FORM 1: REGIONAL LEVEL MONITORING AND ASSESSMENT OF READINESS FOR OUTBREAK RESPONSE IMMUNIZATION

Region: _____________________________ Target Population (0-59 months): ________________________

Name of Supervisor/ Monitor: ___________________________________________ Agency: _________________________

3 wks 2 wks 1 wk
plan 23-27/09 30/09-04/10 7-11/10
If not accomplished describe
Area Critical activities achieved Action required
deficiency
(Y/N) Mark "X" planned activity deadline.

1. Budgeted macro-plan developed for

resource mobilization purposes
2. Campaign budget allocation done at
regional level
3. Political commitment of the
Management Committee & Regional
Director
4. Discussions with LGUs (prov/city) to
mobilize local resources
5. Regional Coordinating or Steering
PLANNING, COORDINATION & FINANCING

Committee established and meeting

regularly

6. Regional Sub-committees established

with clearly defined roles:

a. Technical committtee (including

monitoring)
b. Vaccine, Cold Chain & Logistics
c. Advocacy, Social Mobilization &
Communication
d. Risk Management/Media
Relations/AEFI
 PLANNING, C

7. National campaign guidelines and

microplanning tools prepared and
distributed
8. Funds available to the regional level for
operational costs
9. Microplanning workshops conducted at
province/city level

10. Supervisory checklists, tally sheets,

summary report forms, AEFI forms, etc.
developed, printed and distributed

11. OPV guidelines reproduced and

distributed
MONITORING/
SUPERVISION

12. Plan and budget for campaign

monitoring, RCA of the campaign
available

13. Plan and implement pre-campaign

monitoring visits to province/city levels to
assess preparedness
VACCINES, COLD CHAIN AND LOGISTICS

14. A budgeted regional logistics plan

developed
15. Received required vaccines, safety
boxes or alternate disposal method and
additional commodities
16. Cold chain assessment completed at
all levels and action taken
17.Immunization Waste management
plan available and budgeted
18. Bundled vaccine and other ancillary
supplies distributed to province/city
levels
 19. A budgeted regional plan for
advocacy, social mobilization and
communication developed
SOCIAL MOBILIZATION AND COMMUNICATION

20. Advocacy & planning meetings held

with partners and stakeholders - e.g.,
other line ministries (e.g., education, local
government, religion), NGOs,
professional/scientific societies,
journalists, civil society groups (e.g.,
scouts, Red Cross/Red Crescent, Lions,
LDS,) and others

21. Advocacy, social mobilization and

communication materials developed and
distributed (e.g., pamphlets, leaflets, T-
shirts, caps, banners, posters, jingles,
radio/TV announcements, etc.)
(1) With no time frame in the Activity Plan, no timeline against which to check
Total score: No. items with "Yes" 0% (2) High Risk Identification not done yet
Circle time of assessment: 3w 2w 1w
Is the regional level on track to conduct the ORI?
Deadline Person Responsible
ainst which to check the progress of their activities
FORM : CITY LEVEL MONITORING AND ASSESSMENT OF READINESS FOR OUTBREAK RESPONSE IMMUNIZATION

City/Municipality: _____________________________ Target Population (0-59 months): ________________________

Name of Supervisor/ Monitor: ___________________________________________ Agency: _________________________ Dates of visits: (1) __________ (2) __________ (3) ______________

Fully 3 wks 2 wks 1 wk

Critical activities Achieved Jan. 6-10 Jan. 13-17 Jan. 20-24 If not fully achieved on time, Action required Deadline Person Responsible
Source of information (Y/N) describe deficiency
Mark X planned activity deadline
1. Have the following ORI components been operationally
planned?
Workpl an wi th l ist of ass igned a ctivi ties a nd dates

a. immunizations logistics management including

transport provisions (monitors, RCA teams, transport for
delivery of immunization supplies/vaccines,etc)
b. immunization waste management
c. AEFI investigation
d. training & orientation
e. social mobilization/communication
f. daily data aggregation, reporting and analysis

PLANNING AND COORDINATION

g. supervison and RCAs
2. Is there a coordination body at the city/munipality
level? Sou rce: Minu tes of coordina tion meetings

3. Is there political commitment for the campaign?

Source: evid ence of i nvol vement o f local a uthoriti es on
coordina tion, communication, l ocal resource mobil izaton , pl anned
l aunch, and /or i nvol vement of different government s ectors
4. Do validated microplans identify target population by
geographic area/vaccination site?
Source:
Microplans , maps and lis ts
5. Are “special” strategies planned for geographically high
risk areas, hard to reach and for marginalised / resistant
populations?
Mi crop lans, maps
and li sts: team depl oyment ada pted to sp ecial needs group w ith
s peci al l ogisti c and budget all ocati on
6. Have the LGUs (prov/city) provided funds for the ORI
planned activities?
Mi cro plan, budget an d financial statement

