Handout 5 2.4a

The complete RHIS curriculum is available here:
5.2.4
CALCULATING IMMUNIZATION COVERAGE

INDICATORS
Exercise on Practicing Data Analysis, Step 2
Instructions
For immunization programs (see Excel file Handout 5.2.4b), coverage and dropout rates are used as
indicators of the availability, accessibility, and use of services, as well as other program
characteristics.
 Penta1 coverage indicates availability of access to and initial use of immunization

services by children.
 Penta3 coverage indicates continuity of use by parents, client satisfaction with

services, and capacity of the system to deliver a series of vaccinations.
 Penta1 to Penta3 dropout rates indicate the quality of services as perceived by parents
and the quality of communication between parents and health workers.
1. Calculate the following:
a. Penta1 coverage rate in 2014
b. Penta3 coverage rate in 2014
c. Penta1–Penta3 dropout rate in 2014
2. Specify in column “N” the quality of access (good or poor) depending on the value of the DTP1
coverage (“good” is defined, in this exercise, as Penta1 coverage >=80% in the target age group,
and “poor” corresponds to a Penta1 coverage in the target age group < 80%).
3. Specify in column “O” the quality of utilization (good or poor) depending on the value of the
dropout rate (“good” is defined, in this exercise, as a dropout rate in the target age group < 10%,
and “poor” corresponds to a dropout rate in the target age group >=10%).
4. Categorize the problem present in each area in 2014. There are four situations:
1: No problem Dropout rates are low = good utilization

Penta1 coverage is high = good access
2: Problem Dropout rates are high = poor utilization

Penta1 coverage is high = good access
3: Problem Dropout rates are low = good utilization

Penta1 coverage is low = poor access
4: Problem Dropout rates are high = poor utilization

Penta1 coverage is low = poor access
5. The next step is to decide the area (listed in column “a”) that should receive top priority when
starting to implement the identified solutions. Participants should complete column “P,” writing
the order of priority (i.e., the number of the problem category: 1, 2, 3, or 4).
6. Upon completion of calculations, as a group, brainstorm about the differences in coverage

between regions and possible causes. Discuss what action managers can take if coverage and
dropout indicate problems.
Formulas for Calculating Immunization Coverage from Health Facility Data
Routine coverage estimates are calculated using statistics collected by health workers.
Penta1 coverage = Number immunized by 12 months with Penta1 in 2014 x 100
Number of surviving infants < 12 months of age in 2014
Penta3 coverage = Number immunized by 12 months with Penta3 in 2014 x 100
Number of surviving infants < 12 months of age in 2014
Penta1-Penta3 dropout rate Doses of Penta1 administered – Doses of Penta3 administered x 100
=
Doses of Penta1 administered

Identifying Problems and Their Possible Causes
Problems Possible Causes of Problems

Parents do not bring children in for 1. Health workers have not clearly explained to parents what
additional immunizations (utilization vaccinations are due, when they are due, and why they are needed.
problem). 2. Health workers do not understand what vaccinations are due, when
they are due, and why they are needed.
3. Barriers discourage parental return (e.g., hours of clinic operation,
cost, and long waits).
4. Health workers do not clearly explain to parents when vaccinations
are administered at the clinic.
5. Health workers have not shown parents respect or conveyed an
interest in the child’s health.
Children and mothers are not immunized 1. Health workers forget to check records or ask about what vaccines
when coming to the clinic for sick visits and doses a child/mother has received.
(utilization problem). 2. Health workers do not understand the contraindications for
immunizations or health workers do not understand that
immunizations may be given to mildly ill children.
3. Health workers fail to explain to parents that it is often acceptable to
immunize a mildly ill child.
4. Immunizations are not available on that day.
5. Immunization supplies are not available.
Health workers cannot determine what 1. Health workers forget to remind parents to bring the immunization
immunizations a child has received card.
(utilization problem). 2. Clinic records are not organized so that it is easy to find a child’s
records.
Children are not receiving all vaccines 1. Health workers do not understand what vaccinations are due, when
that they are eligible to receive during a they are due, and why they are needed.
visit (utilization problem). 2. All immunizations are not available or offered at the clinic on the
same day.
3. Supplies of some immunizations are not sufficient.
Children never come to the clinic to begin 1. The clinic is located too far away.
immunization (access problem). 2. Clinic hours are not convenient or are not understood by the
community.
3. Outreach activities are too infrequent, or their timing is not
understood by the community.
4. Cultural, financial, racial, gender, or other barriers are preventing use
of immunization services.
Adapted from World Health Organization (WHO). (2002). Increasing immunization coverage at the health facility level. Geneva,
Switzerland: WHO. Retrieved from http://apps.who.int/iris/handle/10665/67791

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The complete RHIS curriculum is available here:

CALCULATING IMMUNIZATION COVERAGE

 Penta1 coverage indicates availability of access to and initial use of immunization

 Penta3 coverage indicates continuity of use by parents, client satisfaction with

1. Calculate the following:

a. Penta1 coverage rate in 2014

b. Penta3 coverage rate in 2014

c. Penta1–Penta3 dropout rate in 2014

1: No problem Dropout rates are low = good utilization

2: Problem Dropout rates are high = poor utilization

3: Problem Dropout rates are low = good utilization

4: Problem Dropout rates are high = poor utilization

6. Upon completion of calculations, as a group, brainstorm about the differences in coverage

Formulas for Calculating Immunization Coverage from Health Facility Data

Penta1 coverage = Number immunized by 12 months with Penta1 in 2014 x 100

Number of surviving infants < 12 months of age in 2014

Penta3 coverage = Number immunized by 12 months with Penta3 in 2014 x 100

Number of surviving infants < 12 months of age in 2014

Doses of Penta1 administered

Problems Possible Causes of Problems

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