BEST PRACTICES IN

MICROPLANNING FOR
POLIO ERADICATION
BEST PRACTICES IN
MICROPLANNING FOR
POLIO ERADICATION
ACKNOWLEDGEMENTS
These best practices documents for polio eradication have been developed from the contributions of many people
from all over the world. The people concerned have themselves spent many years striving to eradicate polio,
learning from successes and failures to understand what works best and what does not, and quickly making
changes to suit the situation. In writing these best practices the aim has been to distil the collective experiences
into pages that are easy to read and detailed enough to be adapted for other health programmes.

‘To strive, to seek, to find, and not to yield’

CONTENTS
ACRONYMS iv

INTRODUCTION 1

THE PURPOSE OF THIS DOCUMENT 2

MICROPLANNING ELEMENTS 4

MICROPLAN RESOURCE ESTIMATE 8

COLD CHAIN AND LOGISTICS MICROPLAN 9

OPERATIONAL MICROPLAN 9

SUPERVISION MICROPLAN 23

RECORDING AND REPORTING TOOLS 28

MONITORING MICROPLAN 30

CONCLUSION 33

ANNEX 1 MICROPLAN RESOURCE ESTIMATE 34

ANNEX 2 COLD CHAIN AND SUPPLIES 39

ANNEX 3 CHECKLISTS 41

ANNEX 4 TALLY SHEET 46

SUPPLEMENTS TO THIS DOCUMENT (PROVIDED IN SEPARATE DOCUMENTS)

• BEST PRACTICES IN MICROPLANNING IN AREAS WITH POOR ACCESS

(INCLUDING THE KOSI RIVER AREA OF BIHAR, INDIA)
• BEST PRACTICES IN MICROPLANNING FOR CHILDREN OUT OF THE HOUSEHOLD: AN EXAMPLE
FROM NORTHERN NIGERIA
• BEST PRACTICES IN INNOVATIONS IN MICROPLANNING FOR POLIO ERADICATION
• BEST PRACTICES FOR PLANNING A VACCINATION CAMPAIGN FOR AN ENTIRE POPULATION
ACRONYMS

AEFI Adverse event following immunization

AFP Acute flaccid paralysis

GPEI Global Polio Eradication Initiative

HC Health centre

NGO Nongovernmental organization

OPV Oral polio vaccine

RCM Rapid campaign monitoring

SIA Supplementary immunization activity

SOP Standard operating procedure

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iv POLIO ERADICATION
BEST PRACTICES IN MICROPLANNING FOR
POLIO ERADICATION
(POLIO SUPPLEMENTARY IMMUNIZATION
ACTIVITIES)

INTRODUCTION

DOCUMENTING BEST PRACTICES FROM POLIO ERADICATION

Objective 4 of the Polio Eradication & Endgame Strategic Plan 2013–2018 calls for the Global Polio Eradication
Initiative (GPEI) to undertake planning to "ensure that the investments made to eradicate poliomyelitis
contribute to future health goals, through a work programme that systematically documents and transitions
the GPEI's knowledge, lessons learnt and assets". As outlined in the Plan, the key elements of this body
of work include:
• ensuring that functions needed to maintain a polio-free world after eradication are mainstreamed
into ongoing public health programmes (such as immunization, surveillance, communication,
response and containment);
• transitioning non-essential capabilities and processes, where feasible, desirable and appropriate,
to support other health priorities and ensure sustainability of the global polio programme;
• ensuring that the knowledge generated and lessons learnt from polio eradication activities are
documented and shared with other health initiatives.

THE SCOPE OF DOCUMENTING BEST PRACTICES

Best practice documents deal with technical aspects of polio eradication. The documents will include clear
guidelines, case studies of effective programmes and processes, case studies of failures, and innovations
developed at the national, regional and global levels, and will highlight areas where other programmes
could benefit from the polio practices to achieve their health priorities. A series of technical subjects are
being developed on:
• improving microplanning
• ensuring quality acute flaccid paralysis (AFP) surveillance
• monitoring the quality of supplementary immunization activities (SIAs)
• securing access for Immunization in security-compromised areas
• targeting and planning for vaccination of older age groups during polio SIAs
• coordinating cross-border vaccination campaigns
• integrating other antigens or other interventions into polio SIAs
• targeting and planning for the vaccination of nomadic populations during polio SIAs
• benefiting from other relevant technical areas where WHO country, regional and headquarter polio
teams have significant expertise.

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THE PURPOSE OF THIS DOCUMENT

THE RELEVANCE OF THIS DOCUMENT TO OTHER HEALTH INITIATIVES

Many public health interventions are currently delivered through a campaign approach, which is likely to
continue. This approach not only includes vaccines but other interventions for communicable diseases
and nutrition, for children and, in certain circumstances, for an entire population, especially those facing
emerging diseases.

THE SCOPE OF THIS DOCUMENT

This document describes best practices in microplanning for polio eradication campaigns, also known
as supplementary immunization activities (SIAs) with oral polio vaccine (OPV). A microplan must aim to
reach 100% of the target population, usually children aged under 5 years. Experience over the years has
shown that the poliovirus can continue to circulate in quite small populations of unvaccinated children,
thus requiring that the microplan be sufficiently detailed to reach every child with OPV.

The elements for making a microplan are described, along with the relevant best practices learnt over
time. This document is a practical guide with working examples that can be adapted as needed. The best
practices can serve as a guide for other public health programmes.

Over the last 25 years, microplanning for SIAs to eradicate polio has undergone changes and innovations.
Errors were made and corrected, best practices were learnt through trial and error, without any textbook
to follow. This document highlights what works best, but also indicates what does not work as well.
The great strength of the polio eradication initiative is its flexibility and ability to identify problems rapidly
in order to make significant changes, even at short notice.

This document does not replace the many guides, technical sheets and training materials already in
existence; these published documents provide detailed information on strategies, principles, methods
and operations. This document outlines the same strategies and elements, but gives advice on how the
tried-and-tested practices can best be put into action. It does not include budget examples, which vary
greatly from country to country.

DEFINITION OF A MICROPLAN
A microplan is a population-based set of components for delivering health-care interventions – in this
case, supplementary polio vaccination for every child aged under 5 years. The microplan contains technical
details and can be adapted as needed at every level, whether by national institutions, health-care workers
or community participants. It is not a reference book but a dynamic set of tools that can be used and
modified at any time to suit the demands of implementation according to the circumstances.

The microplan is divided into six sections:

• resource estimate
• cold chain and logistics
• operations
• supervision
• recording and reporting tools
• monitoring

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OBJECTIVE OF THE MICROPLAN
Every person engaged in making and implementing the microplan must have a clear understanding
of the objective: to achieve polio eradication through the systematic immunization of every child in the
target population with polio vaccine.

Polio eradication microplans have adopted the innovative strategy of house-to-house

vaccination over time. The health services in countries in which polio has been endemic did not
reach everyone, and underserved communities had a greater burden of polio. Services were
therefore brought to the community.

ENGAGING THE OPERATIONAL LEVEL IN MICROPLANNING

The microplan must work with the health service at the operational level, usually the health centre.
• Microplans must be validated in the field and not from afar at a high level of command.
• The details of their implementation must consider the real situation of the people in field
operations.
• Standards must be set to plan and secure supplies and logistics, but flexibility to make changes to
suit local conditions must be possible at every step.

Important lessons learnt

The polio SIA microplan is not just a collection of spreadsheets and budgets, it is a flexible and
evolving set of plans at each level of operation that can be adapted and corrected rapidly, even
between each campaign round.

The microplan requires field validation; spreadsheets may not reflect the reality of operations at
the field level where access is difficult and resources are scarce. Detailed plans must be made
at the operational field level (health centre or an equivalent institution).

Assigning teams to vaccinate children in a certain number of households per day in a defined
area is often more effective than designating a total number of children per day.

The microplan must be able to show the details of exactly where every person needs to be and
when, as well as their duties and movements during the entire period of the SIA.

Coverage data alone are not a reliable way to measure the results of a microplan. It is better
to triangulate data using a variety of sources, for example supervisory reports, independent
monitoring and surveillance data, to understand whether a microplan is adequate or needs to
be modified.

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MICROPLANNING ELEMENTS

CAMPAIGN STRATEGY DECISION

The campaign strategy must be decided and understood by the health service and community:
the immunization of all children aged 0 to 59 months with OPV on an equitable basis regardless of prior
immunization status, location and social condition in a defined wide area (country, province).

ESTABLISHING A COORDINATION STRUCTURE

A structure that can oversee and coordinate the development and implementation of the microplan must
be established. It must include national-level decision-makers and representatives at other levels involved
in the area of the microplan’s operations. Imposing a plan at any one level should be avoided as full
participation at every level is essential to make the plan work.

SETTING THE REQUIRED MICROPLANNING STANDARDS

Planning standards must be set for supplies, logistics, human resources, transport, equipment and
the span of management control. The standards should be flexible enough to allow local variations.

ESTIMATING MICROPLAN RESOURCES

• Make an initial population-based estimate of the total requirement for supplies, logistics, human
resources, transport and cold-chain equipment at the highest level.
• Use the same population-based method to estimate requirements for supplies, logistics, human
resources, transport and equipment at each level: province, district, subdistrict, health centre.
• Estimate resources according to the local characteristics, such as the extent of urban and rural
areas, as they should not be standardized.
• Use simple form to estimate population distribution, supplies and human resource requirements at
the district and health centre levels as conditions may vary greatly from place to place.

