1. Overview of system for immunization reporting and analysis
CAMEROON
By: Mariette DIA
Head of Unit responsible for validation and data management
CTG-EPI

2. Outline 1- Context 2- National Health Information System actors
3- Organogram of the EPI in Cameroon
4- Tools for reporting and analysis of immunization data
5- National Health Informations System procédures
6- National system of data transmission and feed-back information
7- Strengths & weaknesses
8- Challenges and perspectives
9- Conclusion

3. Context
Population totale 2013 : 20
Border with Nigeria to west, Chad and CAR to East, Equatorial Guinea, Gabon, Congo to south
Population 2014: (census 2005)
Superficie: Km2;
2 official languages (french and english)
Climate: Equatorial and Tropical;
4 ecological areas: coastal (LT, SU, SW); sub-saharan (AD, NO, FN); forest (CE, SU, ES); highlands(WE, NW);
10 administrative and Health regions;
189 Health districts;
1 707 Health areas;

4. National Health Information System actors (1/3)
They are found at all levels of the pyramid:
Central Level:
Health Informations Unit
National Observatory of Public Health
Department of family health
Technical Departments
Central Technical Groups of Programs (eg: CTG-EPI, CTC- NC/AIDS, …)
General Hospitals / Central Hospitals

5. National Health Information System actors (2/3)
Intermediate Level:
Regional Delegations of Public Health
Service of Planning and Health Information
Regional Unit (EPI, Malaria,…)
Technical services
Regional Hospitals

6. National Health Information System actors (3/3)
 Operational Level:
Health Districts
Districts Hospitals
1st and 2nd class Health Facilities (CMA, IHC (Integrated Health Centers), Private Health Centers, Clinics…)
Community Level:
Community Relay Workers

7. Organogram of the EPI Programme in Cameroon
Execution’s level
Regional Unit-EPI
Health District
Health Area
Regional Delegation for Public
Health
District Team
Area Team
Decision’s level
Interagency Coordinating
Committee
Central level
intermediate level
Central Technical
Group-EPI
Operationnal level

8. National Health Information System tools

9. National Health Information System tools (1/2)
There are several tools
Collection Tools: Health Facilities Registers.
They provide primary data collection and are the source of data verification for the sake of quality assurance.
Harmonized registers exist for different services and domains. (e.g.: vaccination, outpatient, hospitalizations, ANC, Laboratories, mother CPON, CPON Child, medical imaging...)

10. National Health Information System tools (2/2)
Transmissions Tools: Reports and Monthly Activities Sheets
MAR (Monthly Activities Report) from Health Facilities,
The monthly data sheet from programs;
The weekly Summary Report of DEP (Diseases with Epidemic Potential);
Analysis Tools: data Synthesis/Analysis software for every levels.

11. Tools for reporting and analysis of immunization data

12. Tools for collecting, reporting and analysis of immunization data
LEVEL
OBSERVATIONS
TOOLS FOR COLLECTING OF IMMUNIZATION DATA
Tally sheet
Health facility
used to count the number of persons vaccinated
Vaccination registers
used to record information about persons vaccinated
TOOLS FOR REPORTING OF IMMUNIZATION DATA
Monthly report for activities
Health facility, health area, health district
used to transmit data to the next level

13. Tools for collecting, reporting and analysis of immunization data
LEVEL
OBSERVATIONS
TOOLS FOR ANALYSIS OF IMMUNIZATION DATA
Monthly monitoring curves
Health Facility, Health Area, Health District
used for monthly monitoring of vaccination coverage at all levels
Defaulter register
Health Facility
used to search children defaulter
District Vaccine Data Management Tool (DVDMT)
Health District, Regional and Central level
To analyse data from Health facilities and Health Districts
Routine Immunization (RIM)
Central level
Epi Info application for encoding and analysis of immunization data
Data review template
Review data monthly
Data Quality Self assessment (DQS)
to ensure there is no under or over-estimate data from operational level

14. Reporting and analysis tools for immunization data : DVDMT
Version 2013,

15. Reporting and analysis tools for immunization data : DVDMT
to collect data from Health areas by the district

16. Reporting and analysis tools for immunization data : DVDMT
to analyse data from Health areas by the district

17. Reporting and analysis tools for immunization data : RIM
to collect and analyse data from Health districts by central level

18. National Health Information System procédures

19. National Health Information System procédures (1/2)
At the operational level:
Health Facilities
To collect health information and fill transmission forms (MAR, weekly reporting, ...);
To transmit no later than the 5th of the month to Health District the monthly activity report;
To archive physical reports submitted to Health District
Health District
To collect, analyze and use health information of health facilities, enter data received from health facilities in the existing application program (DVDMT for EPI);
To forward to the RDPH, synthesis of data received from health facilities no later than the 10 of the month for EPI;
To transmit to Health Facilities the synthesis of District’s statistics (feedback);
To archive received and transmitted report

20. National Health Information System procédures (2/2)
Regional Level
Regional Unit of Programs: do the monthly District’s data summary and transmit to the Planning and Health Information Service, and to the CTG of programs ;
Central Technical Groups
To make a monthly summary of data from the regions and transmission to the Health Information Unit;
To contribute to the production of annual report;
Health information unit and National Observatory of Public Health)
To participate in the publication of health data;
To transmit validated data to partners

21. National system of data transmission and feed-back informationHA HD
Region
Report HF
Tally sheet
Report
District Report
(compilation) district
District report
Compilation
(region)
NHIS
NOPH
Central level
- Vaccination register
- monitoring curves
Partners
-WHO
-UNICEF
-AMP
RIM
(CTG-EPI)
Transmission
Feed-back

22. Strengths & weaknesses in the use of RIM
data from several years ( ) are in the same .mdb file
allows for comparative analysis of several years
generate analysis as cumulative monthly and covers
Weaknesses
Data are agregated: vaccine acts are not presented by strategy (outreach, mobile and fixed) and Sex;
Vaccine management data are not included;
used only at the central level
Some analysis produce wrong results;
The new vaccines are not taken into account,

23. Strengths & weaknesses in the use of DVDMT
used by all regions for the analysis of district data
immunization data analysis with indicators of the RED
Logistic data analysis with global and specific wastage rates;
Weaknesses
Data are agregated: vaccine acts are not presented by strategy (advanced, mobile and fixed) and gender
This version is heavy and require high performance equipment;
District team are not trained;
used in less than 50% of the district,
Incomplete filling

24. Strengths & weaknesses of National Health Information System
Phone fleet for the transmission of data in real time;
Internet connection in the RDPH
existence of procedures for the collection and transmission of data
Weaknesses
insufficient staff in the districts and health facilities;
insufficient computer equipment and poorly maintained;
inadequacy of supervision by the higher level

25. Challenges and perspectives
To ensure a maintenance system of computers at all levels.
Deploy the RIM tool at the regional level
To monitore immunization activities using a dashboard in all districts
Elaborate a plan to improve data quality by 2015
Perspectives
To shift from DVDMT version 2013 to version in all district of the country;
To organize a training on DVDMT and dashboard;
Expansion of internet connection in Health Districts;
to use DQS for all supervisions

26. CONCLUSION
"It is not because countries are poor that they cannot afford good health information system. It is precisely because they are poor that they cannot afford to do without. "

27. Thanks for your Kind Attention