Questions Responses field

1. Does your country have a strategic plan

(e.g., cMYP)?

2. How frequently are strategic plans

developed?
3. When was the current strategic plan
developed?

4. What is the period for which the current Start Year:

End Year:
strategic plan will be used?
5. Who leads the strategic plan development process? Please select one option.

6. How collaborative is the strategic plan

development process?
Please select one option.
7. Is a stakeholder map developed before
the strategic planning process begins?

8. How often is the stakeholder map

updated?
Please select one option.
9. Are there SOPs for the strategic plan
development process that defines the role
and responsibility of each stakeholder?
10. If there is an SOP, how often is it
disseminated to all stakeholders before the
planning process begins?

11. Is a refresher training on plan

development conducted before the plan
development process begins?

12. If there is a refresher training, are all

stakeholders required to participate in it?
13. What areas of support are each - Ministry of Health
--Situational Analysis --Priority setting
stakeholders engaged in to ensure --Options appraisal --Programming &
alignment of resources and information for Budgeting --Implementation & Monitoring
--Evaluation
the strategic plan development process?
- Vaccines Program/Department within
Please select all options that apply. Ministry of Health
--Situational Analysis --Priority setting
--Options appraisal --Programming &
Budgeting --Implementation & Monitoring
--Evaluation
- Planning Program/Department within
Ministry of Health
--Situational Analysis --Priority setting
--Options appraisal --Programming &
Budgeting --Implementation & Monitoring
--Evaluation
- Other Ministries (e.g., Finance/Treasury,
Education etc)
--Situational Analysis --Priority setting
--Options appraisal --Programming &
Budgeting --Implementation & Monitoring
--Evaluation
- Non-governmental organisations
--Situational Analysis --Priority setting
--Options appraisal --Programming &
Budgeting --Implementation & Monitoring
--Evaluation
- Civil society organisations
--Situational Analysis --Priority setting
--Options appraisal --Programming &
Budgeting --Implementation & Monitoring
14. How is recent program data reviewed
and analyzed for the strategic plan
development process?
Please select the option that applies.
15. Are the following elements considered
in the strategic plan development procesS?
Please select all options that apply:
Please select all options that apply.
Review of previous program performance data/
evidence
Review of data/evidence from various
evaluations and technical assessments
(undertaken in the last planning cycle)
Review of immunization coverage and AEFI
trends.
Review of immunization demand generation
Review of immunization of new vaccine
introduction
Review of surveillance data
Review of human resources
Review of vaccine supply quality, and logistics
Other (Please specify)
None of the above (If you select this option,
please explain)
Does the strategic plan indicate either
what entity is responsible for or what type
of staff are required to execute the key
activities?

16. Are plans costed?

17. If yes, does the costing tool/template Please select all options that apply:

consider the following elements: - Trainings and workshops

- Social mobilization, advocacy, and
communication activities
- Surveillance and monitoring
- Cold chain equipment, maintenance,
overhead
- Vaccine and injection supplies
- Operational/management costs
- Personnel costs
- Transportation costs
- Mapping/tracking of different sources of
funding (domestic and foreign)
- Service delivery
- Other (Please specify)
18. In order to reduce the duplication of
activities, do processes exist to ensure
activities and priorities of all stakeholders
are captured in the strategic plan?
19. Is the strategic plan disseminated to all
stakeholders?
Please select all that apply.
EPI staff Partners Subnational authorities District level authorities Leaders a
Are there any requirements (e.g. protocols)
or incentives (e.g., legally binding
regulations) that require the appropriate
adherence for implementation of strategic
plans?

For the strategic plan, how is the execution - Program performance dashboards - Quarterly review meetings - Metho

of activities or progress routinely

monitored or tracked?
Select the mechanisms that apply.

For the strategic plan, how often are

findings from program performance review
meetings disseminated to all meeting
participants?
20. Does your country develop operational
immunization plans?