PLANNING THE COLD CHAIN AND LOGISTICS ELEMENTS

The microplan should include information pertaining to:
• the availability and deployment of cold-chain equipment;
• a plan for transporting vaccine and supplies.

PLANNING THE OPERATIONAL ELEMENTS

The operational aspects of the microplan should include:
• management procedures;
• a training plan;
• a health centre session plan (see Figure 1);
• a vaccination team daily logistics checklist;
• an individual team movement plan (see Figure 2);
• detailed operational maps and itineraries for the teams, organized by the number of households to
visit with start and end points;

BEST PRACTICES IN MICROPLANNING FOR

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• fixed site information;
• house-marking information;
• finger-marking information;
• a special team deployment plan for transit points, markets and streets;
• a community engagement plan.

PLANNING THE SUPERVISORY ELEMENTS

The microplan should describe the duties of supervisors in detail. At every stage in its development and
implementation, supervisors are expected to observe operations and take corrective action where needed.
Their duties include:
• field validation
• immunization supervision and training
• team planning and scheduling
• responsibility for operational maps
• pre- and post-implementation checks
• checklist updates.

USING RECORDING AND REPORTING TOOLS

Simple field-based tools should be used to collect and report data on the implementation of the microplan.

MONITORING THE MICROPLAN

A plan for deploying monitors who will check the preparations and implementation of the microplan must
be put into place.

ESTABLISHING A COORDINATION STRUCTURE

A coordination structure should include national-level decision-makers and representatives at other
levels who are involved in the area of the microplan’s operations. One innovation has been to establish
Emergency Operation Centres working at the province and district levels to coordinate polio outbreak
activities, including the extent of the SIA, the budget allocation, communication and training strategies,
monitoring plans and cross-border activities.

The coordination structure’s various committees and national and subnational committee members should
ensure that:
• the same standards are applied everywhere;
• correct and appropriate messages are disseminated everywhere;
• all microplanning materials and all resources are available when and where needed.

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Table 1. Coordination structure committees

National committee is responsible for the overall monitoring of the planning,

implementation and evaluation stages.
Technical subcommittee follows up on the technical aspects of the process, verifying the
national work plan and its target population and age groups; and
assesses the adequacy of the training modules for every level.
Logistics subcommittee ensures the availability of vaccines, adequate cold chain,
transportation and supplies; and develops and implements the
logistical distribution plan.
Social mobilization develops social mobilization materials and key messages, and
subcommittee plans their dissemination; and coordinates the recruitment of local
social mobilization and community engagement focal points at the
subdistrict level.
Finance subcommittee ensures the availability of funds and their timely release to all levels,
as well as the post-campaign financial report.

SETTING THE REQUIRED STANDARDS FOR SUPPLIES, LOGISTICS, HUMAN RESOURCES,

TRANSPORT AND COLD-CHAIN EQUIPMENT

BEST PRACTICE FOR SETTING MICROPLANNING STANDARDS

Planning standards should be set on realistic estimates, especially regarding the amount of work that
vaccinators and supervisors must conduct in the time available. To keep an equitable workload throughout,
it is necessary to vary the standards according to accessibility, distance and other local conditions including
security. Regardless of their assigned workload, all vaccination teams are responsible for vaccinating
children in their assigned area whether the children are in the house or out of the household.

ASSIGNING DAILY TARGETS OF TOTAL HOUSEHOLDS PER DAY OR TOTAL CHILDREN PER DAY
In the early years of polio eradication, countries would implement two or three rounds of polio immunization
per year, and many children were missed. Often teams were set targets of around 200 children or more
per day to vaccinate, and they would stop work when they had achieved the target number. They would
then claim 100% coverage, even though additional children may have been in the assigned area. In later
years as operations intensified, some countries would hold as many as 12 campaigns per year but, as
it became critical that no child be missed, the strategy of setting total children as a target had to be
modified. Communities became reluctant to accept many vaccination rounds and had to be convinced of
their purpose. More time had to be spent on engaging the community and gaining its trust.

House-to-house vaccination provided the opportunity to engage families and convince them of its benefits,
but it proved more time-consuming and fewer children could be immunized per working day. Microplans
were changed; in urban and semi-urban areas, it became more effective to assign each team to a certain
number of households per day (approximately 50ะ75) than to designate a certain number of children.
• In urban areas, street maps can be used, and vaccination teams can be assigned a certain number
of households to visit. A team’s daily work can be precisely mapped, with identified start and end
points. The houses can be numbered and the vaccination team can mark them according to the
immunization status of the children within. Supervisors and monitors can more easily follow up on
the work of the teams.
• In rural areas, such as villages where houses may not be organized on a street pattern, setting the
target of reaching every household and every child in a village is more effective. However, simple
maps showing designated start and end points can still be used, together with house-marking.

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Table 2. Example of the standardization of resources (variable according to country and location)

Variable Standard
Population aged <5 years (0 to 59 months) Varies by country (approx. 13.5%)
Population aged <10 years <5 years population x 1.5
Population aged <15 years <5 years population x 2
Vaccinators per team 2 (minimum)
Support staff at post or in team 1–2
District refrigerator capacity 100 litres per refrigerator
Health centre refrigerator capacity Approx. 20 litres per refrigerator
Number of households to be visited for 50–100 households
immunization per day
3 children
Average number of children aged 0 to 59 months per
household

Number of children immunized per team per day 100–200 in urban areas
60–80 in rural areas
Number of teams per supervisor 4–5 in urban areas
2–3 in rural areas
2 in transit areas
Fuel consumption of a 4x4 vehicle 15 litres per 100 km on good roads
20 litres per 100 km off the road
Fuel consumption of a motorbike 4–5 litres per 100 km
Maximum daily distance for a national supervisor 150 km
Maximum daily distance for a team supervisor 100 km
Maximum daily distance for a vaccination team 30 km, if motorized
OPV wastage in 20-dose vials during SIA 15%; 1.2 wastage factor
Volume of a dose of 1.5 ml OPV 1000 doses per 1.5 litres cold storage volume
Capacity of 1 vaccine carrier with 4 ice packs Approx. 1–1.5 litres
Capacity of 1 ice-pack freezer Approx. 100 ice packs
Number of finger-marking pens needed per team 2 pens per team per day of work

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MICROPLAN RESOURCE ESTIMATE
(see Annex 1 for examples)

• Make an initial population-based estimate of the total requirement for supplies, logistics, human
resources, transport and cold-chain equipment at the highest level.
• Use the same population-based method to estimate requirements for supplies, logistics, human
resources, transport and equipment at each level: province, district, subdistrict, health centre.
• Estimate resources according to the local characteristics, such as the extent of urban and rural
areas, as they should not be standardized.
• Use simple formats to estimate population distribution, supplies and human resource requirements
at the district and health centre levels, as conditions may vary greatly from place to place.

BEST PRACTICE FOR ESTIMATING RESOURCES

• The microplan must start with an estimate of total resources, made several months in advance so
supplies can be ordered and delivered in time.
• When planning a campaign, it is best to estimate the total resources needed in a timely manner.
• Time will be needed to gather the resources: vaccine must often be ordered from overseas, vehicles
distributed, personnel trained and supervisors assigned. The extent of all these resources needs to
be known well in advance at every level.
• Early planning estimates are also essential because a shortage of resources is more likely at the
district level.
• Accurate resource estimates are calculated from population estimates, but the latter may vary
according to the information source. Planning estimates should be made from the bottom-up, using
the same framework despite varying population totals (i.e. using the same type of logistical plan
with standardized variables but with values that may change from village to health centre to district
due to the many different population estimates at each level).
• It is always best to slightly overestimate the population to ensure sufficient vaccines and other
resources are available.

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COLD CHAIN AND LOGISTICS MICROPLAN
(see Annex 2 for examples)

The microplan should include information pertaining to:

• the availability and deployment of cold-chain equipment
• a plan for the transport of vaccine and supplies.

BEST PRACTICE FOR PLANNING THE COLD CHAIN AND LOGISTICS

• Every province should estimate its cold-chain equipment situation early on. During a campaign,
the demand for refrigerators, cold boxes to carry vaccine and freezer space is high.
• All districts should manage their cold-chain resources accordingly and well in advance.
• A district that has a shortfall in cold-chain equipment can receive assistance through the
deployment of equipment from the province level or a neighbouring district.
• If district centres are not far from each other, pooling freezer capacity for ice packs may be possible
at a shared location.
• Vaccine should be distributed from the province to the district no later than one month from the
start of the campaign. Equipment can also be transported in advance in case of a shortfall.
• The province and district should regularly update their lists of equipment according to local
transport information and the cold-chain equipment plan.

OPERATIONAL MICROPLAN
The operational aspects of the microplan should include:
• management procedures;
• a training plan;
• a health centre session plan (see Figure 1);
• a vaccination team daily logistics checklist;
• an individual team movement plan (see Figure 2);
• detailed operational maps and itineraries for the teams, organized by the number of households to
visit with start and end points;
• fixed site information;
• house-marking information;
• finger-marking information;
• a special team deployment plan for transit points, markets and streets;
• a community engagement plan.

