Academic journal article Journal of Health Population and Nutrition

Evaluating the Experience of GAPS-A Methodology for Improving Quality of Mass Immunization Campaigns in Developing Countries

Academic journal article Journal of Health Population and Nutrition

Evaluating the Experience of GAPS-A Methodology for Improving Quality of Mass Immunization Campaigns in Developing Countries

Article excerpt


Achieving a high percentage of vaccination coverage, while necessary, may not be sufficient for the elimination or eradication of disease. The existence of pockets of under-vaccinated persons has allowed outbreaks of disease in countries that have achieved high levels of vaccination coverage (1-7). For this reason, information about coverage levels in the general population is not sufficient to determine if a population is at risk of importation or continued transmission of disease. Information about whether or not pockets of under-vaccinated persons exist would also help understand the risks of disease transmission.

Weiss et al. identified factors that predict whether or not a child will receive vaccine during a mass campaign (8). These factors can help us predict and/or identify the existence of pockets of susceptible children. For example, if one or more predictive factors are geographically clustered, the population living in this geographic cluster is at risk of having a pocket of unvaccinated persons. We can use this information before, during, and after the campaign to help us take steps to prevent and/or address the development of a pocket of unvaccinated persons. A way to predict likely geographic clusters of unvaccinated persons may be useful when planning, supervising, and evaluating mass campaigns (8). With this information, priority can be given to assess the quality of planning for such sites. Priority can also be given to supervision and post-campaign evaluation of these sites. If indicated, steps can be taken to prevent problems that may lead to geographic clusters of unvaccinated, or to address any problems identified. This paper describes an evaluation of the experience to date with one such field-based methodology, which we call GAPS (Geographic Assessment of Planning and Services) in two settings (Ethiopia and Nepal). Before presenting the evaluation, a brief description of GAPS is provided below [The GAPS manual with the questionnaire and interview guides and instructions, and more detailed reports of the two applications of GAPS are available from the authors].

Description of GAPS

We carry out GAPS before, during, and immediately after a mass vaccination campaign. Following this pattern, GAPS has three phases: (a) improve planning before the campaign begins, (b) improve implementation/monitoring of the campaign, and (c) carry out the post-campaign evaluation and follow- up. We describe below the action-steps we take in each phase.

GAPS Phase 1: Improve planning before the campaign begins

As a first step during Phase 1, we identify a geographic area-usually a district or province that will participate in a mass vaccination campaign. The second step is to identify sites within that area that warrant special attention through expert interviews. The interview format is semi-structured that follows a guide available in the manual. During the interview, local experts are asked if certain factors-those identified during the past studies as factors that predict missed vaccination in mass immunization campaigns (8)-are clustered in any sites within the area. Sites mentioned several times by each expert during the interview are selected as geographic areas that warrant special attention (a form of triangulation). The third step is to review campaign plans for the sites selected for special attention. The fourth and final step is to address any gaps identified in the campaign plan for sites we have designated as high-priority. In our actions, we are limited to solutions that can be carried out with available resources; these resources may come from government, UN agencies, health programmes of non-governmental organizations (NGOs), or community-based organizations. For example, if there is a gap in social mobilization activities in a site, an NGO might conduct a community meeting or other health-promotion activities, such as a skit, rally, or parade. By these actions, before the campaign begins, we may prevent problems in the campaign. …

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