21. Who leads the operational plan development process?

22. How collaborative is the operational

plan development process?
23. What areas of support are each
stakeholders engaged in to ensure
alignment of resources and information for
the operational plan development process?
Please select all that apply.
24. Are there SOPs for the operational plan
development process that defines the role
and responsibility of each stakeholder?
25. If there is an SOP, how often is it
disseminated to all stakeholders before the
operational planning process begins?
26. Is a refresher training on plan
development conducted before the
operational planning process begins?
- Ministry of Health
-Define annual goals/targets -Identify
key activities/strategic actions -Assign
resources e.g., people, budget etc. -
Monitor implementation and progress -
Adjust elements of the plan (e.g., areas linked
to weak or low performance)
- Vaccines Program/Department within
Ministry of Health
-Define annual goals/targets -Identify
key activities/strategic actions -Assign
resources e.g., people, budget etc. -
Monitor implementation and progress -
Adjust elements of the plan (e.g., areas linked
to weak or low performance)
- Planning Program/Department within
Ministry of Health
-Define annual goals/targets -Identify
key activities/strategic actions -Assign
resources e.g., people, budget etc. -
Monitor implementation and progress -
Adjust elements of the plan (e.g., areas linked
to weak or low performance)
- Other Ministries (e.g., Finance/Treasury,
Education etc)
-Define annual goals/targets -Identify
key activities/strategic actions -Assign
resources e.g., people, budget etc. -
Monitor implementation and progress -
Adjust elements of the plan (e.g., areas linked
to weak or low performance)
- Non-governmental organisations
27. Are there activities in the operational Please select all that apply and add 'other' :

plan that relate to the following elements? Coverage and monitoring trends
Surveillance standards
Access and equity (e.g., interventions to ensure
access to high risk or marginalized populations such as
pastoralist , refugees, geographically hard to access
communities, marginalized populations)
Planning
Financing
Strategies and policies
Research
Human resources
Coordination and communication
Advocacy
Sustainability
Other (Please specify)

Are all identified activities included in the

operational plan organized by priority
level?
Are plans costed?

If yes, does the costing tool/template Please select all options that apply:

consider the following elements: - Trainings and workshops

- Social mobilization, advocacy, and
communication activities
- Surveillance and monitoring
- Cold chain equipment, maintenance,
overhead
- Vaccine and injection supplies
- Operational/management costs
- Personnel costs
- Transportation costs
- Mapping/tracking of different sources of
funding (domestic and foreign)
- Other (Please specify)

Does the operational plan indicate either

what entity is responsible for or what type
of staff are required to execute the key
activities?
28. What mechanism is most effective for
aligning the operational plan with other
plans (e.g., strategic or across stakeholder
plans ) so existing resources across levels
(national and subnational) are streamlined?
- Pre-planning sessions
- Annual planning workshop
- Performance review meetings
- Technical working group meetings
- Other (Please specify)

Please select all that apply.

29. Is the operational plan disseminated to

all stakeholders?
Please select all that apply. EPI staff Partners Subnational authorities District level authorities Leaders a
Are there any requirements (e.g. protocols)
or incentives (e.g., legally binding
regulations) that require the appropriate
adherence for implementation of
operational plans?

30. For the operational plan, how is the - Program performance dashboards - Quarterly review meetings - Metho

execution of activities or progress routinely

monitored or tracked?
Select the mechanisms that apply.

For the operational plan, how often are

findings from program performance review
meetings disseminated to all meeting
participants?

31. In the last year, did the country receive
Gavi support?
1. Health system strengthening (HSS) support Yes or
No
2. Vaccine support Yes or No
3. Cold chain equipment optimisation platform
(CCEOP) support Yes or No
4. Targeted country assistance (TCA) - Yes or No
32. In the last five years, has the country 1. Health system strengthening (HSS) support
Application Year: Received
applied for any of the following Gavi Funds: Yes or No
support and received it? 2. Vaccine support Application Year:
Received Funds: Yes or No
3. Cold chain equipment optimisation platform
(CCEOP) support Application Year:
Received Funds: Yes or No
4. Targeted country assistance (TCA) -
Application Year: Received
Funds: Yes or No

33. Within the last year, was a new vaccine

introduced?
34. Has the EPI program declared any plans
to introduce a new vaccine(s) in the coming
one to three years?
35. Does the EPI program plan to introduce
any of these vaccines (these vaccines
are exempt from co-financing ):
Measles second dose: Yes or No
Inactivated polio vaccine (IPV): Yes or No
Japanese Encephalitis: Yes or No
HPV: Yes or No
Measles Rubella: Yes or No
Meningococcal A: Yes or No
Yellow fever vaccines: Yes or No

36. Over the last three years, has the

country had an average GNI per capita
equal to or below Gavi’s threshold ($1,045
USD), making it eligible for Gavi transition?

37. If the country has been eligible for Gavi
transition support, at what phase of
transition is it currently in?
Please select one.
1. Initial self financing (Phase 1)
2. In preparatory transition (Phase 2)
3. Accelerated transition (Phase 3)
4. Fully self-financing
5. Not applicable

38. If the country is in transition, has the

government led the process to develop a
Gavi transition plan to address key
bottlenecks and leverage opportunities
towards successful transition?

