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Performance Audit
The GAVI Alliance Data Quality Audit experience
May 2008 ICGFM conference
Dr. Mercy AhunGAVI Alliance Secretariat, Geneva
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Performance Audit• DQA history and rationale
• DQA overview
• Requirements
• Report Content
• GAVI DQA Experience
• Strengths of DQA
• Limitations of DQA
• Future Opportunities
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History and rationale for DQA
• History: DQA emerged as an assessment tool to accompany the investment component of GAVI’s Immunization System Support (ISS) window
• Rationale: DQA aims to provide GAVI with assurance that the level of reward payable through ISS is based on a data validation process
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Overview of Data Quality Audit
• Goal: assure that management of immunisation services are based on sound and accurate data
• Operational objectives:
1. assess the quality, accuracy, timeliness and completeness of immunisation reporting systems
2. audit the reported DTP3 coverage in infants in a specific calendar year and then estimate the National verification factor to use in reward allocations
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Requirements• Countries receiving Immunisation Services
Support are required to conduct DQA during 2nd year of support
• External audit team engaged to review records & reports
• 4 districts randomly selected & data for previous year reviewed
• 6 Health facilities visited per district
• Number of vaccinations checked at facility, district & national levels
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DQA report content• Performance indicators (DTP drop out rate,
wastage, coverage, Verification factor)
• Verification factor– Estimation based on all DTP3 records and reports
audited at facility & district level– Based on ratio of recounted DTP3 and reported
DTP3 (consistency )– Successful DQAs – VF of at least 0.80
• Quality of the system index: Composite index based on the recording, reporting, storage, M&E and system design for data
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DQA reporting process
• In-country presentation
• Draft report with electronic copy
• Opportunities for feedback
• Confidentiality
• Monitoring of plan of action to address weaknesses in GAVI Annual Progress Report
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GAVI DQA experience
Of the 52* GAVI-eligible countries that applied for ISS funding 2000-2007:
Number of Countries
Presented for review 43
Passed
Under review
* 9 countries did not require a DQA as ISS expenditure was below the minimum needed for review
39
4
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Innovative: improving MIS
40
50
60
70
80
90
100
110
2002 2003 2004 2005 2006 2007
Average DQA 'verification
factor' (80=passing
score)
With introduction of Data Quality Audit (DQA), health data are becoming more reliable in all countries
Passed
All countries
Failed
78 11
5
415
1115
8
4
3
00 1
1
2
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DQA strengths• Innovative Management, diagnostic and
capacity building tool – DQS – self assessment tool developed to
help countries diagnose and address data weaknesses
• Exposed need to improve skills in management of health data
• Induced improvements in repeat DQA countries• Enhances donor confidence and contributes to
transparency and accountability
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Limitations of DQA
• Expensive & labour intensive
• Imprecision of verification factor– Wide confidence intervals
• Unable to capture verification of vaccination at point of delivery
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Future opportunities for DQA
• Major evaluation underway to examine methods, sources scope
• Will review best practice and decision model
• Opportunities for expanding DQA to include other health system metrics
• Capacity building to enable local DQA or peer review process