Protocol for the Use of the Performance Monitoring Tool for the National Expanded Program on Immunization

What this guideline says

GMJ summary

This protocol provides a structured methodology for national Expanded Programmes on Immunization (EPI) to conduct comprehensive self-assessments across 14 components including policy, planning, surveillance, human resources, cold chain, vaccine supply, communication, and implementation. The tool uses a five-level maturity scale (from 1-initial/insufficient to 5-optimized/continuously improving) to rate performance in each component.

Implementation occurs in three phases over approximately 12 weeks: preparation (establishing working teams, desk review, situational analysis, and tool adaptation), implementation (conducting self-assessments at national, subnational, and local health facility levels through structured workshops), and follow-up (data analysis, final reporting, and development of a 12-month action plan). The assessment is designed to validate national-level findings through subnational visits to three areas and nine health facilities, though subnational scores inform rather than determine the final national rating.

The protocol was developed by PAHO in response to declining vaccination coverage in the Americas (DPT3 coverage fell to 80% in 2021, the lowest since polio eradication in 1994) and aims to support the Immunization Agenda 2030 by enabling countries to identify weaknesses, prioritize technical cooperation, and implement concrete improvement measures tailored to national contexts.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. The tool evaluates 14 EPI components: political priority, planning/scheduling, organization/coordination, epidemiological surveillance, human resources/finance, training/supervision, information systems, cold chain, vaccine supply, evaluation/research, social communication, safe vaccination, implementation, and health facility performance
2. Each component is rated on a 5-level maturity scale: 1 (initial/insufficient elements), 2 (available but incomplete or inappropriately used), 3 (routinely implemented with biases), 4 (available, complete, up-to-date, and reliable with minor problems), 5 (optimized with consistent implementation)
3. Implementation requires three subnational areas (ideally high, medium, and low risk) and three health facilities per area (high, medium, and low performing) for field validation
4. The desk review must cover a five-year period of EPI performance data including coverage trends, surveillance quality indicators (AFP, measles, rubella reporting), and component-specific documentation
5. National self-assessment workshops run for five days with simultaneous component-specific sessions, each managed by a facilitation team with defined roles
6. Final component scores are calculated as the average of all national-level question scores, rounded to whole numbers using a consistent methodology across all components
7. The action plan must specify for each priority: recommendations, actions to move up one performance level, responsible parties, implementation sphere (national/subnational/local), 12-month timeline, financing, special requirements, and progress indicators
8. The National Coordination Team (NCT) comprises Ministry of Health representatives, national EPI officials, PAHO country office CIM focal point, and contracted consultants who remain available for four weeks post-assessment to support action plan implementation

Performance Scale for EPI Component Assessment

Table extracted from the guideline

Source: Pan American Health Organization, Protocol for the Use of the Performance Monitoring Tool for the National Expanded Program on Immunization. Reproduced in summary form.

From the guideline

Verbatim

“The purpose of the self-assessment is to identify difficulties and challenges that arise during the performance of each EPI component and, accordingly, to inform actions for continuous improvement plans in the short and medium term.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

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