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OPERATIONAL MICROPLAN FOR THE HEALTH CENTRE
• After the microplan resource estimates have been made, detailed operational plans will be
required. The operational microplan is like a workplan: it describes the dates and places where
teams, community representatives, volunteers and supervisors will need to be located on each day.
• The details outlined in the operational microplan depend on an assessment of the local situation
and cannot be standardized.

BEST PRACTICE FOR MANAGING OPERATIONAL MICROPLANS

1. Send a simple message to all participants

The goal is to vaccinate all target-age children in a given geographical area.
Teams are assigned to specific areas and must visit every household in that area to ensure vaccination.
Supervisors will check that teams have visited every household and that no child has been missed.

2. Divide the operational area into three categories of access

The number of children or households to be reached will depend on access and the time the teams have
to work. Operational areas can be mapped, and vaccination teams and supervisors can be assigned
accordingly.

Table 3. Three categories of access

1. Easy access: households can be reached on foot each day 50–80 households per day or 200
children
2. Intermediate access: transport is needed between areas, but 30–50 households per day or 100
households can be reached on foot children
3. Difficult access: areas include geographical obstacles, such 30–50 households per day or 100
as rivers, hills or bush tracks with poor road conditions children

3. Pay special attention to high-risk areas

High-risk areas require the best vaccinators and supervisors suited to the areas. Community mobilizers
and influencers must be identified in advance to accompany teams.

High-risk areas can include those with:

• recent circulation
• low performances in previous rounds
• low routine coverage
• low surveillance performance
• settlements of urban poor
• new and informal settlements
• remote rural populations
• minority populations
• highly mobile populations
• nomads.

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4. Select the best vaccinators
• Large numbers of vaccinators are needed to deliver OPV drops. If possible, select vaccinators
from the community by engaging community leaders. This may be more effective than recruiting
vaccinators through health service officials.
• Vaccinators should be from the same ethnic group as the target population, be familiar with
the location and speak the same language. Previous experience is desirable.
• Sufficient female vaccinators should be available, given the need to engage mothers with young
children.
• Nursing students, other university students and nongovernmental organization (NGO) staff often
work well as vaccinators.
• Supervisors may be health service staff, teachers, NGO staff and other people with knowledge of
the community.

BEST PRACTICE FOR TRAINING VACCINATORS

• All vaccinators and supervisors must be trained preferably in small groups by experienced senior
staff and partners.
• The location of training is important. It should be local, and the participants should be able to hear
clearly and interact with trainers with no outside distractions.
• The vaccinator’s basic job is to administer vaccine, tally, and mark the finger and the house. The
vaccination team should not be overloaded with other jobs unless they are essential to the plan.

Vaccinator training
• The training of vaccinators should not be left to newly trained supervisors; it should be undertaken
by the most experienced professionals.
• The training site should be near the area where the teams will work (such as schools), with enough
room for participants to be seated.
• The vaccinators’ attention should be gained through interactive training in a number of small
groups (around 20 persons) rather than in large groups.
• The training course should take one day, with half of the day spent on hands-on training and role
playing with simulated vaccination activities.
• The training should be completed around five days before the campaign starts.
• An additional 5–10% more vaccinators should be trained in case of absentees on the campaign days.

Simple but clear vaccinator training content

• Vaccinators must know the campaign’s purpose and objective.
• Every team and supervisor must use a map during each day of the campaign.
• Maps showing the boundaries where each team will work can be made during training or provided
by supervisors.
• The maps for vaccinators must show landmarks where they should start and finish each day’s work,
and the route each team should take to move from house to house each day.
• Every team and supervisor must provide their mobile phone numbers to facilitate supervision and
report problems.
• House-to-house vaccination should follow the assigned route shown on the map, with vaccinators
marking houses and fingers as they go.
• Vaccinators should communicate politely with families, even those that refuse the vaccination.

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• Training should include answers to frequently asked questions.
• Teams should know how to systematically record households to be revisited or absent children,
noting the names of absent children, locked houses and family refusals on the back of the tally
sheet.
• Follow-up of absent children should be conducted before the end of the day.

Key questions for vaccinators to avoid missing children

• At the household door: “How many mothers are in this house?”
• Then ask each mother: “How many children do you have?”
• To make sure all children, especially young infants, are included, ask each mother:
–– “Do you have an infant?”
–– “Do you have any sick children?”
–– “Do you have any visiting children?”
–– “Are any children sleeping?”

Vaccine distribution plan for vaccinators and supervisors

• Every vaccinator should know where to pick up vaccine and replenish it.
• Health centres should set up cold boxes and/or refrigerators where teams can conveniently pick up
vaccine and ice packs before starting the day’s work.
• Supervisors should have vaccine carriers with vaccine to replenish teams when needed.

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 Figure 1. Health centre session plan

Health Centre Dates of Campaign Vaccine Pick-Up Points

Village Community
Names of Dates Number Supervisor
High Vials community engagement
Cate- Total vaccinators of visit of house- name and
Name of risk Team Names of of OPV Mode of focal point person
gory of house- and mobile to each holds per mobile
area Yes/ number volunteers needed transport name and name and
access holds phone area for day to be phone
No per day mobile phone mobile phone
number campaign reached number
number number

Town 23/12 100 20 walk

13
2
Centre No 1 200 1 24/12 100 20 walk
vaccinators
North    
23/12 50 10 walk needed
Town
2
Centre Yes 2 150 2 24/12 50 10 walk
South vaccinators
25/12 50 10 walk
23/12 60 10 walk
2

POLIO ERADICATION
Village 2 No 2 60 3      
vaccinators
     

  bus and
24/12 75 20  
3 walk
Village 3 Yes 3 75 4  
vaccinators      
       

BEST PRACTICES IN MICROPLANNING FOR

Total            

BEST PRACTICE IN HEALTH CENTRE SESSION PLANNING FOR VACCINATOR TEAM MANAGEMENT
The health centre session plan is organized by areas served. Teams are managed according to the area they will visit. The number of households per day,
the number of people on the team and the community support will depend on local knowledge of the area. Some high-risk areas will require more time and
community engagement, especially if there is vaccine hesitancy. It may be possible to split the work in one area over more than one day, but more distant
areas may have to be completed in one day, due to transport constraints. Remote areas may require an overnight stay. Staying in communication by mobile
phone is essential.
 Figure 2. Individual team movement plan

Health Centre Supervisor Name and Phone# Team Number and Phone#

OPV Markers Vaccine Tally sheets Transport Vaccine

Route to be taken by team, required required carrier and pens type if pick up
Day # required point
with start and end points
vials unit (specify) (specify) (specify)
Day 1 Town centre: 100 households
at health
20 2 1 2 walk

14
Start at 08:00 with first house on the right of the market centre
and end at the bus station

Day 2 Village 2: approx. 60 households

Take bus from bus station to village, then walk in local bus and at bus station
20 2 1 2
village and complete all households starting at the walk fixed post
school and ending at the school
Day 3  

POLIO ERADICATION
Day 4  

BEST PRACTICE IN INDIVIDUAL TEAM MOVEMENT PLANS

Each team has an individual plan to show exactly where it must go each day. The health centre assigns teams to each area but, in the assigned area, the team
must follow an assigned route, visit all the assigned households and vaccinate all children aged 0 to 59 months in those households. The team movement
plan must be based on the local situation; in some communities, households will not open the door until late in the morning while, in others, mothers and

BEST PRACTICES IN MICROPLANNING FOR

children leave the house very early to go to the market. Each team’s simple map shows how it must move from household to household with assigned start
and end points. Each household should be marked by the visiting team to show the house has been visited and the status of the children within.
OPERATIONAL MAP FOR TEAMS

BEST PRACTICE IN OPERATIONAL MAPPING

(see also the separate section on GIS mapping)
Each team should have its own map to show exactly where the team will work each day according to the
team movement plan.

The image on the left shows a large town map on which team areas have been shaded: Day 1, Day2, Day 3.

Hand-drawn maps are also useful when they show:

• streets and landmarks within each settlement and city;
• houses and hamlets lying outside the main roads;
• major landmarks (such as rivers, bridges, health centres, schools, markets, nurseries, train/bus
station, police check points, etc.);
• roads and tracks;
• the limits of the team’s catchment area (the border of their working area).

The location where each team works can be shown as in the example below.

BEST PRACTICE IN HOUSE-MARKING

House-marking is evidence that a team has visited a house. It informs teams, supervisors, monitors and
evaluators about whether a household was visited, all children were immunized or the house needs to
be revisited.

The definition of a household should be applied flexibly: a household can be the smallest family unit or
a compound. It can include temporary settlements, boat people or nomads. Each household should be
marked. In compounds where several households share the same entrance, each household as well as
the main entrance should be marked.

Houses should be marked with a crayon, or any other locally accepted product, but never with ink markers.
The mark should be placed on, beside or above the door. If that is not possible, any other immobile object
(a rock, tree, fence, etc.) should be chosen. The location of the mark should preferably be protected from
rain. Houses can be marked in many ways; the marking has not been standardized in all countries.

