In Palestine, there are two main providers for vaccination: the Palestinian Ministry of Health and UNRWA. There are three levels where immunization and disease surveillance data are collected, analyzed and decisions are made:

At the local level (Primary health care center), where vaccination sessions are took place. At the beginning of the working day, the staff check and monitor the cold chain for the last 24 hours and document the actual temperature. Verification of the availability of all vaccines also done. As vaccines are provided to all infants, a medical check are also provided at the same time. The medical staff verify the vaccines that infant has been received and asking about any adverse event following immunization (AEFI) faced after the last visit. Then a next time visit is determine by the staff. At the end of the day, the staff verify if defaulters are exist in order to contact them. So at this level, vaccination coverage for this catchment area is calculated with the determination more at risk population or some pockets who are difficult to reach.

At the district level, a weekly round is done for reviewing the documentation of attending infants, the number of vaccines given, the rest number of vaccines, asking about the vaccination sessions that took place as planned, the number of reported AEFI during the last week. At this level the rate of AEFI can be calculated with the rate of sessions that took place as planned.

At the national level, all data are collected from districts on a monthly base where the vaccination coverage for the country is calculated. Also the national rate of defaulters and AEFI also are calculated. Based on the collected data, the needed decisions are implemented; the impact of vaccines are taking in consideration; the performance of the program is monitored; the priority areas that need supports are determined and responding to a reported outbreak on time.

At all level monitoring is very helpful. It can find the gaps in the system and can guide us where interventions could be implemented. Different processes could be monitored like vaccination coverage, the vaccine stock, cold chain, vaccine wastages, the safety of the program, the quality of services, the achievement towards the goals etc.

Knowing these data can guide us for the improvement of the program as follow:

1. If we know that the coverage is low, this can led us to improve the coverage in a certain region after knowing the cause where there are high number of unimmunized children.
2. If at all levels data are not used properly to get information for action, then we can intervene to improve the use of available data.
3. On preparing the cMYP, the available data are vital for accurate plan that based on the past and new improved data.
4. If we face a problem with the denominator, we can contact the registry unit in order to have new and latest data for accurate calculations.
5. When we face an increase of the number of AEFI after using a certain vaccine, then we can follow this patch number or the technique or other factor than can cause this increase.
6. Sometimes we can face duplicated data, so we can improve the reporting when we discover this error as it can guide us worsely.
   

   Week_202_20assignment.docx