAM NUMBER
23
08:30
AT VILLAGE
A
10:30
AT VILLAGE
B
12:30
AT VILLAGE
C
14:30
AT VILLAGE
D
16:30
AT VILLAGE
E
BEST PRACTICE FOR MANAGING SUPERVISORY WORK
• Allsupervisorsshouldhavedetailedplansanddailyworkschedulesthatdescribepreciselywheretheyshouldbeduringtheday.
• Thedate,placeandtimecanbespecified,whichmakesiteasiertofollowupandoverseethesupervisors.
• Onecopyshouldbegiventoeachsupervisor,andonecopyshouldbegiventothehealthcentre.
• Everysupervisorshouldhavethe:
– overalldistrictorhealthcentresupervisorycampaignplan(seeFigure5)– districtorhealthcentredailysupervisoryplan(seeFigure6) – supervisory map – daily schedule of supervisory visits (see Figure 7).
(See Annex 3 for examples of checklists.) BEST PRACTICE IN SUPERVISORY CHECKLISTS
• Checklistsaremostusefultosupervisorstocheckonteampreparationwhenalargenumberofsupplycomponentsmustbeputinplace.
• Only a very brief and simple checklist should be used for intra-campaign supervision to allow the supervisor time to observe team operations in detail.
28 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
RECORDING AND REPORTING TOOLS (seeAnnex4forexamples)
Simple field-based tools should be used to collect and report data on the microplan’s implementation.
• SIAresultconsolidation
• tally sheet.
RECORDING AND REPORTING THE RESPONSIBILITIES OF VACCINATORSTo record vaccinations, use:
• atallysheet(seeAnnex4)
• finger-marking
• house-marking.
Tally sheets can be used at a post or door to door during the vaccination campaign. They should not be filled in after the work has finished.
• Atallysheetshouldbeusedtorecordthenumberofchildrenimmunizedatapostorhousetohouse.
• Fortheassignednumberofhouses,theteamshouldrecordthenumbersofthefirstandlasthouse.
• Everyday,eachteamshouldrecordthedetailsofthehousestoberevisitedonthebackofthetallysheets.
– Some houses may be revisited on the same day and others on the next day, depending on team availability.
• Each day, the details of the vaccine received and vaccine vials returned (used and unused) should be recorded on the tally sheet.
RECORDING AND REPORTING THE RESPONSIBILITIES OF TEAM SUPERVISORSTeam supervisors must:
• reviewalltallysheetswithteams;
• makeaconsolidatedreport;
• attendeveningmeetingsandgivefeedbackoncorrectiveactiontobetaken;
• gothroughthetallysheetsoftheirteamsattheendofeachday:
– to provide appropriate instructions for vaccinators – to compile tally-sheet information and submit a daily report using the reporting form for
supervisors;• comparetheratioofthenumberofchildrenaged0–11monthstothenumberofchildrenaged
12–59months(theratioshouldbe1:5);
• correlatethenumberofvialsusedwiththereportednumberofdosesadministeredaccordingtothetallysheet;
• signthetallysheetshowingthetimeoftheirvisit;
• verify the tally sheet looks authentic and has genuinely been used in the field.
29 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
USING A DAILY REPORTING FORM• Thedailyreportingformconsolidatesthedatafromthetallysheets.
• Thesameformcanbeusedateachlevel.
• Attheendofeachdayandeachweek,eachdistrictshouldsendaconsolidatedreportofchildrenimmunized.Allreportsshouldbeanalysedonadailybasistobeinapositiontorespondtoproblemsandadaptthestrategy.Questionstoaskinclude:
– Are there areas with specific problems and how were they corrected? – Were all teams and supervisors present? – Was vaccine availability ensured everywhere?
SIA RESULT REPORTING FORMThis form can be used at any level:
• atthehealthcentreleveltoprovidetheteams’dailyresults;
• atthedistrictleveltoprovideconsolidatedresultsfromeachhealthcentre;
• attheprovinceleveltoprovideconsolidatedresultsfromeachdistrict.
The form should indicate at which level it is being used.
Figure 8. Form to report SIA results
Team/health centre/district/ province (indicate
which level)
Eligible population
Aged 0–11
months
Aged 12–59
months
Total % of eligible popula-
tion
OPV vials received
OPV vials used
30 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
MONITORING MICROPLAN (seeAnnex3forchecklistexamples)
Microplan checks occur at three levels:
• pre-campaignmonitoring
• intra-campaignmonitoring
• post-campaign monitoring.
BEST PRACTICE IN USING CHECKLISTSChecklists can become a burden on supervisors and monitors. To avoid this encumbrance, they should concentrate on collecting data that can be used immediately and only listing essential components for which action can be taken.
• The pre-campaign readiness checklist canbeusedbysupervisorsormonitorswhovisithealthcentrestoensureallthecampaigncomponentsareinplace.
• The intra-campaign monitoring checklist canbeusedbymonitorswhocompiletheirobservationsaccordingtothefindingsoneachteam.
Supervisorsshoulduseasimplerchecklist,givingthemtimetoconcentrateoncorrectiveaction(seethesectiononsupervision).
POST-CAMPAIGN RAPID CAMPAIGN MONITORING
The purpose of rapid campaign monitoring (RCM) is to find and vaccinate missed children.• MonitorsconductRCMinselectedcommunities(oftenthoseathighrisk)duringandimmediately
aftertheteamshavecompletedtheirwork(thesameday,orthenextatthelatest).
• Monitorsshouldcheck10householdsdoortodoorfortheOPVstatusofchildreninthetargetagegroup(e.g.aged0–59months)inthosehouses.
• Asampleof10householdsispreferableto10childrenbecauseaselectionofdifferenthouseswillbemorerepresentativethanaselectionofmanychildreninonehouse.