BEST PRACTICES IN MICROPLANNING FOR

15 POLIO ERADICATION
Examples of simple basic house-marking
T15 H23 29/6 4/4

Interpretation: Team 15 visited (√) household number 23 on 29 June and immunized all four children.
(The tick mark is circled.)

T18 H74 29/6 2/3 +1

Interpretation: Team 18 visited (√) household number 74 on 29 June, two out of three children were
vaccinated. but some children were missed and the household needs to be revisited (no circle). When
the team revisits, it adds +1 to the house-marking.

Some houses may be locked and empty. Houses should be marked for revisiting only when individuals in
the target age group are absent and can be immunized by a revisit during the campaign. A list of houses to
be revisited should be made on the back of the tally sheet and each team should submit it to the supervisor
at the end of each day.

The marking on the wall indicates that all 10 children in the household were vaccinated on 2 March 2010.

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BEST PRACTICE IN FIXED SITE CAMPAIGN IMMUNIZATION
Many years of experience have shown that a successful campaign cannot be conducted with fixed sites
alone. A combination of fixed site and door-to-door vaccination is sometimes used, often on the first day
of the campaign, after which the campaign becomes focused on door-to-door visits.

• The fixed sites should be in prominent and convenient places in the shade with enough space for
mothers and children to wait.
• The site is fixed, but the personnel are not. Vaccinators, volunteers and social mobilizers should all
move around the site to look for children to vaccinate.
• Health centres and hospitals can remain open and function as fixed site posts for the duration of
the campaign.
• The exterior of schools, places of worship, bus stations and other locations can be vaccination
areas for a certain number of days but should not replace door-to-door visits.
• Banners and posters should draw attention to the site.

Each fixed site should have at least two vaccinators to immunize children and record doses administered,
and two support staff to help manage the flow of waiting clients and to mobilize mothers and children in
the area.

Each child of eligible age is tallied on the tally sheets and gets a finger-mark. There is no need to record
addresses or other information.

BEST PRACTICE IN FINGER-MARKING

Finger-marking during SIAs allows teams, supervisors, monitors and evaluators to know whether a
child has actually been immunized. Fingers should preferably be marked with indelible ink markers,
rather than with gentian violet or other products that usually do not stay visible sufficiently long.
Fingers marked the correct way and with quality markers, stored and handled appropriately, will
normally remain visible for the duration of the campaign and a few days thereafter. It is important that
teams strictly follow the recommended method for finger-marking. Always cap the finger-marker pen
after use to prevent it from drying out.
Finger-marking process:
• The finger should be marked after administering
the OPV and not before.
• Before marking, the team should properly clean
the child’s nail using a piece of cloth/cotton.
• Only the child’s left little finger should be marked – NO
other place.
• The ink should be applied on the nail and nail bed.
Marking the nail bed is important because the stain
will remain longer.
• The ink should be allowed to dry for 30 seconds.

BEST PRACTICE IN TEAM MANAGEMENT AT TRANSIT POINTS

The locations of common transit points include:
• railway stations
• bus terminals and major road crossings
• highway checkpoints

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17 POLIO ERADICATION
• tollbooths on highways
• major river bridges
• ferry crossings
• airports
• children’s parks
• religious and social community event venues.

Vaccination teams assigned to work at transit points need special training and careful supervision. In many
countries, thousands of children move in and out of transit points every day. They would be missed by
teams that only visit households. An important factor is engaging the cooperation of the people who are in
transit with their children, although they are often in a hurry and may resent the presence of vaccinators.
It may be helpful to engage youth groups, to steer parents with children towards the vaccinators. Local
authorities and police must approve the vaccination work at transit points.

Planning steps
• Every important transit point should be identified and mapped.
• Trained vaccinators should be deployed at the transit points depending on the size of the area and
the movement of traffic and public at various times of the day.
• Transit teams should be deployed for all the SIA days. This may require two shifts to cover traffic
moving from early morning to late evening.
• Vaccination teams should be deployed at all exit/entry points in big transit areas with multiple
entries and exits.
• A supervisor should be deployed for every 2–3 transit teams.

Microplanning steps
• Visit the transit point to estimate the likely workload.
• Estimate the number of target children passing through the transit point and the number of entry
and exit points.
• Take into consideration variations in traffic load in the mornings and evenings.
• Judge the most appropriate location for placing vaccination teams.

Transit team vaccinator training

Transit team vaccinators need dedicated training because their work is different from that of house-to-
house teams. Some transit teams are static, working at major crossings to vaccinate children as they pass
by. Others are mobile, entering buses or trains and vaccinating children inside them.

Transit team vaccinators need to know:

• the basics about polio eradication and how to handle vaccine and vaccinate;
• how to negotiate entry to crossing points, buses and trains;
• how to approach parents politely in crowded circumstances;
• how to check for vaccinated and unvaccinated children by finger-mark;
• how to convince parents reluctant to accept vaccination;
• the importance of actively seeking children.

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Vaccine and the cold chain
• Transit teams should be given enough vaccine vials for the estimated number of children passing
through the site. A team may need as many as 1000 doses of OPV (50 x 20-dose vials) for major
transit points, such as large railway stations.
• All vials (empty, full or partial) should be returned to the cold store at the end of each day.
Every vaccination team and supervisor should have a vaccine carrier to store the daily vaccine
requirements.

Information, education and communication/mobilization

• Posters and banners should help indicate and make visible where transit teams are operating.
• Tee shirts, caps and identification badges should be worn so parents can easily identify the team
members.
• Radio and television messaging should be developed and shared through appropriate channels to
ensure parents are sensitized to transit teams operating in their areas.
• The controlling authority (e.g. railway or bus terminus authorities) should ensure endorsements
and announcements at the transit point.
• Religious leaders should make announcements at places of worship.

Supervision
• At least one supervisor should oversee every 2–3 transit teams.
• If transit teams are deployed in shifts, every shift should have separate supervisors.
• Supervisors should move around to check vaccinators’ activities carefully.

Working at transit points

• Vaccinators must identify parents and caretakers with target children at transit points and politely
ask to check the children’s vaccination status.
• If unimmunized children are present, vaccinators should immunize them and mark the finger.
• Vaccinators must obtain consent from parents before vaccinating children. If a child is alone,
vaccinators should try to locate the child’s parents or caretakers to ask permission to vaccinate the
child.
• If parents refuse vaccination, vaccinators should politely try to convince them to accept OPV. If
parents refuse, vaccinators should not waste time trying to persuade them.
• Vaccinators should check all children for finger-markings, even when parents claim children have
been immunized.
• Every vaccinator deployed must be independent and should carry vaccine, marker pens and tally
sheets.

Recording and reporting

The tally sheet should record:
• date, place and timing of activity
• number of children checked for vaccination status
• number of children vaccinated
• number of vaccine vials received, spent and returned.

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Figure 3. Transit team management form

Location for Team Names of Name of supervisor and

Hours of work
transit team number vaccinators mobile phone number
         
 
         
 
         
 
         
 
         

Figure 4. Form for community engagement activities in high-risk communities

Name of person
selected for Name of
Location of Names of community supervisor and Dates of
community vaccinators engagement and mobile phone engagement
mobile phone number
number
       

       

       

       

       

       

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BEST PRACTICE IN COMMUNITY ENGAGEMENT IN HIGH-RISK COMMUNITIES

High-risk communities
High-risk communities are defined as areas with:
• recent circulation
• low performances in previous rounds
• low routine coverage
• low surveillance performance
• settlements of urban poor
• new and informal settlements
• remote rural populations
• minority populations
• highly mobile populations
• nomads.

High-risk communities need careful microplanning to make sure the community is visited by the best
possible teams, best supervisors and persons from the local community who can engage and influence
the community.

Certain high-risk communities may be reluctant to accept vaccination and other interventions. In these
circumstances, it is necessary to engage the community through a person it knows well and trusts. Such
a person may be a religious or other leader who is well informed and able to explain why vaccination is
needed and its benefits to the community.

Community engagement
Communities can be engaged through team work involving a visit from a trusted community person,
a supervisor and the vaccination team all working together.

1. During local planning

• Identify influential people in the community by visiting it and asking the advice of the community.
• Brief the identified influential people on polio eradication: describe what the health service is trying
to achieve with polio eradication, and describe how important it is that every child in the target age
group be vaccinated.
• When in the community, identify volunteers who can help to mobilize the community with the
influential persons.
• Aim to find local people who are well-known and are welcome in any house in the community.
• Be prepared to pay volunteers and community influencers for their work. It is better to have
a formal engagement with an agreed allowance than to depend on voluntary assistance, especially
in poverty areas.

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2. During house-to-house campaign visits

• Make sure all eligible children in a household are identified and vaccinated.
• Get a community volunteer to help by entering the house and speaking to mothers.
• If the community is known to be hesitant about vaccination, ask the influential person present to
answer questions and convince the community to allow the children to be vaccinated.
• Note any households that refuse immunization on the back of the tally sheet, with some indication
of why the refusal occurred. Refusals can be addressed by different people according to the reason
for refusal.

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22 POLIO ERADICATION
SUPERVISION MICROPLAN
(see Annex 3 for examples)

The duties of supervisors include:

• field validation
• immunization supervision and training
• team planning and scheduling
• responsibility for operational maps
• pre- and post-implementation checks
• checklist updates.

