Gathering data on low immunisation communities is an important first step to increasing vaccination coverage for citizens.
Once immunisation coverage data is available, governments in low- and middle-income countries can meet the needs of their citizens quickly. Teams of vaccinators can be sent out to communities where vaccination coverage is dangerously low, thereby making citizens in these communities safer. But combining immunisation coverage data with knowledge on the reasons behind low vaccination coverage, enables even more effective actions to be taken.
What are rapid coverage assessments?
Rapid coverage assessments are short surveys, usually consisting of 5 to 15 questions, designed to determine immunisation rates within a particular geography. With the surveys often used to discover immunisation rates for young children aged 12 to 23 months, caregivers complete the surveys on behalf of their children.
Commonly asking questions including, 'Has your child ever received the vaccine?' (e.g. for measles), and, 'What was the date of the child's last vaccination?', the surveys also ask questions about the child's name, age, gender, the method of vaccination data collection (e.g. from memory or a vaccination card), and the number of relevant vaccines the child has received.
These questions aim to discover communities with a particularly high proportion of "zero-dose" children, meaning children who have not yet received any vaccines for a particular infectious disease, such as polio, measles or HPV. Health departments can then quickly send out teams of vaccinators to vaccinate these communities, in order to keep citizens safe.
A few questions from a rapid coverage survey, used for assessing vaccination coverage.
Using rapid coverage assessments to increase vaccination coverage
Since November 2022, the Acasus team in Khyber Pakhtunkhwa, Pakistan, has been supporting the Government with using rapid coverage assessments to track vaccination coverage among children in the province, covering diseases including measles, diphtheria, tetanus, pertussis (whooping cough), and hepatitis B.
When supervisors visit outreach vaccination sites, the Health Department trains them on conducting effective rapid coverage assessments. This equips the supervisors with the knowledge on how to conduct the surveys. For instance, they learn that they must assess the immunisation coverage of 10 children with each survey, and that they should complete at least one survey for every community visited, to ensure sufficient data coverage.
Crucially, the Acasus team provides district Governments with real-time access to data on the rapid coverage assessments submitted by supervisors. This allows for the identification of communities with "zero-dose" hotspots. With these surveys then conducted on a monthly basis in all Union Councils (communities), this process ensures that real-time data can continue being collected.
As a result of these efforts, over half a million children have been assessed through rapid coverage assessments since November 2022 in Khyber Pakhtunkhwa. In terms of results, over 65% of communities identified as being "zero-dose" hotspots had already been fully vaccinated in the south of the province by April 2023.
Supervisors conducting rapid coverage surveys in Khyber Pakhtunkhwa.
Combining rapid coverage assessments with demand surveys
While rapid coverage assessments are useful for discovering zero-dose and under-immunised hotspots, combining them with demand surveys can bring about even more effective results, especially in the long term. Slightly longer in length, demand surveys are often around 20 to 30 questions, and aim to find out the reasons why the demand levels for vaccines are low in some communities. If these reasons are addressable, then there is potential to increase immunisation coverage.
Since early 2024, the Acasus team has been supporting the Government of Mozambique with launching demand surveys in conjunction with rapid coverage sureys. Over 16,000 surveys have been launched so far, asking questions such as, 'How important do you think vaccines are for your child's health?', and, 'What is your main source of information regarding vaccination services?'
These surveys have revealed some of the major reasons for lower vaccination coverage in some communities, including a lack of awareness on the benefits of immunisation, fear of vaccination, and immunisation not being a social norm.
A teacher carrying out demand surveys in Sofala, Mozambique.
This newfound demand awareness provides the opportunity to launch innovative ways of changing minds and raising awareness. In Mozambique, this knowledge has already led to a recent pilot launching reminder bracelets in the country, which is a strategy that was already used to dramatically reduce diphtheria vaccination dropout rates in piloted areas of Ethiopia by 62%.
Rapid coverage assessments can ultimately serve to quickly identify immunisation coverage across communities. Where coverage is low, vaccination teams should be sent out quickly to conduct outreach sessions. However, to increase the proportion of people willing to receive vaccinations during these outreach sessions, demand surveys should be used in conjunction. This two-way approach can be an effective way of optimising immunisation coverage in low- and middle-income countries.