• Any community that fails RCM (two or more children out of 10 missed) should be revisited by a vaccination team.
Method• Monitorsshouldgetasamplethatisasrepresentativeaspossiblebychoosingasmanydifferent
areasasfeasibleinthetimeavailable(forexample,4ะ5differentstreets,or2–3villages,orseveralclustersofhouses).
• MonitorsshouldgodoortodoortoverifythatatleastonechildineachhousereceivedtheOPV,visitingapproximately10householdsbeforemovingontothenextarea.
• Monitorsmuchcheckeachchildaged0–59months(oranothertargetagegroup)ineachhouseandrecordtheOPVstatus.
• Finger-marking is used to confirm OPV status.
31 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Checking finger-marking for immunization status• Vaccinatedchildrenshouldbemarked:√
• Unvaccinatedchildrenshouldbemarked:X
• Ifachildhasnotbeenvaccinated,thenameandlocationofthatchildisnotedontheform.Themothercanbeaskedwhythechildisnotvaccinated,whichisalsorecordedontheRCMform.
• Ifamothersaysherchildwasvaccinated,herresponseshouldbeacceptedandnotedunderthereasons,evenifnofingerismarked.
• Monitorsshouldinformsupervisorsbyphoneifmanyunvaccinatedchildrenarefoundinonecommunity,inordertoorganizeanimmediatemop-upcampaign.
• The results should be totalled by age group: 0–11 months and 12ะ59 months.
Vaccinating missed children• Themonitorinformstheteamsupervisorofmissedchildrenbymobilephoneandprovidesthe
detailedmonitoringform,whichcanbepresentedatfeedbackmeetings.
• Theteamsupervisorputstogetheravaccinationteamtovisittothecommunity.
• The team revisits the community and vaccinates all missed children, including any children not yet identified by the RCM team.
Figure 9. Simple form for rapid campaign monitoring (RCM)
Province/District Village/Community External Supervisor Team Number
RCM OPV – 0–59 months
0–11 months 12–59 months If NO,
writename,houseand
streetnumber
If NO,
writereasonnotvaccinated
Vaccinated OPV
Finger-mark
YES √
Finger-mark
NO X
Finger-mark
YES √
Finger-mark
NO X
1
2
3
4
5
6
7
8
9
10
TOTAL
32 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figure 10. Form to report results of rapid campaign monitoring
Health Centre Name Monitoring Team Name/Number Date
Location of monitoring visit
Vaccination team #
assigned
Area selected for monitoring
# of households monitored
Total # of children checked
# of missed children
Supervisor notified
Block 44 12 Omega Heights
10 15 2 Yes, team will return tomorrow
13 Rose Garden
10 6 0
BEST PRACTICE IN RAPID CAMPAIGN MONITORING• Monitoringteamsshouldvisitasmanydifferentareasaspossible,includingareasknownforlow
performanceandhighrisk.
• Theresultsshouldbediscussedattheeveningmeeting.
• Themoretheinformationgiventothesupervisorisdetailed,theeasieritistotakeaction.
• Missed children should be identified by name and location so the team can return to vaccinate door to door.
33 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
CONCLUSION
These best practices in microplanning for polio eradication are based on many years of success and failure in interrupting poliovirus transmission in many diverse situations. The elements described, and the recommended steps and forms, are all aimed at keeping the microplan as simple as possible and relevant to the situation in the field. There is no ideal microplan; there are only examples. In fact, one of the greatest achievements of polio microplanning has been its capacity to remain flexible and change rapidly, even from one day to the next, when problems arise. For polio eradication, achieving 80–90% of the goal is not an option – the only goal is 100%. Every child must be vaccinated, often through separate doses administered in successive rounds. Children missed results in continued transmission, and a pocket of local transmission, if not halted rapidly, can soon become an international outbreak.
34 BESTPRACTICESINMICROPLANNINGFORPOLIOERADICATION
ANNE
X 1
MIC
ROPL
AN R
ESOU
RCE
ESTI
MAT
E
Cal
cula
tion
of a
pop
ulat
ion-
base
d es
timat
e fo
r to
tal
supp
ly,
logi
stic
s, h
uman
res
ourc
es,
tran
spor
t an
d co
ld-c
hain
equ
ipm
ent
requ
irem
ents
at
the
high
est
leve
l (u
sual
ly
the
natio
nal l
evel
)
Figu
re A
1.1.
Nat
iona
l res
ourc
e an
d lo
gist
ics
mic
ropl
an o
rgan
ized
by
prov
inci
al p
opul
atio
n
This
spr
eads
heet
is a
n ex
ampl
e of
a p
opul
atio
n-ba
sed
natio
nal r
esou
rce
estim
ate
for
a co
untr
y w
ith a
tota
l pop
ulat
ion
of 2
0 70
0 00
0 im
plem
entin
g a
natio
nwid
e ca
mpa
ign
to
imm
uniz
e ev
ery
child
age
d 0–
59 m
onth
s (e
stim
ated
to b
e 13
.5%
of t
he to
tal p
opul
atio
n) w
ith O
PV,
rega
rdle
ss o
f pri
or im
mun
izat
ion
stat
us. E
ach
prov
ince
is li
sted
in th
is n
atio
nal
spre
adsh
eet,
and
supp
lies
and
reso
urce
s ar
e es
timat
ed a
ccor
ding
to th
e pr
ovin
cial
pop
ulat
ions
.
1. N
ame
Pro
vinc
e/
Stat
e
2. T
otal
P
opul
atio
n fo
r ye
ar
3. O
PV
targ
et
popu
lati
on
13.5
%
(0 T
O 5
9 M
ON
THS)
4. #
ho
useh
olds
va
ccin
ated
by
one
te
am p
er
day
5 #
of
team
day
s re
quir
ed*
6. #
day
s sc
hecu
led
for
impl
emen
ta
tion
7. #
if
team
s re
quir
ed
(2 O
PV
vacc
inat
iors
pe
r te
am)
8. #
of
vacc
inat
ors
need
ed
( 2 p
er
team
)
9. #
su
ppor
t st
aff
(2 p
er
team
)
10. #
of
team
su
perv
isor
s (1
per
5
team
s)
11.