DIFFERENCES BETWEEN SUPERVISING AND MONITORING POLIO ERADICATION SIAs

• Supervisors support teams during training, preparation and operations. They are mobile, observe
the work and take corrective action often on the spot, and report their findings at feedback meetings.
–– Supervisors should not be burdened with long checklists to complete when they are observing
intra-campaign house-to-house team operations. They should devote their time to visiting teams
and taking corrective action. They may carry vaccine to vaccinate missed children.
• Monitors observe operations and take note of the quality of operations, but do not take corrective
action. Their reports are compiled, discussed at feedback meetings and used to take corrective
action through the supervisors.
–– Monitors have more time to complete checklists and to consolidate and report their findings.
They do not usually carry vaccine.

BEST PRACTICE FOR MANAGING SUPERVISORS

Supervisors should understand their roles clearly. They need hands-on training, and the quality of their
work is monitored. District and health centre supervisors should monitor team supervisors.

Field validation of the microplan

Supervisors must check the details of the operational microplans in advance.

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23 POLIO ERADICATION
Table 4. The roles of supervisors

Pre- District and health centre supervisors Team supervisors

implementation
• Oversee and follow up microplan • Ensure all teams have supplies,
(see checklist development equipment, maps, plans and transport
under Annex 3) and take corrective action where needed
• Use checklists to review SIA readiness
and take timely corrective measures • Check details on team maps and
movement plans and ensure team
• Review and validate supervisory plans and
boundaries are clear
maps
• Make sure all team members have been
trained and no untrained people on the
team are used as substitutes

Table 5. Implementation observation and corrective action

During District and health centre supervisors Team supervisors

implementation
• Check and correct manpower deployment, • Follow and manage vaccination team
(see checklist access and supply problems activities and take corrective action
under Annex 3)
• Monitor the work of team supervisors • Oversee teams travelling house-to-house
• Participate in rapid campaign monitoring • Oversee revisits and the vaccination of
with external supervisors missed children
• Carry vaccine in the vaccine carrier to
restock teams
• Collect and consolidate reports from all levels
• Provide daily feedback at evening meetings to solve problems

Selection of team supervisors

Supervisors should be selected from among people who have some responsibility and respect in
the community, such as school teachers and NGO staff, among others. Retaining good supervisors is
essential because they make an important contribution.

Training
All supervisors must preferably be trained in small groups by experienced senior staff and partners. They
should be trained by the most experienced professionals, which often includes external supervisors. The
training course usually lasts two days. It should cover everything in the vaccinator training, plus hands-on
field work training on the second day:
• Before the start of the campaign, supervisors should visit locations where the population is known
to be mobile to update their maps with new settlements.
• Maps should show where each team is working so supervisors can visit them and observe their
work closely.
• Supervisors should be familiar with the high-risk areas and know the names of the community
leaders who can act as influencers.
• Supervisors should solve problems and especially deal politely with refusals, requesting the support
of people who can engage with the community.
• Supervisors should use simple checklists and debrief with teams at the end of the day, advising on
corrective action.
• Supervisors should attend evening meetings with external supervisors to report their daily findings.

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24 POLIO ERADICATION
Mobility
• Supervisors must be mobile during the day and visit every team assigned to them.
• All supervisors must have a daily plan and map to manage their movements.
• Supervisors should encourage and support teams by making regular visits to the vaccinator teams
throughout the day.
• Supervisors may use some form of transport to move from team to team, but must walk with each
assigned house-to-house team.

Evening supervisor meetings

• Evening meetings for supervisors should be chaired by the district administrator or a person of
equivalent level in the presence of team supervisors and external supervisors.
• The agenda should be action-oriented and focus on corrective action, including strengths and
weaknesses, and the action to take the next day. A full account of the day’s procedures is not
needed.
• External supervisors can take the opportunity to review tally-sheet samples (a tally-sheet audit).

Figure 5. Overall district or health centre supervisory campaign plan

Health centre name Supervisor 1 Supervisor 2 Supervisor 3 Supervisor 4

(name) (name) (name) (name)
Team # Team # Team # Team #
Day 1 (date) Teams Teams Teams Teams
1, 2, 3, 4, 5 6, 7, 8, 9, 10 11, 12, 13, 14, 15 16, 17, 18, 19, 20
Day 2 (date)

Day 3 (date)

Day 4 (date)

Day 5 (date)

Figure 6. District or health centre daily supervisory plan

Health Centre Name Date

Supervisor Mobile phone Team Location Location Mode of

name number number for of villages of high- transport
supervision for house- risk areas
to-house for rapid
vaccination campaign
monitoring
A 1, 2, 3, 4, 5 Town South Side marketplace motorbike
and bus station

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SUPERVISORY MAP

EXAMPLE OF BEST PRACTICE IN SUPERVISORY MAP USE

This supervisory map shows the location of each team to be supervised on each day (Day 1, Day 2, Day 3).

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26 POLIO ERADICATION
Figure 7. Daily schedule of supervisory visits

Health Centre Date

SUPERVISOR NAME TIME TIME TIME TIME TIME 18:00

AND PHONE NUMBER
LOCATION LOCATION LOCATION LOCATION LOCATION AT
HEALTH
CENTRE
SUPERVISOR 1 TEAM TEAM TEAM TEAM TEAM
NUMBER NUMBER NUMBER NUMBER NUMBER
14 15 16 17 18
09:00 11:00 13:00 15:00 17:00
AT BUS AT STREET STREET 45 STREET MAIN
STATION BESIDE NEXT ROAD
MARKET TO HIGH
SCHOOL
SUPERVISOR 2 TEAM TEAM TEAM TEAM TEAM
NUMBER NUMBER NUMBER NUMBER NUMBER

19 20 21 22 23

08:30 10:30 12:30 14:30 16:30

AT AT AT AT AT
VILLAGE VILLAGE VILLAGE VILLAGE VILLAGE
A B C D E

BEST PRACTICE FOR MANAGING SUPERVISORY WORK

• All supervisors should have detailed plans and daily work schedules that describe precisely where
they should be during the day.
• The date, place and time can be specified, which makes it easier to follow up and oversee
the supervisors.
• One copy should be given to each supervisor, and one copy should be given to the health centre.
• Every supervisor should have the:
–– overall district or health centre supervisory campaign plan (see Figure 5)
–– district or health centre daily supervisory plan (see Figure 6)
–– supervisory map
–– daily schedule of supervisory visits (see Figure 7).
(See Annex 3 for examples of checklists.)

BEST PRACTICE IN SUPERVISORY CHECKLISTS

• Checklists are most useful to supervisors to check on team preparation when a large number of
supply components must be put in place.
• Only a very brief and simple checklist should be used for intra-campaign supervision to allow the
supervisor time to observe team operations in detail.

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27 POLIO ERADICATION
RECORDING AND REPORTING TOOLS
(see Annex 4 for examples)

Simple field-based tools should be used to collect and report data on the microplan’s implementation.

• SIA result consolidation

• tally sheet.

RECORDING AND REPORTING THE RESPONSIBILITIES OF VACCINATORS

To record vaccinations, use:
• a tally sheet (see Annex 4)
• finger-marking
• house-marking.
Tally sheets can be used at a post or door to door during the vaccination campaign. They should not be
filled in after the work has finished.

• A tally sheet should be used to record the number of children immunized at a post or house to
house.
• For the assigned number of houses, the team should record the numbers of the first and last
house.
• Every day, each team should record the details of the houses to be revisited on the back of the tally
sheets.
–– Some houses may be revisited on the same day and others on the next day, depending on team
availability.
• Each day, the details of the vaccine received and vaccine vials returned (used and unused) should
be recorded on the tally sheet.

RECORDING AND REPORTING THE RESPONSIBILITIES OF TEAM SUPERVISORS

Team supervisors must:
• review all tally sheets with teams;
• make a consolidated report;
• attend evening meetings and give feedback on corrective action to be taken;
• go through the tally sheets of their teams at the end of each day:
–– to provide appropriate instructions for vaccinators
–– to compile tally-sheet information and submit a daily report using the reporting form for
supervisors;
• compare the ratio of the number of children aged 0–11 months to the number of children aged
12–59 months (the ratio should be 1 : 5);
• correlate the number of vials used with the reported number of doses administered according
to the tally sheet;
• sign the tally sheet showing the time of their visit;
• verify the tally sheet looks authentic and has genuinely been used in the field.

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28 POLIO ERADICATION
USING A DAILY REPORTING FORM
• The daily reporting form consolidates the data from the tally sheets.
• The same form can be used at each level.
• At the end of each day and each week, each district should send a consolidated report of children
immunized. All reports should be analysed on a daily basis to be in a position to respond to
problems and adapt the strategy. Questions to ask include:
–– Are there areas with specific problems and how were they corrected?
–– Were all teams and supervisors present?
–– Was vaccine availability ensured everywhere?

SIA RESULT REPORTING FORM

This form can be used at any level:
• at the health centre level to provide the teams’ daily results;
• at the district level to provide consolidated results from each health centre;
• at the province level to provide consolidated results from each district.
The form should indicate at which level it is being used.

Figure 8. Form to report SIA results

Team/health Eligible Aged Aged Total % of OPV vials OPV vials

centre/ population 0–11 12–59 eligible received used
district/ months months popula-
province tion
(indicate
which level)

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29 POLIO ERADICATION
MONITORING MICROPLAN
(see Annex 3 for checklist examples)

Microplan checks occur at three levels:

• pre-campaign monitoring
• intra-campaign monitoring
• post-campaign monitoring.