39. To date, is there an approved Gavi

transition plan for your country?
40. Who is responsible for implementation
of the transition plan across levels?
Sub-component 2 - Financing

1. What is the national budget cycle? Start date:

End date:

2. Are the national budget cycle and

planning cycle aligned?
3. Is the national health strategy used to
develop the annual health budget across all
levels?
4. Do the annual health budget activities
align with the priority activities identified in
the operational plans across all levels?
5. Is the immunization program budgeted Separate line item: Yes or No
Amount:
as a separate line item or is it budgeted as Part of overall health budget: Yes or No
part of the overall health budget? Amount:

6. Is there a maximum ceiling for the

immunization budget e.g., as a % of the
total health budget awarded by the
government?
7. At the national level, is resource
mapping done for all health partners to
account for resources allocated to different
health programs (e.g., RI, MNCH, HIV, TB
etc.)?

8. How much of the health budget is made

up of domestic funding?
9. Is there a resource map that identifies
the different sources of available funding
for immunization programs?
10. Is the resource map updated before the
immunization budget development process
begins?
11. Does the resource map including the - Funding flows across levels (national, subnational, district) - Priority/critica

following components?
Please select all that apply:
12. Is the health program's financial data
accessible to the public?
13. At the national level, what percentage
of health program directors and managers
develop proposals for non-domestic funding
for their program activities?

14. Do SOPs exist to help program directors

and managers apply for and manage non-
domestic funding?

15. Who leads the immunization budget

development process?
16. Who is involved in the immunization Please select all that apply:

budgeting process? - Ministry of Health

Please select all that apply.
- Vaccines Program/Department within Ministry
of Health
- Planning Program/Department within Ministry
of Health
- Other Ministries (e.g., Finance/Treasury,
Education etc)
- Non-governmental organisations
- Civil society organisations
- Private sector entity
- Local government
- Donors/ Partners
- Others (If other, please explain)

17. How collaborative is the immunization

budgeting process?
18. Are there SOPs for the immunization
budget development process?
19. Please select all components that the
SOPs include:
20. Is there a tool (e.g., a monthly dispersal
schedule) that shows whether or not funds
are disbursed on time?
How often are funds disbursed on time, as
per schedule?
21. If funds are disbursed on time, how
much of the fully requested amount is
released?
22. Who monitors and tracks the
disbursement of funds?
23. Are there SOPs for how to monitor and
track disbursed funds?
24. Are these key financial performance
indicators included in the mechanism for
monitoring and tracking of disbursed funds?
Please select all that apply.
25. Is there a process for reporting and
verifying the use of funds?
- Minimum checklist
- Budget forecasting/costing template
- Roles and responsibilities for all stakeholders
- Processes for requesting domestic funds
- Processes for requesting foreign funds (e.g.,
developing + submitting grant proposals)
- Processes for allocating domestic funds
- Processes for allocating foreign funds
- Processes for disbursing domestic funds
- Processes for disbursing foreign funds
- Other
- Description of funded activity
- Implementation status of activity
- Key cost drivers
- Amount of funds requested
- Amount allocated/approved budget
- Amount received
- Dispersal date
- Source of funds
- Opening balance
- Amount spent/Expenditure
- Delays in fund dispersal
- Reallocation of funds
- Remaining balance
- Burn rate
- Other (Please explain)
Is there a means (e.g., a monthly alert or
notification system) by which program
managers at the national level are able to
identify over spend within their program
budget?

26. In the last quarter or year, have any of - Planning: Yes or No

the critical immunization activities listed
been cancelled because of a lack of funds?
Please select all that apply.
- Budgeting: Yes or No
- Trainings: Yes or No
- Program performance monitoring: Yes or No
- Supportive supervision: Yes or No
-Cold chain management: Yes or No
- Supply chain logistics: Yes or No
- Procurement: Yes or No
- Coordination and communication: Yes or No
- Advocacy/ Social mobilization: Yes or No
- Other (Please explain)

27. At the national level, are program

managers allowed to reallocate unspent
funds from one activity to another activity?

28. Are there SOPs that define the process

for how unused funds can be reallocated to
meet program needs?
29. How often are financial performance
reports prepared?
30. Who receives copies of financial
performance reports?

Please select all that apply.