Tota
l #
of s
taff
re
quir
ed
( sum
of
8+9+
10)
12. #
of
20 d
oes
OP
V vi
als
requ
ired
=
(tar
get
popu
lati
on
x w
asta
ge
fact
or
(1.2
0/20
)
13. D
aily
Tr
ansp
orta
tion
N
eed
(1ve
hicl
e pe
r su
perv
isor
m
oto,
or
car)
14. V
olum
e of
OP
V do
es
requ
ired
in
Lit
res
= (t
arge
t po
pula
tion
x
was
tage
fa
ctor
x
volu
me
of 1
doe
s O
PV)
/100
0
15. T
otal
re
frig
erat
or
spac
e re
quir
ed in
Li
tres
(+2
to
+8 C
)
16.
Est.
#
of
frid
ge
unit
s (2
0 L
per
frid
ge)
17. #
of 2
0 L
cold
box
re
quir
ed
(1 p
er
supe
rvis
or)
18. #
of
vacc
ine
requ
ired
(2
per
te
am)
19. #
of
ice
pack
s (2
x 4
ic
epac
ks
for
vacc
ine
carr
ier)
pl
us 2
0 pe
r co
ld
box
20. E
st.
# o
f fr
eeze
rs
(1 p
er
100
ice
pack
s)
21. #
of
imm
uniz
ati
on fi
xed
post
s (1
per
5
team
s)
22. #
C
opie
s of
re
cord
ing/
re
port
ing
form
s (t
eam
day
s x
2)
23. #
set
s of
wri
ting
m
ater
ials
(e
xerc
ise
book
s an
d pe
ns)
24. #
fi
nger
m
arke
r pe
ns
(tea
m
days
x
2)
A 1
,000
,000
1
35,0
00
50 9
00
518
036
036
036
756
8
,100
36
243
243
2. 4
3636
0 3
,600
36
36 1
,800
1
,800
1
,800
B
1,5
00,0
00
202
,500
50
1,3
50
527
054
054
054
1,1
34
12,
150
5436
536
53.
654
540
5,4
00
5454
2,7
00
2,7
00
2,7
00
C 2
,200
,000
2
97,0
00
50 1
,980
5
396
792
792
79 1
,663
1
7,82
0 79
535
535
5.3
7979
2 7
,920
79
79 3
,960
3
,960
3
,960
D
2,0
00,0
00
270
,000
50
1,8
00
536
072
072
072
1,5
12
16,
200
7248
648
64.
972
720
7,2
00
7272
3,6
00
3,6
00
3,6
00
E 2
,500
,000
3
37,5
00
50 2
,250
5
450
900
900
90 1
,890
2
0,25
0 90
608
608
6.1
9090
0 9
,000
90
90 4
,500
4
,500
4
,500
F
3,2
00,0
00
432
,000
50
2,8
80
557
611
5211
5211
5 2
,419
2
5,92
0 11
577
877
87.
811
511
52 1
1,52
0 11
511
5 5
,760
5
,760
5
,760
G
2,2
00,0
00
297
,000
50
1,9
80
539
679
279
279
1,6
63
17,
820
7953
553
55.
379
792
7,9
20
7979
3,9
60
3,9
60
3,9
60
H 1
,300
,000
1
75,5
00
50 1
,170
5
234
468
468
47 9
83
10,
530
4731
631
63.
247
468
4,6
80
4747
2,3
40
2,3
40
2,3
40
I 2
,300
,000
3
10,5
00
50 2
,070
5
414
828
828
83 1
,739
1
8,63
0 83
559
559
5.6
8382
8 8
,280
83
83 4
,140
4
,140
4
,140
J
2,5
00,0
00
337
,500
50
2,2
50
545
090
090
090
1,8
90
20,
250
9060
860
86.
190
900
9,0
00
9090
4,5
00
4,5
00
4,5
00
TOTA
L20
,700
,000
2
,794
,500
3,7
29
7452
7452
745
15,
649
167
,670
74
550
3050
3050
.374
574
52 7
4,52
0 74
574
5 3
7,26
0 3
7,26
0 3
7,26
0 *a
ssum
ing
and
aver
age
of 3
chi
ldre
n ag
ed 0
t0 5
9 m
onth
s pe
r ho
useh
old
35 BESTPRACTICESINMICROPLANNINGFORPOLIOERADICATION
BEST
PRA
CTIC
E FO
R ES
TIM
ATIN
G RE
SOUR
CES
The
mic
ropl
an m
ust s
tart
with
an
estim
ate
of to
tal r
esou
rces
, mad
e se
vera
l mon
ths
in a
dvan
ce s
o su
pplie
s ca
n be
ord
ered
and
del
iver
ed in
tim
e.
This
spr
eads
heet
is b
ased
on
stan
dard
s se
t by
the
coun
try
for
supp
ly, l
ogis
tics,
hum
an r
esou
rces
, tra
nspo
rt a
nd c
old-
chai
n eq
uipm
ent.
