Department of Health - Regional Office I

Strengthening
Routine Immunization
 PRELIMINARY STEPS

1. Make a list of each Barangay in an RHU/ HC

catchment area.
2. List every purok within each Barangay.
REACHING EVERY PUROK PROCESS

PLANNING
 STEP 1. MAKING A MASTERLIST OF CHILDREN

Card/without card,
Complete or
incomplete
immunization

DOOR TO DOOR COLLECTION OF NAMES OF

CHILDREN AND IMMUNIZATION STATUS*

Remember: Making a masterlist needs training and supervision. The masterlist should be of good detailed
quality and as complete as possible.
 STEP 1. MAKING A MASTERLIST OF CHILDREN

• Before going from door-to-door, prepare the master list by adding names
and vaccination details of children from that purok who are already in the
TCL.
• Go from door-to-door in the purok and ask if there is a child aged between
6 weeks and two years in the house.
• If yes, write the name of the child and mother and the detailed address,
and ask the mother for the immunization card.
• If an immunization card is available: Place a √ on the form against
each vaccine that has been given from the record on the immunization
card
• If no immunization card available:
• If the mother can remember well, place √ against each vaccine on
the form. Provide a new card, place √ on the card against vaccines
already given (dates will not be known). Try to find the name of the
child in the TCL to validate the mother’s recall and add the dates
that the vaccines were given.
• If the mother cannot remember, try to find the name of the child in
the TCL. Provide a new card and enter the name in the TCL if it
cannot be found.
STEP 1. MAKING A MASTERLIST OF CHILDREN
STEP 1. MAKING A MASTERLIST OF CHILDREN
 STEP 1. MAKING A MASTERLIST OF CHILDREN

HOW TO CLASSIFY PUROKS AS HIGH OR LOW RISK

• Review the results of latest door-to-door card check:

• Compute the proportion (%) of children with complete
immunization as indicated in the cards using this formula:
Number of children with complete immunization from card check X 100
Total number of children with cards

High Risk Purok: <90% of children had complete immunization

• In puroks where a significant number of children do not have
cards, compute the proportion (%) of Children with no cards using
this formula:
Number of children without cards X 100
Total number of children checked

High Risk Purok: ≥80% of children aged 12 to 23 months are

without cards
STEP 2:HEALTH CENTER WORKPLAN FOR REACHING EVERY PUROK EVERY QUARTER

• Use FORM 1 to make a simple work plan for REP

• List HR puroks
• Schedule Action
•master listing,
•catch up immunization
•card checks
•results of card checks

*HR= high risk, LR= low risk, ND= not done

STEP3:MAKING A BARANGAY MAP SHOWINH HIGH RISK PUROKS
STEP3:MAKING A BARANGAY MAP SHOWINH HIGH RISK PUROKS

Map Codes in the HC Microplans

(For Focus & Prioritization During Outreach IZN)
Red – High-risk areas; urban slums, disorganized
settlements, etc
Yellow – reachable middle class; more or less
organized areas like established
housings/apartments
Blue – commercial areas but with potential presence
of target children
Green – villages/condos/upscale subdivisions
STEP4:MANAGING TARGET CLIENT LIST BY PUROK

TCL OPTION 1
Sub-divide the pages of
one TCL

TCL OPTION 2
separate TCL for each
block

TCL OPTION 3 (least

preferred)
Use one TCL but add full
details on location of each
child (plus family number)
to ensure easy tracking.
STEP4:MANAGING TARGET CLIENT LIST BY PUROK

This is an example of a TCL with pages divided per barangay and per purok used in one health center in
Region III. Color-coded tags are used to mark records per barangay and per purok. Yellow tags mark the
beginning of the recording for a barangay followed by green tags to separate the records per purok within the
same barangay. This was prepared after master listing per purok has been completed.
REACHING EVERY PUROK PROCESS

TAKING
ACTION
STEP5:DECIDING WHEN A FOLLOW-UP VACCINATION SHOULD BE DONE

A follow up immunization is
needed in a high risk purok
where card check shows <90%
of children are completely
immunized.
STEP5:DECIDING WHEN A FOLLOW-UP VACCINATION SHOULD BE DONE
 6. CATCH-UP ACTIVITY / DEFAULTER TRACKING
Some children under 2 years of age may have no immunization records because they are lost
or damaged by flood/fire etc.