BEST PRACTICE IN USING CHECKLISTS

Checklists can become a burden on supervisors and monitors. To avoid this encumbrance, they should
concentrate on collecting data that can be used immediately and only listing essential components for
which action can be taken.

• The pre-campaign readiness checklist can be used by supervisors or monitors who visit health
centres to ensure all the campaign components are in place.
• The intra-campaign monitoring checklist can be used by monitors who compile their observations
according to the findings on each team.
Supervisors should use a simpler checklist, giving them time to concentrate on corrective action (see the
section on supervision).

POST-CAMPAIGN RAPID CAMPAIGN MONITORING

The purpose of rapid campaign monitoring (RCM) is to find and vaccinate missed children.
• Monitors conduct RCM in selected communities (often those at high risk) during and immediately
after the teams have completed their work (the same day, or the next at the latest).
• Monitors should check 10 households door to door for the OPV status of children in the target age
group (e.g. aged 0–59 months) in those houses.
• A sample of 10 households is preferable to 10 children because a selection of different houses will
be more representative than a selection of many children in one house.
• Any community that fails RCM (two or more children out of 10 missed) should be revisited by a
vaccination team.

Method
• Monitors should get a sample that is as representative as possible by choosing as many different
areas as feasible in the time available (for example, 4ะ5 different streets, or 2–3 villages, or several
clusters of houses).
• Monitors should go door to door to verify that at least one child in each house received the OPV,
visiting approximately 10 households before moving on to the next area.
• Monitors much check each child aged 0–59 months (or another target age group) in each house and
record the OPV status.
• Finger-marking is used to confirm OPV status.

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30 POLIO ERADICATION
Checking finger-marking for immunization status
• Vaccinated children should be marked: √
• Unvaccinated children should be marked: X
• If a child has not been vaccinated, the name and location of that child is noted on the form. The
mother can be asked why the child is not vaccinated, which is also recorded on the RCM form.
• If a mother says her child was vaccinated, her response should be accepted and noted under the
reasons, even if no finger is marked.
• Monitors should inform supervisors by phone if many unvaccinated children are found in one
community, in order to organize an immediate mop-up campaign.
• The results should be totalled by age group: 0–11 months and 12ะ59 months.

Vaccinating missed children

• The monitor informs the team supervisor of missed children by mobile phone and provides the
detailed monitoring form, which can be presented at feedback meetings.
• The team supervisor puts together a vaccination team to visit to the community.
• The team revisits the community and vaccinates all missed children, including any children not yet
identified by the RCM team.

Figure 9. Simple form for rapid campaign monitoring (RCM)

Province/District Village/Community
External Supervisor Team Number

RCM OPV – 0–59 months

  0–11 months 12–59 months
If NO,
If NO,
Finger- Finger- Finger- Finger- write name,
Vaccinated mark mark mark mark write reason not
house and
OPV vaccinated
street number
YES √ NO X YES √ NO X
1    
2    
3    
4    
5    
6    
7    
8    
9    
10    

TOTAL    

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Figure 10. Form to report results of rapid campaign monitoring

Health Centre Name Monitoring Team Name/Number Date

Location of Vaccination Area # of Total # of

# of missed Supervisor
monitoring team # selected for households children
children notified
visit assigned monitoring monitored checked
Block 44 12 Omega 10 15 2 Yes, team
Heights will return
tomorrow
13 Rose 10 6 0
Garden

BEST PRACTICE IN RAPID CAMPAIGN MONITORING

• Monitoring teams should visit as many different areas as possible, including areas known for low
performance and high risk.
• The results should be discussed at the evening meeting.
• The more the information given to the supervisor is detailed, the easier it is to take action.
• Missed children should be identified by name and location so the team can return to vaccinate door
to door.

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32 POLIO ERADICATION
CONCLUSION
These best practices in microplanning for polio eradication are based on many years of success and
failure in interrupting poliovirus transmission in many diverse situations. The elements described, and
the recommended steps and forms, are all aimed at keeping the microplan as simple as possible and
relevant to the situation in the field. There is no ideal microplan; there are only examples. In fact, one of
the greatest achievements of polio microplanning has been its capacity to remain flexible and change
rapidly, even from one day to the next, when problems arise. For polio eradication, achieving 80–90% of
the goal is not an option – the only goal is 100%. Every child must be vaccinated, often through separate
doses administered in successive rounds. Children missed results in continued transmission, and a pocket
of local transmission, if not halted rapidly, can soon become an international outbreak.

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33 POLIO ERADICATION
 ANNEX 1
MICROPLAN RESOURCE ESTIMATE
Calculation of a population-based estimate for total supply, logistics, human resources, transport and cold-chain equipment requirements at the highest level (usually
the national level)

Figure A1.1. National resource and logistics microplan organized by provincial population

34
1. Name 2. Total 3. OPV 4. # 5 # of 6. # days 7. # if 8. # of 9. # 10. # of 11. 12. # of 13. Daily 14. Volume 15. Total 16. 17. # of 20 18. # of 19. # 20. Est. 21. # of 22. # 23. # sets 24. #
Province/ Population target households team days scheculed teams vaccinators support team Total # 20 does Transportation of OPV refrigerator Est. L cold box vaccine of ice # of immunizati Copies of of writing finger
State for year population vaccinated required* for required needed staff supervisors of staff OPV vials Need (1vehicle does space # of required required packs freezers on fixed recording/ materials marker
13.5% by one implemen (2 OPV ( 2 per (2 per (1 per 5 required required per supervisor required required in fridge (1 per (2 per (2 x 4 (1 per posts reporting (exercise pens
(0 TO 59 team per tation vaccinatiors team) team) teams) ( sum of = (target moto, or car) in Litres Litres (+2 to units supervisor) team) icepacks 100 ice (1 per 5 forms books and (team
MONTHS) day per team) 8+9+10) population = (target +8 C) (20 L for packs) teams) (team days pens) days
x wastage population per vaccine x 2) x 2)
factor x wastage fridge) carrier)
(1.20/20) factor x plus 20
volume per cold
of 1 does box
OPV)/1000
A 1,000,000 135,000 50 900 5 180 360 360 36 756 8,100 36 243 243 2. 4 36 360 3,600 36 36 1,800 1,800 1,800
B 1,500,000 202,500 50 1,350 5 270 540 540 54 1,134 12,150 54 365 365 3.6 54 540 5,400 54 54 2,700 2,700 2,700
C 2,200,000 297,000 50 1,980 5 396 792 792 79 1,663 17,820 79 535 535 5.3 79 792 7,920 79 79 3,960 3,960 3,960
D 2,000,000 270,000 50 1,800 5 360 720 720 72 1,512 16,200 72 486 486 4.9 72 720 7,200 72 72 3,600 3,600 3,600
E 2,500,000 337,500 50 2,250 5 450 900 900 90 1,890 20,250 90 608 608 6.1 90 900 9,000 90 90 4,500 4,500 4,500
F 3,200,000 432,000 50 2,880 5 576 1152 1152 115 2,419 25,920 115 778 778 7.8 115 1152 11,520 115 115 5,760 5,760 5,760
G 2,200,000 297,000 50 1,980 5 396 792 792 79 1,663 17,820 79 535 535 5.3 79 792 7,920 79 79 3,960 3,960 3,960
H 1,300,000 175,500 50 1,170 5 234 468 468 47 983 10,530 47 316 316 3.2 47 468 4,680 47 47 2,340 2,340 2,340
I 2,300,000 310,500 50 2,070 5 414 828 828 83 1,739 18,630 83 559 559 5.6 83 828 8,280 83 83 4,140 4,140 4,140
J 2,500,000 337,500 50 2,250 5 450 900 900 90 1,890 20,250 90 608 608 6.1 90 900 9,000 90 90 4,500 4,500 4,500
TOTAL 20,700,000 2,794,500       3,729 7452 7452 745 15,649 167,670 745 5030 5030 50.3 745 7452 74,520 745 745 37,260 37,260 37,260

*assuming and average of 3 children aged 0 t0 59 months per household

This spreadsheet is an example of a population-based national resource estimate for a country with a total population of 20 700 000 implementing a nationwide campaign to

BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION

immunize every child aged 0–59 months (estimated to be 13.5% of the total population) with OPV, regardless of prior immunization status. Each province is listed in this national
spreadsheet, and supplies and resources are estimated according to the provincial populations.
 BEST PRACTICE FOR ESTIMATING RESOURCES
The microplan must start with an estimate of total resources, made several months in advance so supplies can be ordered and delivered in time.
This spreadsheet is based on standards set by the country for supply, logistics, human resources, transport and cold-chain equipment. It is only an example and does not
represent any policy; all fields can be modified according to the standards set at the national level. In this spreadsheet, each vaccination team of two people plus two support
staff visit 50 households per day and vaccinate every eligible child in those households. This example assumes three children aged 0ะ59 months per household (an average
of 150 children per day). The spreadsheet can be used at the province and district levels as shown in the following tables.