It is
onl
y an
exa
mpl
e an
d do
es n
ot
repr
esen
t any
pol
icy;
all
field
s ca
n be
mod
ified
acc
ordi
ng to
the
stan
dard
s se
t at t
he n
atio
nal l
evel
. In
this
spr
eads
heet
, eac
h va
ccin
atio
n te
am o
f tw
o pe
ople
plu
s tw
o su
ppor
t st
aff v
isit
50 h
ouse
hold
s pe
r da
y an
d va
ccin
ate
ever
y el
igib
le c
hild
in th
ose
hous
ehol
ds. T
his
exam
ple
assu
mes
thre
e ch
ildre
n ag
ed 0
ะ59
mon
ths
per
hous
ehol
d (a
n av
erag
e of
150
chi
ldre
n pe
r da
y). T
he s
prea
dshe
et c
an b
e us
ed a
t the
pro
vinc
e an
d di
stri
ct le
vels
as
show
n in
the
follo
win
g ta
bles
.
Figu
re A
1.2.
Pro
vinc
e re
sour
ce a
nd lo
gist
ics
mic
ropl
an o
rgan
ized
by
dist
rict
pop
ulat
ion
Figu
re A
1.3.
Dis
tric
t res
ourc
e an
d lo
gist
ics
mic
ropl
an o
rgan
ized
by
heal
th ce
ntre
pop
ulat
ion
1. N
ame
Pro
vinc
e/
Stat
e
2. T
otal
P
opul
atio
n fo
r ye
ar
3. O
PV
targ
et
popu
lati
on
13.5
% (0
TO
59
MO
NTH
S)
4. #
ch
ildre
n to
be
imm
uniz
ed
by o
ne te
am
per
day
5 #
of
team
da
ys
requ
ired
*
6. #
day
s sc
hecu
led
fo
r im
plem
en
tati
on
7. #
if te
ams
requ
ired
(2
OP
V va
ccin
atio
rs
per
team
)
8. #
of
vacc
inat
ors
need
ed (
2 pe
r te
am)
9. #
su
ppor
t st
aff (
2 pe
r te
am)
10. #
of
team
su
perv
isor
s (1
per
5
team
s)
11. T
otal
#
of s
taff
re
quir
ed
( sum
of
8+9+
10)
12. #
of
20 d
oes
OP
V vi
als
requ
ired
=
(tar
get
popu
lati
on
x w
asta
ge
fact
or
(1.2
0/20
)
13. D
aily
Tr
ansp
orta
tion
N
eed
(1ve
hicl
e pe
r su
perv
isor
m
oto,
or
car)
14. V
olum
e of
OP
V do
es
requ
ired
in
Lit
res
= (t
arge
t po
pula
tion
x
was
tage
fa
ctor
x
volu
me
of 1
doe
s O
PV)
/100
0
15. T
otal
re
frig
erat
or
spac
e re
quir
ed in
Li
tres
(+2
to
+8 C
)
16. E
st.
# o
f fr
idge
un
its
(20
L pe
r fr
idge
)
17. #
of 2
0 L
cold
box
re
quir
ed
(1 p
er
supe
rvis
or)
18. #
of
vacc
ine
requ
ired
(2
per
te
am)
19. #
of
ice
pack
s (2
x 4
ic
epac
ks
for
vacc
ine
carr
ier)
pl
us 2
0 pe
r co
ld
box
20. E
st.
# o
f fr
eeze
rs
(1 p
er
100
ice
pack
s)
21. #
of
imm
uniz
ati
on fi
xed
post
s (1
per
5
team
s)
22. #
C
opie
s of
re
cord
ing/
re
port
ing
form
s (t
eam
da
ys x
2)
23. #
set
s of
wri
ting
m
ater
ials
(e
xerc
ise
book
s an
d pe
ns)
24. #
fi
nger
m
arke
r pe
ns
(tea
m
days
x
2)
A 1
20,0
00
16,
200
200
81
516
3232
3 6
8 9
72
329
290.
33
32 3
24
33
162
1
62
162
B
140
,000
1
8,90
0 20
0 9
5 5
1938
384
79
1,1
34
434
340.
34
38 3
78
44
189
1
89
189
C
130
,000
1
7,55
0 20
0 8
8 5
1835
354
74
1,0
53
432
320.
34
35 3
51
44
176
1
76
176
D
156
,000
2
1,06
0 20
0 1
05
521
4242
4 8
8 1
,264
4
3838
0.4
442
421
4
4 2
11
211
2
11
E 2
43,0
00
32,
805
200
164
5
3366
667
138
1
,968
7
5959
0.6
766
656
7
7 3
28
328
3
28
F 1
36,0
00
18,
360
200
92
518
3737
4 7
7 1
,102
4
3333
0.3
437
367
4
4 1
84
184
1
84
G 1
14,0
00
15,
390
200
77
515
3131
3 6
5 9
23
328
280.
33
31 3
08
33
154
1
54
154
H
100
,000
1
3,50
0 20
0 6
8 5
1427
273
57
810
3
2424
0.2
327
270
3
3 1
35
135
1
35
I 1
60,0
00
21,
600
200
108
5
2243
434
91
1,2
96
439
390.
44
43 4
32
44
216
2
16
216
J
135
,000
1
8,22
5 20
0 9
1 5
1836
364
77
1,0
94
433
330.
34
36 3
65
44
182
1
82
182
TO
TAL
1,4
34,0
00
193
,590
194
38
738
739
813
1
1,61
5 39
348
348
3.5
3938
7 3
,872
39
39 1
,936
1
,936
1
,936
1. N
ame
Pro
vinc
e/
Stat
e
2. T
otal
P
opul
atio
n fo
r ye
ar
3. O
PV
targ
et
popu
lati
on
13.5
% (0
TO
59
MO
NTH
S)
4. #
ch
ildre
n to
be
imm
uniz
ed
by o
ne
team
per
da
y
5 #
of
team
da
ys
requ
ired
6. #
day
s sc
hecu
led
fo
r im
plem
en
tati
on
7. #
if te
ams
requ
ired
(2
OP
V va
ccin
atio
rs
per
team
)
8. #
of
vacc
inat
ors
need
ed (
2 pe
r te
am)
9. #
su
ppor
t st
aff (
2 pe
r te
am)
10. #
of
team
su
perv
isor
s (1
per
5
team
s)
11. T
otal
#
of s
taff
re
quir
ed
( sum
of
8+9+
10)
12. #
of
20 d
oes
OP
V vi
als
requ
ired
=
(tar
get
popu
lati
on
x w
asta
ge
fact
or
(1.2
0/20
)
13. D
aily
Tr
ansp
orta
tion
N
eed
(1ve
hicl
e pe
r su
perv
isor
m
oto,
or
car)
14. V
olum
e of
OP
V do
es
requ
ired
in
Lit
res
= (t
arge
t po
pula
tion
x
was
tage
fa
ctor
x
volu
me
of 1
doe
s O
PV)
/100
0
15. T
otal
re
frig
erat
or
spac
e re
quir
ed in
Li
tres
(+2
to
+8 C
)
16. E
st.
