SN ACTIVITY
1 ROUTINE IMMUNIZATION MICROPLAN, TARGET POPULATION
1.1 Is there and updated health facility micro-plan for routine immunization including GIDA/HTR area? If Yes verify
1.2 Do you have updated target pop for routine immunization?
1.3 How many fixed and outreach sessions have been planned monthly?
Fixed…… Outreach…….. Mobile……..
1.4 How many fixed and outreach sessions conducted last monthly?
Fixed…… Outreach…….. Mobile……..
1.5 Is there a spot map displayed showing immunization catchment areas?
1.6 Has the health facility conducted catch up for routine immunization in last 6 months?
1.7 Is annual routine immunization microplan of the Barangay been shared with BRGY officials, capt, KAGAWAD for health?
1.8 Is there any kind of supporting being provided by the Barangay officials?
1.9 If yes, what type of support? Purchase of Supplies______________
Transportation____ Budget____ HR____ Advocacy____ M&S_____
AREA 1
2 Vaccine, Cold chain, other logistics
2.1 Where do you store vaccine?
TCW___ Domestic fridge___ ILR___ Others_____
2.2 Is there WHO prequalified (TCW/ILR) functional and adequate refrigerator in the HF?
2.3 During immunization session is the Health Facility using passive cold chain to store vaccine?
2.4 During immunization session is the HW using precondition icepack?
2.6 Is there well functioning temperature monitoring devices (Fridge tags, digital thermometers, etc)
2.7 Is the temperature of the refrigerator recorded twice a day?
2.8 Is the temperature of the refrigerator within +2 to +8 degree Celsius?
2.9 Is there any deviation of temperature from +2 to +8 degree in the last one month?
If yes, remark for reason.
2.10 Have all vaccines been stored in proper compartment?
2.11 Are the vaccines VVM usable, are they within expiry date?
2.12 Do you know what is First Expiry First Out(FEFO)?
2.13 Which vaccines are most sensitive to freezing? (Hep B, IPV, Penta, Td/TT)
2.14 Which vaccine are most sensitive to heat? (OPV,MCV,BCG)
2.15 Which vaccine are most sensitive to light? (BCG,MCV)
2.16 Do you know what Shake test is?
2.17 Is there non vaccine item in the fridge?
AREA 2
AREA 3
3 Monitoring & Supervision
3.1 Is the Immunization schedule displayed at the health facility?
3.2 Is the Immunization monitoring chart with the updated data displayed at the health facility?
3.3 Can the HW interpret the immunization monitoring chart?
3.4 Is the Full Immunized Child (FIC) annualized coverage attained for this month?
3.5 Is the TCL/NIP registers updated?
3.6 Does the HF conduct program implementation review meeting every month?
3.7 Does the HF conduct routine immunization problem analysis and prioritize Barangays based on access and utilization? If yes, Verify
3.8 Do the LGU representatives (SB on Health, LHB/MHO participate in Immunization monthly review meeting?
3.9 Has HF been supervised by LHB, SB, Province, CHD, partner agencies In the last 6 months?
3.10 Do you as health personnel participate in local health board meeting?
3.11 Any written feedback received? If Yes, Verify from visitor log book/ or any relevant documents
3.12 Action taken from previous supervisory feedback?
AREA 4
4 Training
4.1 Do you know the definition of Full Immunized Child (FIC)?
4.2 Is NIP guideline (MOP/ basic NIP manual) available in the HF?
4.3 Have you received any NIP basic/refresher vaccinator training? If Yes, When?
<1Yr ago____ 2 yrs ago___ >3yrs ago___
4.4 Do you know what access and utilization in routine Immunization mean?
AREA 5
5 Recording and Reporting
5.1 Does the HF timely collect and enter monthly Immunization data to the excel/google sheet/FHSIS?
5.2 Does the HF have list of private health Institution (Hospitals, Clinics) Implementation routine Immunization services as part of microplan? If Yes, Number of
HF___
5.3 Has the HF shared reporting format to private health facilities to obtain monthly reports of RI services? If yes, Number of children reported
5.4 Is the HF tracking defaulters? If Yes, Number of Children tracked in the last month
AREA 6
6 Advocacy, social mobilization & Communication
6.1 Does the HF have community engagement awareness program for Routine Immunization with NGO’s, LGU officials, BHW, Mother’s group, DSWD? If yes,
Verify through microplan
6.2 Is there any advocacy integrated programs with partners?
6.3 What is the source of supply for IEC materials?
DOH___ Region___ Province___ LGU___ Others___
6.4 Are IEC/BCC materials , flyers, leaflets, banners, posters, etc., adequate?
6.5 Are mothers given counseling (about vaccine given, next visit, AEFI, when to seek medical help etc.) during NIP session? Verify during vaccination session.
AREA 7
7 Advocacy, social mobilization & Communication
7.1 Does the HW know the definition of AEFI?
7.2 Are the HWs aware of the signs and symptoms of anaphylaxis?
7.3 Are the HWs trained in AEFI management specifically anaphylaxis?
7.4 Is AEFI guideline available in the HF for the HWs to refer on the sign & symptoms of anaphylaxis?
7.5 Is AEFI kit available in HF and during session sites?
7.6 Is there an available/on call ambulance and identified hospital to receive the patient?
7.7 Does the HF submit non serious and serious AEFIs?
7.8 If Yes, what is the reporting process? Vigiflow___ AEFI Info Sys___ Paper based ___ Others___
AREA 8
8 VPD surveillance (PIDSR)
8.1 Does the HW knows what is Vaccine Preventable Disease Surveillance/PIDSR?
8.2 Do you know the case definition of AFP? Measles, NT?
8.3 Do you know the case definition of Measles?
8.4 Do you know the case definition of Neonatals Tetanus?
8.5 No. of reports of suspected VPD’s cases this year?
8.6 Is there case Investigation forms (CIF) available in the health facility?
8.7 Is there sample collection kit of VPD cases?
8.8 If Yes, what is the reporting process? Vigiflow___ AEFI Info Sys___ Paper based ___ Others___
