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▪ Task 1. Flag all the suspicious values. (Outliers, repetitions, etc.) (spend max 15 minutes) - districts 14 out of 15 in Grandtown reported repetitions in February and March 2017, district 14 reported repletion in April and May and district 1 in November and December. - Two districts reported more than 200% coverage and 6 districts of Grandtown reported more than reported more than 100% coverage. ▪

Task 2. Review the national and subnational coverage for MR1. Your data manager produces the following tables. What can you conclude from the administrative data? - Data manager reported different coverage of Chello in 2016 (85% instead of 84%) and 2017 (82% instead of 81%) from what the National and Subnational HMIS reported. - In Grandtan the Manager reported (85% coverage while the national and subnational reported 86% coverage) in 2017. - The MR1 doses given reported by the data manager is less than 100 doses of what the National and subnational reported in Grantan district in 2017. This affected the total doses given in 2017. - The data manager reported 142 less surviving infants in Chello in 2017. ▪

Task 3. Review coverage evaluation survey data. You remember that in 2013, there was a coverage evaluation survey. You pull up the data for that. Does this change your view about coverage at national level? For any of the regions? - Though the population of the regions decreased and Grandtwon population increased; The region’s survey remained the same and this makes the coverage not accurate at some regions and the national level one. ▪

Task 4. Review the chart with the age distribution of measles cases. Does that tell you anything additional about coverage? - The administrative coverage reported shows in 2016 number of children vaccinated was less than the previous months coverage. - Pool of susceptible children emerged with in the years after the campaign and this caused the outbreak of the measles in the country. Part 2. Brief the Minister ▪

Task 5. Brief the Minister (spend max 1/2 hour on this section). Summarize the situation in three bullet points. ▪

Task 6. Brief the Minister. Propose three actions to respond to the outbreak. - Data reported is repeated and inflated in some facilities which caused a lot of false achievement. - Supportive supervision and monitoring to all EPI facilities, district, regional and National level such as data recording, reporting and analyzing activities were weak and needs improvement. - Data management tools used in facilities are outdated and new tools are required for all levels and make sure that they are used effectively. ▪

Task 7. Formulate recommendations. List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland. - Develop data improvement plan for the country and monitor progress. - Train all EPI staff in the country to improve their capacity towards data improvement in the country. - Develop supportive supervision plan from National to regions, from regions to districts and from districts to facilities. - Conduct EPI review meetings related to EPI data improvement progress and weaknesses at least quarterly at all levels. - Conduct micro-planning for all facilities across the country to reach all eligible children in hard to reach areas and marginalized communities.