# o
f fr
idge
un
its
(20
L pe
r fr
idge
)
17. #
of 2
0 L
cold
box
re
quir
ed
(1 p
er
supe
rvis
or)
18. #
of
vacc
ine
requ
ired
(2
per
te
am)
19. #
of
ice
pack
s (2
x 4
ic
epac
ks
for
vacc
ine
carr
ier)
pl
us 2
0 pe
r co
ld
box
20. E
st.
# o
f fr
eeze
rs
(1 p
er
100
ice
pack
s)
21. #
of
imm
uniz
ati
on fi
xed
post
s (1
per
5
team
s)
22. #
C
opie
s of
re
cord
ing/
re
port
ing
form
s (t
eam
da
ys x
2)
23. #
set
s of
wri
ting
m
ater
ials
(e
xerc
ise
book
s an
d pe
ns)
24. #
fi
nger
m
arke
r pe
ns
(tea
m
days
x
2)
A 2
3,00
0 3
,105
20
016
53
66
113
186
16
60.
31
662
11
3131
31B
11,
000
1,4
85
200
75
13
31
789
13
30.
11
344
01
1515
15C
12,
000
1,6
20
200
85
23
31
797
13
30.
11
346
01
1616
16D
17,
000
2,2
95
200
115
25
51
1013
81
44
0.2
15
571
123
2323
E 1
9,00
0 2
,565
20
013
53
55
111
154
15
50.
21
551
11
2626
26F
16,
000
2,1
60
200
115
24
41
1013
01
44
0.2
14
551
122
2222
G 1
4,00
0 1
,890
20
09
52
44
19
113
13
30.
21
450
11
1919
19H
11,
000
1,4
85
200
75
13
31
789
13
30.
11
344
01
1515
15I
14,
000
1,8
90
200
95
24
41
911
31
33
0.2
14
501
119
1919
J 1
0,00
0 1
,350
20
07
51
33
16
811
22
0.1
13
420
114
1414
TOTA
L 1
47,0
00
19,
845
20
4040
989
1,1
91
936
361.
89
4050
05
919
819
819
8
36 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
EXPLANATION OF THE FIELDS IN THE RESOURCE AND LOGISTICS MICROPLANThese examples show a resource and logistics plan with 24 fields. Each field must comply with standards initially set at the national level. The advantage of this spreadsheet is that it shows the total resources needed such that, when prepared in advance, it allows organizing total needs in a timely manner and ordering the required resources.
1. Name of the province/state for implementation2. Total population in the year of implementation3. Target population (0–59 months = 13.5% of the total population)4. Number of households to be visited for immunization by one team in one day (= 50 households).
The assumption of three children aged 0–59 months per household represents an average of 150 children per day. (This field can be standardized in various ways, for example 100 or 200 children per day.)
5. Number of team days required (the target population is divided by the number of children to be immunized in one day, in this case, 50 households x 3 = 150 children per day)
6. Number of days scheduled to implement the plan (in this example, five days)7. Number of teams required for implementation (the number of team days is divided by the number
of days scheduled)8. Number of vaccinators required (in this example, 2 vaccinators per team)9. Number of support staff required (in this example, 2 support staff per team to help manage the
team’s work)10. Number of team supervisors required (in this example, 1 supervisor per 5 teams)11. Total number of staff needed (total vaccinators + support staff + supervisors)12. Number of 20-dose vials of OPV required (target population x wastage multiplication factor for
vaccine divided by 20)13. Daily transportation required; total number of various vehicles needed for supervisor transport (1
per supervisor)14. Volume of OPV doses expressed in litres (target population x wastage factor x volume of 1 dose in
ml divided by 1000)15. Total refrigerator space at 2ะ8 °C required in litres (same as the volume of OPV doses)16. Estimated number of 100-litre refrigerator units required (refrigerator space divided by 100)17. Number of 20-litre cold boxes required (1 per supervisor)18. Number of vaccine carriers required (2 per team)19. Number of ice packs required (4 ice packs per vaccine carrier x 2 per team = 8 per team + 20 ice
packs for each supervisor cold box)20. Estimated number of freezers required to freeze ice packs each day (1 freezer per 100 ice packs)21. Number of immunization fixed posts required (1 fixed post per 5 teams) where a fixed post can
immunize and be used to replenish team supplies22. Number of copies of recording and reporting forms (2 sets of forms per team day)23. Number of sets of writing materials for teams (exercise books and pens for each team day)24. Number of finger-marking pens (2 finger-marking pens per team day)
37 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
NOTE
S ON
BES
T PR
ACTI
CE F
OR E
STIM
ATIN
G RE
SOUR
CES
Whe
n pl
anni
ng a
cam
paig
n, it
is b
est t
o es
timat
e th
e to
tal r
esou
rces
nee
ded
in a
tim
ely
man
ner.