Sub-component -3 Accountability and Measuring Performance/Impact

1. Are there mechanisms to collect

accurate immunization data?
2. Are data collection templates aligned
with existing plans?
3. Please select all tools that are used to - HMIS
- Program performance review/data review dashboard
collect immunization data: - Supportive supervision checklist for feedback
- Immunization register
- Tally sheets/target setting
- Monthly report forms
- Monitoring chart
- Vaccine stock book
- Other (If other, please explain)

4. Are there SOPs that define the process - HMIS

Yes or No
and responsibilities stakeholders should use - Program performance review/data review dashboard
with the data collection tools? Yes or No
- Supportive supervision checklist for feedback
Yes or No
- Immunization register
Yes or No
- Tally sheets/target setting
Yes or No
- Monthly report forms
Yes or No
- Monitoring chart
Yes or No
- Vaccine stock book
Yes or No
- Other (If other, please explain)

5. Do the RI program staff receive training Ask across all levels

National
on how to use the data collection tools? - HMIS
Yes or No
- Program performance review/data review
dashboard Yes or No
- Supportive supervision checklist for feedback
Yes or No
- Immunization register
Yes or No
- Tally sheets/target setting
Yes or No
- Monthly report forms
Yes or No
- Monitoring chart
Yes or No
- Vaccine stock book
Yes or No
- Other (If other, please explain)
6. How often do the RI program staff
receive trainning on the data collection
tools?
7. How often are data collection tools
available?
National (Repeat question across levels)
- HMIS
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Program performance review/data review
dashboard 100% of the time, 75% of the
time, 50% of the time, 25% of the time, Less
than 25% of the time
- Supportive supervision checklist for feedback
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Immunization register
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Tally sheets
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Monthly report forms
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Monitoring chart
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Vaccine stock book
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
8. How often are the tools used to report
up to date and accurate program data?
9. Is data for all relevant tools
automatically or manualy entered?
10. Who is responsible for validating the
reported data?
11. Is there a mechanism to verify and
check the quality of the reported data
across the following components?
Ask across all levels
National
- HMIS
Monthly, Bi-monthly, Quarterly, Bi-anually
- Program performance review/data review
dashboard Monthly, Bi-monthly,
Quarterly, Bi-anually
- Supportive supervision checklist for feedback
Monthly, Bi-monthly, Quarterly, Bi-anually
- Immunization register
Monthly, Bi-monthly, Quarterly, Bi-anually
- Tally sheets/target setting
Monthly, Bi-monthly, Quarterly, Bi-anually
- Monthly report forms
Monthly, Bi-monthly, Quarterly, Bi-anually
- Monitoring chart
Monthly, Bi-monthly, Quarterly, Bi-anually
- Vaccine stock book
Monthly, Bi-monthly, Quarterly, Bi-anually
- Other (If other, please explain)
- HMIS
Automatic or Manual Entry
- Program performance review/data review dashboard
Automatic or Manual Entry
- Supportive supervision checklist for feedback
Automatic or Manual Entry
- Immunization register
Automatic or Manual Entry
- Tally sheets/target setting
Automatic or Manual Entry
- Monthly report forms
Automatic or Manual Entry
- Monitoring chart
Automatic or Manual Entry
- Vaccine stock book
Automatic or Manual Entry
- Other (If other, please explain)
- recording practices: Yes or No
- storage/reporting: Yes or No
- monitoring and evaluation: Yes or No
12. How often are completed data reports
submitted on time?
- HMIS
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Program performance review/data review dashboard
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Supportive supervision checklist for feedback
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Immunization register
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Tally sheets/target setting
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Monthly report forms
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Monitoring chart
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Vaccine stock book
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Other (If other, please explain)
13.How often are inconsistencies or data
quality issues identified arcross the
following sources?
How is data and learning shared at the
national, sub-national, and facility levels?
14. Do program or data review meetings
happen at the national level?
15. How often program or data review
meetings happen?
16. Who leads the program or data review
meetings?
Ask across all levels
National
- HMIS
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Program performance review/data review
dashboard 100% of the time, 75% of the
time, 50% of the time, 25% of the time, Less
than 25% of the time
- Supportive supervision checklist for feedback
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Immunization register
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Tally sheets/target setting
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Monthly report forms
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Monitoring chart
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Vaccine stock book
100% of the time, 75% of the time, 50% of the
17. Which stakeholders are engaged in the A: MOH
B: EPI
program or data review meetings? C: Other programs under MOH (e.g., RMNCH)
Please select all that apply. D: Subnational authorities
E: District authorities
F: Partners
G: Political or civil leaders
H. Community leaders
I: Others: __________________________

18. How often are all stakeholders engaged

in program or data reviews?
19. Are SOPs for review meetings
disseminated to ensure all stakeholders
understand their roles and responsibilities ?

