Immunization Review Meetings: "Low Hanging Fruit" for Capacity Building and Data Quality Improvement?

"Research has shown that peers can learn well from one another, share ideas and build knowledge and skills through adult learning methods like review meetings."

As part of health and immunisation programmes in most African countries, periodic programme reviews are held (e.g., annually, semi-annually, quarterly) to review key indicators, discuss programme status and needs, and consolidate reporting. These systematic review meetings are considered important for information-sharing and as a complement or alternative to more formal classroom or facility/centre-based training. Although immunisation training and supervision have been implemented for decades, there is little documentation on the use, benefit, and potential impact of review meetings and peer learning, which this study provides through four country experiences. These immunisation review meeting examples demonstrate the contribution of adult learning and peer exchange to strengthening immunisation and health services and indicators, as relatively easy and affordable approaches for capacity building and health staff skills development. The processes and use of programme review meetings, notably at district levels (as documented in the countries in this study), can potentially be modeled or adapted by other countries.

The longitudinal case study provides retrospective descriptive analysis and qualitative data collected on over 200 immunisation programme implementation and review meetings conducted within the years of 2011-2016 with district and facility health staff and technical partners from Ethiopia, Kenya, Tanzania, and Uganda. The immunisation review meetings discussed in this article (generally held quarterly and referred to subsequently as QRMs) are part of a combination of approaches for capacity building and performance improvement already in place in the countries and therefore not separate initiatives or case-control studies. These QRM examples come from district level and involve Ministry of Health (MOH) colleagues from health facilities, districts, and in some cases regional and national levels. The case study focuses on the commonalities and best practices found between the QRMs and highlights specificities and learning from the respective countries' planning and implementation.

Based on the examples from these countries, the conclusion can be drawn that review meetings (ideally held at least quarterly and that are already part of - or can be further integrated with - existing health and immunisation planning and budgeting) can be effective tools for improving immunisation programme performance and the capacity of health staff. Review meetings have the following benefits:

• Provide an opportunity for health workers to analyse, appreciate, and use the data that they generate themselves to make programmatic improvements and strengthen their capacity;
• Foster a culture of using data for decision making, regular performance monitoring, and self-assessment;
• Enable sharing of best practices, lessons learned, peer review and benchmarking using adult learning methods and principles;
• Serve as an opportunity to also update district teams and health workers on latest technical information and to provide feedback and dialogue on results and indicators; and
• Contribute to programme cost benefits, when based on advance situational assessments and linked/harmonised with existing planning and performance improvement approaches to minimise budgets and maximise use of human and financial resources.

Among the recommendations offered: Involve participants as co-facilitators. Although some initial external facilitation may be needed as the QRMs are being redesigned/integrated into programme implementation, the use of participants as facilitators can minimize the need for and cost of external or higher-level facilitation. Furthermore, it is noted that, in Ethiopia, QRM summary reports (including participants, main points discussed, participant comments, and recommendations) are provided for each meeting and compared with target plans, with two to four QRMs conducted per year based on woreda resources. One suggestion for other countries as well is to include and/or share review meeting plans, summaries/notes, and recommendations with local partners and stakeholders in order to assist in advocacy for their involvement and buy-in as well as for sustainability of achievements.