Figure A1.2. Province resource and logistics microplan organized by district population
1. Name 2. Total 3. OPV target 4. # 5 # of 6. # days 7. # if teams 8. # of 9. # 10. # of 11. Total 12. # of 13. Daily 14. Volume 15. Total 16. Est. 17. # of 20 18. # of 19. # 20. Est. 21. # of 22. # 23. # sets 24. #
Province/ Population population children team scheculed required vaccinators support team # of staff 20 does Transportation of OPV refrigerator # of L cold box vaccine of ice # of immunizati Copies of of writing finger
State for year 13.5% (0 TO to be days for (2 OPV needed ( 2 staff (2 per supervisors required OPV vials Need does space fridge required required packs freezers on fixed recording/ materials marker

35
59 MONTHS) immunized required* implemen vaccinatiors per team) team) (1 per 5 ( sum of required (1vehicle per required required in units (1 per (2 per (2 x 4 (1 per posts reporting (exercise pens
by one team tation per team) teams) 8+9+10) = (target supervisor in Litres Litres (+2 to (20 L supervisor) team) icepacks 100 ice (1 per 5 forms books (team
per day population moto, or car) = (target +8 C) per for packs) teams) (team and days
x wastage population fridge) vaccine days x 2) pens) x 2)
factor x wastage carrier)
(1.20/20) factor x plus 20
volume per cold
of 1 does box
OPV)/1000
A 120,000 16,200 200 81 5 16 32 32 3 68 972 3 29 29 0.3 3 32 324 3 3 162 162 162
B 140,000 18,900 200 95 5 19 38 38 4 79 1,134 4 34 34 0.3 4 38 378 4 4 189 189 189
C 130,000 17,550 200 88 5 18 35 35 4 74 1,053 4 32 32 0.3 4 35 351 4 4 176 176 176
D 156,000 21,060 200 105 5 21 42 42 4 88 1,264 4 38 38 0.4 4 42 421 4 4 211 211 211
E 243,000 32,805 200 164 5 33 66 66 7 138 1,968 7 59 59 0.6 7 66 656 7 7 328 328 328
F 136,000 18,360 200 92 5 18 37 37 4 77 1,102 4 33 33 0.3 4 37 367 4 4 184 184 184
G 114,000 15,390 200 77 5 15 31 31 3 65 923 3 28 28 0.3 3 31 308 3 3 154 154 154
H 100,000 13,500 200 68 5 14 27 27 3 57 810 3 24 24 0.2 3 27 270 3 3 135 135 135
I 160,000 21,600 200 108 5 22 43 43 4 91 1,296 4 39 39 0.4 4 43 432 4 4 216 216 216
J 135,000 18,225 200 91 5 18 36 36 4 77 1,094 4 33 33 0.3 4 36 365 4 4 182 182 182
TOTAL 1,434,000 193,590       194 387 387 39 813 11,615 39 348 348 3.5 39 387 3,872 39 39 1,936 1,936 1,936

Figure A1.3. District resource and logistics microplan organized by health centre population
1. Name 2. Total 3. OPV target 4. # 5 # of 6. # days 7. # if teams 8. # of 9. # 10. # of 11. Total 12. # of 13. Daily 14. Volume 15. Total 16. Est. 17. # of 20 18. # of 19. # 20. Est. 21. # of 22. # 23. # sets 24. #
Province/ Population population children team scheculed required vaccinators support team # of staff 20 does Transportation of OPV refrigerator # of L cold box vaccine of ice # of immunizati Copies of of writing finger
State for year 13.5% (0 TO to be days for (2 OPV needed ( 2 staff (2 supervisors required OPV vials Need (1vehicle does space fridge required required packs freezers on fixed recording/ materials marker
59 MONTHS) immunized required implemen vaccinatiors per team) per team) (1 per 5 ( sum of required per supervisor required required in units (1 per (2 per (2 x 4 (1 per posts reporting (exercise pens
by one tation per team) teams) 8+9+10) = (target moto, or car) in Litres Litres (+2 to (20 L supervisor) team) icepacks 100 ice (1 per 5 forms books (team
team per population = (target +8 C) per for packs) teams) (team and days
day x wastage population fridge) vaccine days x 2) pens) x 2)
factor x wastage carrier)

BEST PRACTICES IN MICROPLANNING FOR POLIO ERADICATION

(1.20/20) factor x plus 20
volume per cold
of 1 does box
OPV)/1000
A 23,000 3,105 200 16 5 3 6 6 1 13 186 1 6 6 0.3 1 6 62 1 1 31 31 31
B 11,000 1,485 200 7 5 1 3 3 1 7 89 1 3 3 0.1 1 3 44 0 1 15 15 15
C 12,000 1,620 200 8 5 2 3 3 1 7 97 1 3 3 0.1 1 3 46 0 1 16 16 16
D 17,000 2,295 200 11 5 2 5 5 1 10 138 1 4 4 0.2 1 5 57 1 1 23 23 23
E 19,000 2,565 200 13 5 3 5 5 1 11 154 1 5 5 0.2 1 5 51 1 1 26 26 26
F 16,000 2,160 200 11 5 2 4 4 1 10 130 1 4 4 0.2 1 4 55 1 1 22 22 22
G 14,000 1,890 200 9 5 2 4 4 1 9 113 1 3 3 0.2 1 4 50 1 1 19 19 19
H 11,000 1,485 200 7 5 1 3 3 1 7 89 1 3 3 0.1 1 3 44 0 1 15 15 15
I 14,000 1,890 200 9 5 2 4 4 1 9 113 1 3 3 0.2 1 4 50 1 1 19 19 19
J 10,000 1,350 200 7 5 1 3 3 1 6 81 1 2 2 0.1 1 3 42 0 1 14 14 14
TOTAL 147,000 19,845       20 40 40 9 89 1,191 9 36 36 1.8 9 40 500 5 9 198 198 198
EXPLANATION OF THE FIELDS IN THE RESOURCE AND LOGISTICS MICROPLAN
These examples show a resource and logistics plan with 24 fields. Each field must comply with standards
initially set at the national level. The advantage of this spreadsheet is that it shows the total resources
needed such that, when prepared in advance, it allows organizing total needs in a timely manner and
ordering the required resources.

1. Name of the province/state for implementation

2. Total population in the year of implementation
3. Target population (0–59 months = 13.5% of the total population)
4. Number of households to be visited for immunization by one team in one day (= 50 households).
The assumption of three children aged 0–59 months per household represents an average of 150
children per day. (This field can be standardized in various ways, for example 100 or 200 children
per day.)
5. Number of team days required (the target population is divided by the number of children to be
immunized in one day, in this case, 50 households x 3 = 150 children per day)
6. Number of days scheduled to implement the plan (in this example, five days)
7. Number of teams required for implementation (the number of team days is divided by the number
of days scheduled)
8. Number of vaccinators required (in this example, 2 vaccinators per team)
9. Number of support staff required (in this example, 2 support staff per team to help manage the
team’s work)
10. Number of team supervisors required (in this example, 1 supervisor per 5 teams)
11. Total number of staff needed (total vaccinators + support staff + supervisors)
12. Number of 20-dose vials of OPV required (target population x wastage multiplication factor for
vaccine divided by 20)
13. Daily transportation required; total number of various vehicles needed for supervisor transport (1
per supervisor)
14. Volume of OPV doses expressed in litres (target population x wastage factor x volume of 1 dose in
ml divided by 1000)
15. Total refrigerator space at 2ะ8 °C required in litres (same as the volume of OPV doses)
16. Estimated number of 100-litre refrigerator units required (refrigerator space divided by 100)
17. Number of 20-litre cold boxes required (1 per supervisor)
18. Number of vaccine carriers required (2 per team)
19. Number of ice packs required (4 ice packs per vaccine carrier x 2 per team = 8 per team + 20 ice
packs for each supervisor cold box)
20. Estimated number of freezers required to freeze ice packs each day (1 freezer per 100 ice packs)
21. Number of immunization fixed posts required (1 fixed post per 5 teams) where a fixed post can
immunize and be used to replenish team supplies
22. Number of copies of recording and reporting forms (2 sets of forms per team day)
23. Number of sets of writing materials for teams (exercise books and pens for each team day)
24. Number of finger-marking pens (2 finger-marking pens per team day)

BEST PRACTICES IN MICROPLANNING FOR

36 POLIO ERADICATION
 NOTES ON BEST PRACTICE FOR ESTIMATING RESOURCES
When planning a campaign, it is best to estimate the total resources needed in a timely manner. Time will be needed to gather the resources: vaccine must
often be ordered from overseas, vehicles distributed, personnel trained and supervisors assigned. The extent of all these resources needs to be known well
in advance at every level. Early planning estimates are also essential because a shortage of resources is more likely at the district level. Accurate resource
estimates are calculated from population estimates, but the latter may vary according to the information source. Planning estimates should be made from
the bottom-up, using the same framework despite varying population totals. It is always better to slightly overestimate the population to ensure sufficient
vaccines and other resources are available.