7. Have health workers (and volunteers at HC level) been

trained?
(Impl ementati on status of t raining plan,attendance)

1. Is there a supervision plan that includes names, dates

and daily locations of supervisors?
SUPERVISION
MONITORING

Source: Supervisi on pl an
AND

2. Have supervisors or monitors been identified and

trained to do monitoring/ RCA?
Source: Supervis ion plan, attendance sheet)
1. Is there sufficient functional cold chain capacity and/or
contingency plans for vaccine storage and during power
failure?
- refrigerators
- freezers
- cold boxes
- vaccine carriers
VACCINE, COLD CHAIN AND LOGISTICS

2. Do all HCs have a waste management plan that clearly

describes how, when, and by whom safety boxes will be
transported and put for final disposal?

3. Have guidelines for vaccinators, forms, checklists,

training and communication materials been received?
Review docu ments recei ved; l ist mi ssi ng material s

4. Have all HCs secured vehicles and fuel (or other means
of transportation) to transport vaccines, supplies, and
personnel before and during the period of the campaign
especially in the GIDAs?
Transp ort pl an

5. Are the received supplies of bundled vaccines and other

inputs consistent with target population and expected
wastage?
Va cci ne and logi stics p lan
- Vaccine (+ 10% wastage)
- Safety boxes (+ 10% wastage)
1. Are social mobilization and communication activities
being implemented according to plans/microplans?
SOCIAL MOBILIZATION &
COMMUNICATION

Implementa tion s ta tus of plan

2. Is the community/health workers aware of the date(s)
of the OPV ORI?
Spot check of community /CHO members begin ning 2 weeks
before SIA - 5 hous eh olds/ caretakers
3. Have coordination with partners implemented and
specific support put in place?
Review minutes of meeti ng, pledge of commitment/ M OU
Total score: No. items with "Yes" 0
Circle week of visit: 3 wks 2 wks 1 wk
Is the city on track to conduct the ORI as scheduled? (Y/N)
(1) With no time frame in the Activity Plan, no timeline against which to check the progress of their activities
(2) High Risk Identification not done yet
 FORM 4: HEALTH CENTER LEVEL MONITORING AND ASSESSMENT OF SIA READINESS
Province/City/Municipality: _____________________________ ORI start date: _______________ Target Population

Date Monitored: _______________________ Name of Monitor: _______________________________

"Y" or "N" for
Office: _______
each review
Main Activities / Critical
(Source of Information in italics)
(The desired timeframe to complete yellow dihighlight yellow activity) " 2 weeks 1 week

1. Have the following ORI components been operationally planned?

See: Microplan with a list of activities and dates
PLANNING, COORDINATION AND FINANCING

- vaccine & logistics management including finger markers

- waste management
- AEFI Investigation
- Training
- Social Mobilization and communication
- Daily data aggregation, recording, reporting and analysis
2. Is there a coordination team/working groups at this level?
3. Is there a political commitment for this immunization campaign?
4. Do validated microplans identify high risk areas and target
population?
5.Are there specific strategies for reaching geographically and socially
difficult targets (street children, informal settlers, seasonal workers,
etc.)?
6.Whether funds are available for all planned activities?
7. Are health centers staff, barangay health workers and volunteers
oriented and trained?
1.Is there a complete supervision plan that includes names, schedule
and location of supervision?
MONITORING &
SUPERVISION

2. Are supervisors trained for monitoring and supervision?

3. Have arrangements been made to ensure daily reporting of

coverage and other data to the next highest level including analysis?
MOBILIZATIO VACCINES, COLD CHAIN AND

1. Is the vaccine storage capacity adequate and or is there a

contingency plan for vaccine storage?
2. Is there a waste disposal plan covering processes, places and
implementers?
LOGISTICS

3. The guidelines have been distributed

4. Are vehicles and fuel available to distribute vaccines, logistics and staff
before and during the ORI period?
5. Are the received supplies of vaccines and logistics consistent with target
population?
COMMUNICA

1. Are social social mobilization activities being implemented according to

the plan / microplan?
SOCIAL

TION
N&

2. Is the community aware of the date and venue of the ORI?

Total score (item number with "Y"): 0% 0%
_____________ Target Population (0-59 months): _______________

________________ Office: _____________________

Give reasons if not yet done Action Required Deadline

Person Responsible