Tim
e w
ill b
e ne
eded
to g
athe
r th
e re
sour
ces:
vac
cine
mus
t of
ten
be o
rder
ed fr
om o
vers
eas,
veh
icle
s di
stri
bute
d, p
erso
nnel
trai
ned
and
supe
rvis
ors
assi
gned
. The
ext
ent o
f all
thes
e re
sour
ces
need
s to
be
know
n w
ell
in a
dvan
ce a
t eve
ry le
vel.
Earl
y pl
anni
ng e
stim
ates
are
als
o es
sent
ial b
ecau
se a
sho
rtag
e of
res
ourc
es is
mor
e lik
ely
at th
e di
stri
ct le
vel.
Accu
rate
res
ourc
e es
timat
es a
re c
alcu
late
d fr
om p
opul
atio
n es
timat
es, b
ut th
e la
tter
may
var
y ac
cord
ing
to th
e in
form
atio
n so
urce
. Pla
nnin
g es
timat
es s
houl
d be
mad
e fr
om
the
bott
om-u
p, u
sing
the
sam
e fr
amew
ork
desp
ite v
aryi
ng p
opul
atio
n to
tals
. It i
s al
way
s be
tter
to s
light
ly o
vere
stim
ate
the
popu
latio
n to
ens
ure
suffi
cien
t va
ccin
es a
nd o
ther
res
ourc
es a
re a
vaila
ble.
Figu
res
A1.4
. Dis
tric
t and
hea
lth ce
ntre
est
imat
es o
f pop
ulat
ion
dist
ribu
tion
and
hum
an re
sour
ces
Dis
tric
t ___
____
____
____
___
Heal
th
cent
re
Tota
l po
pula
tion
Targ
et
popu
latio
n (#
)
Villa
ges
(#)
Fixe
d po
sts
High
-ris
k ar
eas
(#)
Bord
er
poin
ts
if ap
plic
able
(#
)
Tran
sit
poin
ts
#
Team
s (#
)Va
ccin
ator
s (#
)Vo
lunt
eers
(#
)Ve
hicl
es
(#)
Com
mun
ity
mob
ilize
r na
me
and
phon
e #
Supe
rvis
or
nam
e an
d ph
one
#
HC 1
HC 2
HC 3
HC 4
HC 5
Tota
l
38 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Hea
lth
Cen
tre
____
____
____
____
_
Heal
th
cent
re
Tota
l po
pula
tion
Targ
et
popu
latio
n (#
)
Fixe
d po
sts
High
-ris
k vi
llage
Y/
N
Bord
er
villa
ge
Y/N
Tran
sit
poin
ts
#
Team
s #
Vacc
inat
ors
(#)
Volu
ntee
rs
(#)
Com
mun
ity
mob
ilize
r na
me
and
phon
e #
Supe
rvis
or n
ame
and
phon
e #
Villa
ge 1
Villa
ge 2
Villa
ge 3
Villa
ge 4
Villa
ge 5
Tota
l
NOTE
S ON
BES
T PR
ACTI
CEAt
the
dist
rict
and
hea
lth c
entr
e le
vels
, whe
n de
alin
g w
ith s
mal
ler
popu
latio
ns a
nd s
carc
er re
sour
ces,
big
spr
eads
heet
s ar
e a
star
ting
poin
t but
are
inad
equa
te
to d
eal w
ith th
e re
aliti
es in
the
field
. At t
his
leve
l, it
is b
ette
r to
cre
ate
sim
ple,
mor
e de
taile
d re
sour
ce p
lans
that
will
ena
ble
heal
th c
entr
es to
sha
re a
nd m
ove
reso
urce
s, a
nd id
entif
y th
ose
peop
le w
ho w
ill s
hare
sup
ervi
sory
dut
ies
and
will
be
avai
labl
e to
wor
k at
the
com
mun
ity le
vel.
39 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
ANNE
X 2
COLD
CHA
IN A
ND S
UPPL
IES
Figu
re A
2.1.
Col
d-ch
ain
equi
pmen
t ava
ilabi
lity
and
depl
oym
ent
Pro
vinc
e-le
vel c
old-
chai
n an
d lo
gist
ics
plan
org
aniz
ed b
y di
stri
ct (w
orki
ng e
xam
ple)
Dis
tric
t (N
ames
) Ta
rget
P
opul
atio
nTe
ams
(#)
OP
V VI
ALS
Vacc
ine
Car
rier
sC
old
Box
Ic
e pa
cks
Stor
age
capa
city
(Lt)
in
Ref
rige
rato
rN
umbe
r of
Fre
ezer
s R
equi
red
for
Ice
Pac
ks
Required
Available
Shortfall
Required
Available
Shortfall
Required
Required
Available
Shortfall
Required
Available
Shortfall
1 1
6 20
016
972
3225
73
21
324
2910
00
32
1
2 3
2 80
5 33
1968
6670
07
80
656
5910
00
75
2
3
4
5
6
7
8
9
10
TOTA
L
40 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
NOTE
S ON
BES
T PR
ACTI
CEEv
ery
prov
ince
sho
uld
estim
ate
its c
old-
chai
n eq
uipm
ent
situ
atio
n ea
rly
on. D
urin
g a
cam
paig
n, t
he d
eman
d fo
r re
frig
erat
ors,
col
d bo
xes
to c
arry
vac
cine
an
d fr
eeze
r sp
ace
is h
igh.
All
dist
rict
s sh
ould
man
age
thei
r co
ld-c
hain
res
ourc
es a
ccor
ding
ly a
nd w
ell i
n ad
vanc
e. T
his
exam
ple
show
s th
at a
dis
tric
t may
ha
ve a
sho
rtfa
ll in
col
d-ch
ain
equi
pmen
t but
can
rece
ive
assi
stan
ce th
roug
h th
e de
ploy
men
t of e
quip
men
t fro
m th
e pr
ovin
ce le
vel o
r a
neig
hbou
ring
dis
tric
t. If
dist
rict
cen
tres
are
not
far
from
eac
h ot
her,
poo
ling
free
zer
capa
city
for
ice
pack
s m
ay b
e po
ssib
le a
t a s
hare
d lo
catio
n.