If there is no recall and no record of vaccination:

1. Make a new vaccination card

2. Enter the name and address in the TCL
3. Determine which vaccines to give to the child:
For children 12-23m Children >23
very likely that the likely to be partially very likely that the child likely to be partially
For children Under child is completely immunized / If there is is completely immunized / If there is no
12m unimmunized no recall and no record unimmunized recall and no record of
of vaccination: vaccination:

Preferable to give Give: Give: Depending upon the Depending upon the
whole immunization Penta (3 doses) Penta (1 dose) available of vaccine available of vaccine
series : OPV (3 doses) OPV (3 doses) stocks: stocks:
BCG (1dose) IPV (1 dose) IPV (1 doses) Give: Give:
Hep B (1dose) *PCV13 (1 doses) *PCV13 (1 doses) MCV (2 doses) MCV (2 doses)
Penta (3 doses) MCV (2doses) MCV (2 doses) OPV (3doses) OPV (3 doses)
OPV (3 doses) Except birth dose
IPV (1 doses)
*PCV13 (3 doses) *depending upon the *depending upon the
MCV (1dose) availability of stocks availability of stocks
*depending upon the
availability of stocks
Remember: If the mother can recall the doses given, provide missed doses and make a new card
-OPV and MCV: multiple doses are completely safe
REACHING EVERY PUROK PROCESS

MONITORING
7. QUARTERY CARD CHECK IN HIGH RISK PUROKS

Try to check a minimum of 20 houses with eligible children aged 12 to 23 months

in each high risk purok every quarter. If the purok has less than 20 houses, check
every house.
7. QUARTERY CARD CHECK IN HIGH RISK PUROKS

HOW TO CONDUCT RAPID COVERAGE ASSESSMENT

RAPID COVERAGE ASSESSMENT
• Process of validating the immunization coverage of a catchment
area by checking the doses of antigen at a recommended age in
the immunization card through sampling of 12-23 months children
in the community.
HOW MANY SAMPLES ARE NEEDED?
• For Rural Areas: Check cards of a minimum of 20 houses
with eligible children in each barangay or purok.
• For Urban Areas
Demographic Feature Minimum Sample Size
Well-organized not densely populated 20 houses
Densely populated slums or pockets of 50 houses
urban communities
Mobile population All
 8. CONSOLIDATING AND MONITORING OF QUARTERLY CARD CHECK

Remember: It may not be possible to change a purok status from high risk to low risk status based upon
only on one or two month’s data. It is more reliable to follow progress for 12 months before changing
their status.
 8. CONSOLIDATING AND MONITORING OF QUARTERLY CARD CHECK

HOW TO CLASSIFY PUROKS AS HIGH OR LOW RISK

• Review the results of latest door-to-door card check:

• Compute the proportion (%) of children with complete
immunization as indicated in the cards using this formula:
Number of children with complete immunization from card check X 100
Total number of children with cards

High Risk Purok: <90% of children had complete immunization

• In puroks where a significant number of children do not have
cards, compute the proportion (%) of Children with no cards using
this formula:
Number of children without cards X 100
Total number of children checked

High Risk Purok: ≥80% of children aged 12 to 23 months are

without cards
8. CONSOLIDATING AND MONITORING OF QUARTERLY CARD CHECK

HRP HRP HRP

LRP HRP HRP

HRP LRP HRP

LRP LRP LRP

9. MONITORING AND SUPERVISION OF IMMUNIZATION PROGRAM

•Service Delivery
•Monitoring
•Surveillance
•Cold chain,
Logistics and Supply
•AEFI
•Communication
•Planning and
Supervision
9. MONITORING AND SUPERVISION OF IMMUNIZATION PROGRAM
9. MONITORING AND SUPERVISION OF IMMUNIZATION PROGRAM
9. MONITORING AND SUPERVISION OF IMMUNIZATION PROGRAM
9. MONITORING AND SUPERVISION OF IMMUNIZATION PROGRAM
 11. MONITORING PROGRESS BY PUROK

In barangays with <90 % coverage where the master list also shows that there are significant
number of unimmunized/under immunized children – CATCH UP IMMUNIZATION IS
NEEDED
REACHING EVERY PUROK CYCLE