1. Is Performance-Based Reward the Strategy of the Future for Strengthening the Quality of Reporting and Immunization Systems?—Experiences from GAVI Trap, Rete (1,2); Trap, Birna (3,2); Hansen, Torsten Wind (2); Hansen, Ebba Holme (4) 1: Aabenraa University Hospital, Denmark; 2: Euro Health Group, Denmark; 3: Management Sciences for Health, SURE Program, Kampala, Uganda; 4: Faculty of Pharmaceutical Sciences, Department of Pharmacology and Pharmacotherapy, University of Copenhagen

2. Background and objectives Global DTP3 immunization coverage 80% in 1990 GAVI Immunization Service Support –75 countries –Performance-based financial rewarding – Country specific recommendation and implementation-support. To assess the effectiveness of the combined GAVI ISS 2ICIUM 2011/RT

3. Data Quality Audit (DQA) –WHO validated, standardized survey Sentinel indicators National, district (4) and health unit (24) –Assessing the quality of national immunization system REPORTING QUALITY : –Consistency and accuracy of EPI reporting system –Measured by Verification Factor (VF) SYSTEM SET-UP: –Efficiency, security and usefulness –Measured by quality score (QS) 3ICIUM 2011/RT

4. Medicines management Managerial –Vaccination guidelines /STG –National Reporting Guidelines Economic –Performance based reward scheme Regulatory –Inspection/ DQA –VF with pass or fail GAVI ISS Intervention strategies Educational –On-site mentoring during DQA –Implementation support

5. Methods Retrospective study National immunization data collected at DQA in the period 2002-2005 Study population are nine developing countries having had two consecutive DQA’s ( pre - post) Interventions: GAVI ISS Outcome measure(s): –Reporting quality (verification factor) –System set-up quality (quality scores). 5ICIUM 2011/RT

6. National Verification Factor versus the Combined Quality Score at National, District and Health Unit levels in nine countries with pre and post data quality audits. Pre data quality audit (DQA1): symbolised by    Post data quality audit (DQA2): symbolised by    6 ICIUM 2011/RT

7. Changes in Combined Quality Score between pre and post data quality audits by country at National, District and Health Unit levels. 7ICIUM 2011/RT

8. Verification Factor and Immunization Coverage (DTP3) in the nine countries with pre and post data quality audits. 8ICIUM 2011/RT

9. Lesson learned The combined GAVI ISS performance-based reward intervention strategy is effective resulting in increased immunization coverage improved reporting quality improved quality of the immunizations system set-up at all levels of health care. The positive correlation between increased reporting quality and immunization coverage indicates that: high-quality reporting with accurate and consistent data is instrumental in targeting and focusing immunization management toward increased coverage. 9ICIUM 2011/RT

10. Recommendation Repeated assessments are recommended to ensure sustainable immunization system improvements 10ICIUM 2011/RT

11. Policy Implications & Conclusions The applicability of the performance-based reward system to other areas of supply chain and medicines management needs to be explored. 11ICIUM 2011/RT