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I strongly suggest Harmonia plan an EPI survey for early next year.

As you can see from the recent administrative coverage data (Table 1) there has not been a significant improvement in coverage despite the recent efforts to improve coverage. Dropout rates were increased; difference in coverage rates between DTP 1 and DTP 3 are estimated to have 5% in 2015 (administrative coverage) compared to 7% in 2017. We should take a closer look at why efforts to reduce DTP dropout have not been succeded. on the other hand there is a relatively promising rate of immunization cards, as per the last DHS, so we should not need to rely on recall.

Given the rapid population growth rate, I imagine our denominators are quite outdated (no longer representative of the current birth cohort) and may be causing our coverage data to be overestimated. An EPI coverage survey would provide us with a more accurate snapshot of real-time coverage rates.

Given the timeliness of Harmonia’s eligibility for Gavi funding, conducting and EPI survey early next year would provide key evidence needed for preparing a strong proposal for support from Gavi. As you know, such a survey is a critical performance indicator which will allow Gavi (and other donors) to evaluate Harmonia’s needs in terms of support for immunization services. Harmonia is in a good position to receive Gavi support for Rotavirus Vaccine (RVV) introduction, however we will again need updated denominator data to be able to estimate need and scale. What is the estimated time frame on completing the planned census that is planned for next year?

What do you think will be The steering committee's primary question of interest for the survey? Why?

Given Harmonia’s growing population and rapid urbanization, our coverage survey should primarily focus on evaluating regional variations. Partners will want to know how to focus and target their efforts. The donor may also be interested in understanding where there are equity issues in coverage, so that partners can be coordinated to address these issues.

The MoH will be very interested in understanding the coverage for newly introduced vaccines (PCV and the forthcoming RVV) so that these new initiatives can be evaluated and reported back to the Government of Harmonia. The MoH is going to need additional funding to continue roll out across the whole country, so progress to date will be scrutinized.

Who will comprise the target population and why?

The target population for this EPI should be infants. We need a better understanding of DTP1/ 3 coverage, dropout rates, PCV (which was no included in the administrative coverage data) and new vaccine coverage. There is currently no need to evaluate coverage for older populations (influenza, HPV, etc.)