Monitoring the Performance of National Immunization Programs: Innovative Methodology and Tool for Countries'...

Background/Objectives: In the context of its policy of "Reinvigorating Immunization as a Public Good for Universal Health," the Pan American Health Organization (PAHO) developed a methodology and tool (MD-PAI) to help Member States of the Americas monitor and assess the performance of their national Expanded Program on Immunization (EPI) for each of the 13 technical components that make up the program. Methods: The MD-PAI was developed in several stages, including review of existing national EPI evaluation methodologies, selection and prioritization of questions for each of the 13 EPI components, piloting of the methodology, final calibration to ensure validity, completeness, reliability, standardization, usefulness, and usability across components and across countries, and publication in the four official languages of the PAHO. Results: The implementation of the MD-PAI enables countries to collect data, document lessons learned, develop action plans to close the most urgent gaps in the short and medium term and enforce the management of the EPI as part of the continuous improvement process. Since its introduction in 2023, fourteen countries in the Americas implemented the MD-PAI, using the results for their short- and medium-term planning and budgeting. Of the 13 components of the EPI, those that have performed best are political priority and planning and programming, while social communication is the component that reported the greatest number of gaps across countries. Conclusions: The PAHO has developed a methodology and tool to help countries to assess their EPIs to identify good practices, gaps and challenges, and develop an action plan to strengthen their programs. However, the impact of vaccination coverages and the epidemiology of vaccine-preventable diseases could take time.