Figu
re A
2.2.
Vac
cine
and
sup
ply
tran
spor
t pla
n (workingexample)
Nam
e of
di
stri
ct
Tota
l po
pula
tion
for y
ear
OPV
targ
et
popu
latio
n 13
.5%
(0–5
9 m
onth
s)
# of
20
-dos
e OP
V vi
als
requ
ired
= (ta
rget
po
pula
tion
x w
asta
ge
fact
or
(1.2
)/20
)
# of
20
L co
ld b
oxes
re
quire
d (1
per
su
perv
isor
)
Vacc
ine
tran
spor
t ve
hicl
e
Date
of
dist
ribu
tion
to d
istr
ict
Nam
e of
pr
ovin
ce
pers
on
resp
onsi
ble
for t
rans
port
an
d ph
one
num
ber
Nam
e of
di
stri
ct p
erso
n re
spon
sibl
e fo
r tr
ansp
ort a
nd
phon
e nu
mbe
r
Refr
iger
ator
/fr
eeze
r/co
ld b
ox/
vacc
ine
carr
ier
shor
tfall
need
ing
tran
spor
t or
relo
catio
n
Loca
tion
of ic
e pa
ck fr
eeze
r (in
th
is d
istr
ict o
r a
shar
ed lo
catio
n)
112
0 00
0 16
200
97
2 3
Pro
vinc
e tr
uck
22 J
an
1 co
ld b
ox fr
om
prov
ince
to
dist
rict
1
Loca
ted
in d
istr
ict
1
214
0 00
0 18
900
1
134
4
313
0 00
0 17
550
1
053
4
415
6 00
0 21
060
1
264
4
524
3 00
0 32
805
1
968
7
613
6 00
0 18
360
1
102
4
711
4 00
0 15
390
92
3 3
810
0 00
0 13
500
81
0 3
916
0 00
0 21
600
1
296
4
1013
5 00
0 18
225
1
094
4
Tota
l1
434
000
193
590
11 6
15
40
NOTE
S ON
BES
T PR
ACTI
CEVa
ccin
e sh
ould
be
dist
ribu
ted
from
the
prov
ince
to th
e di
stri
ct n
o la
ter
than
one
mon
th fr
om th
e st
art o
f the
cam
paig
n. E
quip
men
t can
als
o be
tran
spor
ted
in a
dvan
ce in
cas
e of
a s
hort
fall.
The
pro
vinc
e an
d di
stri
ct s
houl
d re
gula
rly
upda
te th
eir
lists
of e
quip
men
t acc
ordi
ng to
loca
l tra
nspo
rt in
form
atio
n an
d th
e co
ld-c
hain
equ
ipm
ent p
lan.
41 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
ANNEX 3 CHECKLISTS
Figure A3.1. Team logistics checklist
Supervisory role for team logistics• Everyteammustbecheckedeachdayatthehealthcentretomakesuretheyarepreparedandall
logisticsareinplacetoproceedontheirassigneditineraryfortheday.
• Supervisors at the health centre can use this checklist at the beginning of the day to ensure all supplies and personnel are available.
DATE TEAM LOGISTICS CHECKLIST
District or HC Province
Staff & Supplies & Transport needs VACCINATION TEAMA
Team #:1 Team #:2 Team #:3 Team #:4 Team #:5
Assignment area
Vaccinator names
Volunteer names
Supervisor Names
Target Pop estimated (#)
OPV needs (does)
Finger markers (#)
House Mark Chalk (#)
Vaccine carrier (#)
Cold box (#)
Ice packs (#)
Tallysheet (#)
Summary sheet (daily)
Supervisory check list #
Vehicle
Motorbike
Other (specify): ………..(#)
Fuel (Lt)
42 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figure A3.2. Supervisory checklist for pre-implementation
At the health centre: check each item for campaign readiness Comments
Microplan
All villages are included in the district plan
All items are included according to the template, with correct calculations
Any supply shortfall has been identified, with the action needed
Maps show catchment areas and location of posts/teams/supervisors per day
Budget has been accurately calculated
High-risk areas/RCMs
High-risk areas have been identified
Rapid campaign monitoring plan is available with supervisors/monitors/sites/dates
Supervisors understand RCM methods
Cold-chain logistics supply
Adequate vaccine storage space for OPV is available in regional and provincial stores
Adequate vaccine carriers/ice packs/freezer capacity is available at each level
Logistics/supply transport plan is available to supply all areas
Standard operating procedures (SOPs) are in place for replenishment in health centres if stocks run low
Advocacy
Local politicians have been informed and are ready to participate/contribute
Local NGO meetings are held to enlist their support for monitoring and for the transport of supervisors/teams
Social mobilization
Each region/province has a local media plan to promote/advertise SIA
Any other local social mobilization materials are available
A plan for community volunteer training is available
A plan for involving community officials and volunteers is available
A plan for identifying community engagement focal points is available
Immunization safety
All supervisors know how to report adverse events following immunization (AEFI)
AEFI Investigation forms and SOPs are available to supervisors
Team management
A plan for team training is available with simple training materials/tally sheets
A team strategy, with fixed post in the morning and mobile post in the afternoon, is in place
Teams are available for mop-up if RCM fails
A team/post distribution plan is available
Supervisor management
The plan shows available supervisors or a shortfall
A plan for training supervisors, including RCM training, is available
43 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
At the health centre: check each item for campaign readiness Comments
A supervisor mobility/transport plan is available to follow an assigned area
Supervisors have checklists
External supervisors have a system for calling teams to do mop-ups when RCM fails
Reporting system
A system for the daily collection and consolidation of tally sheets into reports is available
A computerized database for the consolidation of reports and their dispatch by email to provincial/regional/national offices is accessible
Monitoring system
Region/provinces have a system for the daily monitoring of results
The health centre has a system to react daily to a failed RCM by ordering an immediate mop-up
A system exists at the national level to receive and react to regional reports on at least a weekly basis
Figure A3.3. Simple supervisory intra-campaign checklist
Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action
Cold-chain/vaccine supplies
Marker pens/tally sheets
Post organization, staffing, working hours
Recording on tally sheets/missed children
Team movement plan and map
Team operating hours
Finger-marking quality
House-marking quality
High-risk communities
Presence of community leaders and volunteers
Availability of community engagement persons if needed
44 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action
Revisiting houses with missed children
End of day or next day
Vaccinating children out of the household, in streets and markets
BEST PRACTICE IN SUPERVISION DURING CAMPAIGNSThemaindutyofthesupervisorduringacampaignistotakecorrectiveactionduringteamoperations.Thisveryshortchecklistisusedasareminderofwhattolookfor;itisnotamonitoringformthatrequiresanalysis.Supervisorsshouldplantovisiteachteamat least twiceduringtheday.Theyshouldobserveteamoperationsandtakecorrectiveaction,whichtheyrecordonthesimplechecklist.
