Question #1. Should Harmonia conduct an EPI survey early next year? What are your considerations?

Answer: Yes Harmonia needs to conduct an EPI survey early next year because of the following reasons;

1. As the last structured standardized survey (DHS) was done 3 years prior and next one is due only after three years from now, it would be quite pertinent to undertake the EPI survey following the rigorous methodology as prescribed by WHO Vaccination Coverage Cluster Surveys; Reference Manual 2015 to guide the National Immunization Programme for further improvement and strengthening

2. As Harmonia has worked hard to improve the coverage, the proposed EPI survey will reveal the effectiveness of interventions to increase the coverage

3. To measure the coverage of PCV which will give the comparison with earlier (traditional) vaccines. Findings from these will also throw the light on vaccine inventory, education and communication activities around it(PCV) and simultaneously will assess the programme readiness for the new vaccine.

4. As Rotavirus vaccine is being introduced this year, the survey will also be able to estimate the coverage for this (vaccine) also and also system responsiveness to its introduction as being the most recent entrant.

4. For ascertaining the veracity of administrative coverage as it is now 105% for DTP/Pentavalent1 and 100% for DTP/Pentavalent3, as during last DHS survey, the administrative coverage was 103%(95% DHS) for DTP/Pentavalent1 and 96%(80%) for DTP/Pentavalent3.So the proposed survey will also tell us the effectiveness of the ongoing data quality activities to improve the recording and reporting of vaccination.

5. With the availability of new census data, the denominator will be latest and add to the precision of the coverage findings

Question #2. The steering committee includes representatives from the national Ministry of Health, National Statistics Office, WHO, UNICEF, and a donor. Given what you have already learned about Harmonia, what do you think will be their primary question of interest for the survey (estimation, comparison, or classification)? Why?

Answer: Primary question of interest need to be Estimation, because it will show us the target population coverage and proportion of the target population covered by the national schedule. First time the estimation of PCV and Rotavirus vaccine coverage would also be done. Coverage results would also help in comparison with administrative data and thereby the effectiveness of improving the data quality of it and progress since last DHS. These findings will help in restructuring the immunization programme with areas to be focused as well as to improve the Immunization management information system.

Question #3. Who will comprise the target population and why?

Answer: The target population need to be children aged 12-23 months of age as per the recommendation of WHO Vaccination Coverage Cluster Surveys: Reference Manual 2015 as the primary final vaccination is at age of 9 months. Studying this age group will also be able to estimate the coverage for 2nd dose of MR vaccine which is being given at the age of 18 months. Advantages of selecting this group include, the more availability of Home Based Records (HBRs), lesser recall bias and lesser percentages of nonresponse for the vaccines particularly given in initial phase of life.