Vaccines have substantially reduced or eliminated many infectious diseases which once killed millions of people.

Vaccination programmes not only provide vaccines, but strategic leadership and coordination, cold-chain systems necessary for transport, and programme monitoring and evaluation. Behind every vaccination programme, strong health systems are needed to deliver and scale-up new vaccines and to improve immunisation coverage and equity.

Strong health systems require accurate, relevant and timely data to support programmatic decision-making, such as where to allocate vaccines, how many, and the financial and human resources needed to enable roll-out.

Gavi, the Vaccine Alliance, has developed several initiatives to support Health Systems through a performance-based financing approach, where funding is directly linked to immunisation outcomes based on pre-agreed results.

To ensure systems are functioning correctly and efficiently, monthly immunisation reports at the facility level need to be complete and reported on time to the provincial level and consistent. To accomplish this, Afghanistan’s National Expanded Program of Immunisations (NEPI), has been implementing multiple activities to improve the timeliness, completeness and consistency of immunisation data.

Activities include capacity building of health facility staff, through training to increase knowledge on data collection, data processing and data use; recruitment of provincial-level data quality officers to improve both data quality and use.

KIT’s role is to assess the implementation of these activities, to identify the achievements made, and to analyse which barriers influence the performance of quality improvement initiatives. Together with local consultants, interviews have been conducted with national and provincial-level stakeholders, medical doctors in charge of facilities and vaccinators to assess the leadership and monitoring of the data-quality implementation committee, capacity building, enhanced data use by provinces, population data, innovative mechanisms and micro-planning. Routinely collected immunisation data was analysed on quality dimensions (completeness, timeliness, internal and external consistency) to see if they had improved during the intervention.

Results

The results of the baseline and interim assessments have provided detailed information on the challenges, enablers and lessons learned related to each of the data quality improvement plan objectives. At baseline no data analysis capabilities were available at the facility and provincial level. After the recruitment of Data-driven Quality Improvement in Primary Care (DQIP) officers improvements were seen, but the majority of facility and provincial level staff confirmed that data analysis capabilities still need further improvement. Challenges with insufficient supervisory capacity reported at baseline were found to be less of a problem, however, understaffing remains an issue.

As a result of the assessment, specific recommendations on DQIP have been made which can guide both the NEPI and its stakeholders in the successful implementation of data quality improvement activities.

The end line assessment planned for the first half of 2020 will contribute to the development of the next stage of health systems strengthening activities, allowing more children to be vaccinated and taking Afghanistan further on the path towards disease eradication.