45 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
Figu
re A
3.4.
Intr
a-ca
mpa
ign
mon
itori
ng ch
eckl
ist
Intr
a-ca
mpa
ign
mon
itori
ng ch
eckl
ist q
uest
ion
Yes/
NoCo
mm
ents
Team
1Te
am 2
Team
3Te
am 4
Team
5C
omm
unit
y en
gage
men
t
Is th
e po
st c
lear
ly id
entifi
ed b
y ba
nner
s an
d po
ster
s?
Are
heal
th w
orke
rs/v
olun
teer
s ac
tivel
y se
arch
ing
for
ever
y el
igib
le c
hild
, at h
ouse
or
out o
f hou
se?
Col
d ch
ain/
supp
lies
Are
vacc
ines
sto
red
in v
acci
ne c
arri
ers
with
two
ice
pack
s?
Are
suffi
cien
t via
ls o
f OP
V in
side
the
vacc
ine
carr
ier?
Are
ther
e an
y st
ock-
outs
of O
PV?
Are
suffi
cien
t mar
ker
pens
ava
ilabl
e?
Are
suffi
cien
t tal
ly s
heet
s/re
cord
ing
form
s av
aila
ble?
Org
aniz
atio
n of
the
post
Is th
e po
st w
ell o
rgan
ized
, with
goo
d cl
ient
flow
?
Are
suffi
cien
t vac
cina
tors
and
vol
unte
ers
avai
labl
e? D
oes
the
post
hav
e en
ough
peo
ple?
Rec
ordi
ng a
nd r
epor
ting
pra
ctic
es
Are
tally
she
ets
bein
g us
ed c
orre
ctly
?
Is e
very
chi
ld b
eing
fing
er-m
arke
d?
Are
mis
sed
child
ren
liste
d on
the
back
of t
he ta
lly s
heet
for
a ho
use
revi
sit?
Hou
se-t
o-ho
use
oper
atio
n
Doe
s th
e te
am h
ave
a pl
an a
nd m
ap?
Is th
e te
am g
oing
hou
se to
hou
se a
ccor
ding
to p
lan?
Are
hous
es b
eing
mar
ked
corr
ectly
?
Are
team
s as
king
for
all m
othe
rs a
nd a
ll ch
ildre
n?
Are
team
s w
orki
ng m
orni
ng a
nd a
fter
noon
acc
ordi
ng to
pla
n?
Hig
h-ri
sk c
omm
unit
ies
Are
team
s vi
sitin
g hi
gh-r
isk
com
mun
ities
?
Are
com
mun
ity le
ader
s an
d vo
lunt
eers
invo
lved
in h
ouse
-to-
hous
e op
erat
ions
?
Are
loca
l lea
ders
eng
agin
g th
e co
mm
unity
app
ropr
iate
ly?
Hou
se r
evis
itin
g
Are
team
s re
visi
ting
hous
es a
t the
end
of t
he d
ay w
here
chi
ldre
n w
ere
prev
ious
ly a
bsen
t?
46 BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION
ANNE
X 4
TALL
Y SH
EET
Figu
re A
4.1.
Dai
ly ta
lly s
heet
of v
acci
nate
d ch
ildre
n fo
r tea
ms
Regi
on___________P
rovi
nce/
City___________D
istr
ict_
__________V
illag
e/Lo
catio
n___________
Date___________T
eam
Num
ber:____
Num
ber o
f hou
seho
lds
to b
e vi
site
d fo
r OPV
_____
Tota
l vac
cina
ted___________
Star
t hou
se n
umbe
r ____
End
hous
e nu
mbe
r ____
Inst
ruct
ions
: Put
a c
heck
mar
k (√
) in
each
box
app
ropr
iate
for t
he c
hild
’s ag
e.
Sign
atur
e of
sup
ervi
sor
and
tim
e of
vis
it
NU
MB
ER O
F C
HIL
DR
EN IM
MU
NIZ
ED W
ITH
OP
V
0–11
mon
ths
12–5
9 m
onth
s
Tota
l num
ber __________
Tota
l num
ber __________
Gra
nd to
tal __________
OP
V vi
als
rece
ived
……
…. O
PV
vial
s us
ed …
……
… A
FP c
ases
foun
d……
…..
A L
IST
OF
HO
USE
S TO
BE
REV
ISIT
ED IS
ON
TH
E B
AC
K O
F TH
IS F
OR
M
www.polioeradication.org