20. What resources are used during review - HMIS

meetings to evaluate program
performance/progress towards
achievement of priority RI targets ?
Please select all that apply.
- Program performance review/data review
dashboards
- Supportive supervision checklist for feedback
- Performance Scorecards
- Data Quality Assessment Reports
- Other

21. At the national level, how often do RI

program staff receive trainning on how to
conduct program performance reivews?
22. During performance review meetings,
how often are bottlenecks identified or
contributors to poor performance used to
develop corrective action or improvement
plans?

23. Is there a mechanism that checks - Service delivery

across the following components to ensure
corrective action plans are implemented
and monitored in a timely fashion?
Please select all that apply.
- Vaccine supply, quality, and logistics
- Surveillance and monitoring
- Advocay and communication
- Program management
- Other (If other, please specify)

24. Who is responsible for ensuring

corrective action plans are used for
continuous systems improvement?
25. How often are findings from quarterly
performance review meetings shared with
all meeting stakeholders?
26. Do findings from quarterly performance
review meetings include the following
information?
Please select all that appy.
27. Does an accountability framework
(e.g., for immunization program
deliverables) exist?
28. At the national level, what percent of
stakeholders were involved in the
development of the framework?
29. Has the accountability framework been
published or widely disseminated to all key
stakeholders and decision makers?
30. Who monitors the implementation of
the framework to ensure all key
stakeholders, across levels, adhere to it?
Please select all that apply.
31. Does the framework include the
following features?
Please select all that apply.
- Summary of results across priority indicators
- The most serious problems identified, including
underlying problems or contributing factors
- Areas of substantial improvement or good
performance
- Actions taken or that are recommended and request
for assistance if needed
- Copies of supportive supervision reports
- Other (If other, please specify)
A: MOH
B: EPI
C: Other programs under MOH (e.g., RMNCH)
D: Subnational authorities
E: District authorities
F: Partners
G: Political or civil leaders
H. Community leaders
I: Others: __________________________
- Standard operating procedures for use which explain
roles and responsibilities
- Indicators that cut across different program areas so
program performance and staff performance can be
measured
- Requirement to produce feedback reports (e.g.,
either monthly and quarterly) on program and staff
performance
- Based on reported performance, rewards and
sanctions for all stakeholders involved in implementing
it
- Other (If other, please specify).
32. Are supportive supervision activities
conducted?
33. How frequently are supportive
supervision activities conducted at the
national, subnational, and district level?
34. Is there secured funding for periodic
supportive supervision?
35. Are there SOPs that define the process Detailed instructions/rules for conducting supervision
Yes or No
and responsibilities for stakeholders Checklist for supervisory visit
conducting supportive supervisions? Yes or No
Work planning action sheets
Yes or No
Do’s and don’ts of supervision
Yes or No
Self-assessment of supervisors’ competencies
Yes or No
Tips on delegation
Yes or No
Feedback mechanism
Yes or No
Conflict resolution
Yes or No
Other

36. Are supervisors trained on how to

conduct supportive supervision visits?
37. How often are supervisors across levels
trained on how to conduct SS visits?
38. Before a new supportive superivision
visit, are supervisors required to review
previously submitted feedback from the
last supportive supervision visit?
39. How often are supportive supervision
tools available?
40. How often do supervisors prepare
feedback and share it with supervisees at
the end of each supportive supervision
visit?
Detailed instructions/rules for conducting supervision
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
-Do’s and don’ts of supervision 100%
of the time, 75% of the time, 50% of the time, 25% of
the time, Less than 25% of the time
- Checklist for supervisory visit
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Work planning action sheets
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Self-assessment of supervisors’
competencies 100% of the time, 75% of
the time, 50% of the time, 25% of the time,
Less than 25% of the time
- Feedback mechanism
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Conflict resolution resource
100% of the time, 75% of the time, 50% of the
time, 25% of the time, Less than 25% of the
time
- Other (If other, please specify)
- Work planning action sheets
100% of the time, 75% of the time, 50% of the time,
25% of the time, Less than 25% of the time
- Feedback mechanism 100%
of the time, 75% of the time, 50% of the time, 25% of
the time, Less than 25% of the time
- Other (If other, please specify)