Figures A1.4. District and health centre estimates of population distribution and human resources

37
District __________________

Border
Community
Target High-risk points Transit Supervisor
Health Total Villages Fixed Teams Vaccinators Volunteers Vehicles mobilizer
population areas if points name and
centre population (#) posts (#) (#) (#) (#) name and
(#) (#) applicable # phone #
phone #
(#)
HC 1                        

POLIO ERADICATION
HC 2                        
HC 3                        
HC 4                        
HC 5                        
Total                        

BEST PRACTICES IN MICROPLANNING FOR

 Health Centre _________________

Border Community
Target High-risk Transit
Health Total Fixed village Teams Vaccinators Volunteers mobilizer Supervisor name
population village points
centre population posts # (#) (#) name and and phone #
(#) Y/N Y/N #
phone #
Village 1                
Village 2                
Village 3                

38
Village 4                
Village 5                
Total                

NOTES ON BEST PRACTICE

At the district and health centre levels, when dealing with smaller populations and scarcer resources, big spreadsheets are a starting point but are inadequate
to deal with the realities in the field. At this level, it is better to create simple, more detailed resource plans that will enable health centres to share and move

POLIO ERADICATION
resources, and identify those people who will share supervisory duties and will be available to work at the community level.

BEST PRACTICES IN MICROPLANNING FOR

 ANNEX 2
COLD CHAIN AND SUPPLIES

Figure A2.1. Cold-chain equipment availability and deployment

Province-level cold-chain and logistics plan organized by district (working example)

Ice Storage capacity (Lt) Number of Freezers

39
Vaccine Carriers Cold Box
packs in Refrigerator Required for Ice Packs

District Target Teams OPV

Shortfall
Shortfall
Shortfall
Shortfall

Required
Required
Required
Required
Required

Available
Available
Available
Available

(Names) Population (#) VIALS

1 16 200 16 972 32 25 7 3 2 1 324 29 100 0 3 2 1

2 32 805 33 1968 66 70 0 7 8 0 656 59 100 0 7 5 2

POLIO ERADICATION
3                                
4                                

5                                

6                                

BEST PRACTICES IN MICROPLANNING FOR

7                                

8                                

9                                

10                                
TOTAL                                
 NOTES ON BEST PRACTICE
Every province should estimate its cold-chain equipment situation early on. During a campaign, the demand for refrigerators, cold boxes to carry vaccine
and freezer space is high. All districts should manage their cold-chain resources accordingly and well in advance. This example shows that a district may
have a shortfall in cold-chain equipment but can receive assistance through the deployment of equipment from the province level or a neighbouring district.
If district centres are not far from each other, pooling freezer capacity for ice packs may be possible at a shared location.

Figure A2.2. Vaccine and supply transport plan (working example)

# of
20-dose Name of
OPV target Refrigerator/
OPV vials # of 20 L province Name of
population freezer/cold box/ Location of ice
Name Total required cold boxes Vaccine Date of person district person
13.5% vaccine carrier pack freezer (in

40
of population = (target required transport distribution responsible responsible for
shortfall needing this district or a
district for year (0–59 population (1 per vehicle to district for transport transport and
transport or shared location)
months) x wastage supervisor) and phone phone number
relocation
factor number
(1.2)/20)
1 cold box from Located in district
Province
1 120 000 16 200 972 3 22 Jan   province to 1
truck
district 1
2 140 000 18 900 1 134 4        

POLIO ERADICATION
3 130 000 17 550 1 053 4        
4 156 000 21 060 1 264 4        
5 243 000 32 805 1 968 7        
6 136 000 18 360 1 102 4        
7 114 000 15 390 923 3        

BEST PRACTICES IN MICROPLANNING FOR

8 100 000 13 500 810 3        
9 160 000 21 600 1 296 4        
10 135 000 18 225 1 094 4        
Total 1 434 000 193 590 11 615 40        

NOTES ON BEST PRACTICE

Vaccine should be distributed from the province to the district no later than one month from the start of the campaign. Equipment can also be transported
in advance in case of a shortfall. The province and district should regularly update their lists of equipment according to local transport information and the
cold-chain equipment plan.
ANNEX 3
CHECKLISTS

Figure A3.1. Team logistics checklist

DATE TEAM LOGISTICS CHECKLIST  

District or HC     Province    
VACCINATION TEAMA
Staff & Supplies & Transport needs
Team #:1 Team #:2 Team #:3 Team #:4 Team #:5

Assignment area          

Vaccinator names          

Volunteer names          

Supervisor Names          

Target Pop estimated (#)          

OPV needs (does)          

Finger markers (#)          

House Mark Chalk (#)          

Vaccine carrier (#)          

Cold box (#)          

Ice packs (#)          

Tallysheet (#)          

Summary sheet (daily)          

Supervisory check list #          

Vehicle          

Motorbike          

Other (specify): ………..(#)          

Fuel (Lt)          

           

Supervisory role for team logistics

• Every team must be checked each day at the health centre to make sure they are prepared and all
logistics are in place to proceed on their assigned itinerary for the day.
• Supervisors at the health centre can use this checklist at the beginning of the day to ensure all
supplies and personnel are available.

BEST PRACTICES IN MICROPLANNING FOR

41 POLIO ERADICATION
Figure A3.2. Supervisory checklist for pre-implementation

At the health centre: check each item for campaign readiness Comments
Microplan
All villages are included in the district plan
All items are included according to the template, with correct calculations
Any supply shortfall has been identified, with the action needed
Maps show catchment areas and location of posts/teams/supervisors per day
Budget has been accurately calculated
High-risk areas/RCMs
High-risk areas have been identified
Rapid campaign monitoring plan is available with supervisors/monitors/sites/dates
Supervisors understand RCM methods
Cold-chain logistics supply
Adequate vaccine storage space for OPV is available in regional and provincial stores
Adequate vaccine carriers/ice packs/freezer capacity is available at each level
Logistics/supply transport plan is available to supply all areas
Standard operating procedures (SOPs) are in place for replenishment in health
centres if stocks run low
Advocacy
Local politicians have been informed and are ready to participate/contribute
Local NGO meetings are held to enlist their support for monitoring and for the
transport of supervisors/teams
Social mobilization
Each region/province has a local media plan to promote/advertise SIA
Any other local social mobilization materials are available
A plan for community volunteer training is available
A plan for involving community officials and volunteers is available
A plan for identifying community engagement focal points is available
Immunization safety
All supervisors know how to report adverse events following immunization (AEFI)
AEFI Investigation forms and SOPs are available to supervisors
Team management
A plan for team training is available with simple training materials/tally sheets
A team strategy, with fixed post in the morning and mobile post in the afternoon,
is in place
Teams are available for mop-up if RCM fails
A team/post distribution plan is available
Supervisor management
The plan shows available supervisors or a shortfall
A plan for training supervisors, including RCM training, is available

BEST PRACTICES IN MICROPLANNING FOR

42 POLIO ERADICATION
At the health centre: check each item for campaign readiness Comments
A supervisor mobility/transport plan is available to follow an assigned area
Supervisors have checklists
External supervisors have a system for calling teams to do mop-ups when RCM fails
Reporting system
A system for the daily collection and consolidation of tally sheets into reports is
available
A computerized database for the consolidation of reports and their dispatch by
email to provincial/regional/national offices is accessible
Monitoring system
Region/provinces have a system for the daily monitoring of results
The health centre has a system to react daily to a failed RCM by ordering an
immediate mop-up
A system exists at the national level to receive and react to regional reports on at
least a weekly basis

Figure A3.3. Simple supervisory intra-campaign checklist

Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action

Cold-chain/vaccine supplies

Marker pens/tally sheets

Post organization, staffing, working hours

Recording on tally sheets/missed children

Team movement plan and map

Team operating hours

Finger-marking quality

House-marking quality

High-risk communities

Presence of community leaders and volunteers

Availability of community engagement persons

if needed

BEST PRACTICES IN MICROPLANNING FOR

43 POLIO ERADICATION
 Simple supervisory intra-campaign checklist Note team numbers for comments and corrective action

Revisiting houses with missed children

End of day or next day

Vaccinating children out of the household, in

streets and markets

BEST PRACTICE IN SUPERVISION DURING CAMPAIGNS

The main duty of the supervisor during a campaign is to take corrective action during team operations.
This very short checklist is used as a reminder of what to look for; it is not a monitoring form that requires analysis.
Supervisors should plan to visit each team at least twice during the day. They should observe team
operations and take corrective action, which they record on the simple checklist.

BEST PRACTICES IN MICROPLANNING FOR

44 POLIO ERADICATION
 Figure A3.4. Intra-campaign monitoring checklist

Intra-campaign monitoring checklist question Yes/No Comments

Team 1 Team 2 Team 3 Team 4 Team 5
Community engagement
Is the post clearly identified by banners and posters?
Are health workers/volunteers actively searching for every eligible child, at house or out of house?
Cold chain/supplies
Are vaccines stored in vaccine carriers with two ice packs?

45
Are sufficient vials of OPV inside the vaccine carrier?
Are there any stock-outs of OPV?
Are sufficient marker pens available?
Are sufficient tally sheets/recording forms available?
Organization of the post
Is the post well organized, with good client flow?
Are sufficient vaccinators and volunteers available? Does the post have enough people?

POLIO ERADICATION
Recording and reporting practices
Are tally sheets being used correctly?
Is every child being finger-marked?
Are missed children listed on the back of the tally sheet for a house revisit?
House-to-house operation

BEST PRACTICES IN MICROPLANNING FOR

Does the team have a plan and map?
Is the team going house to house according to plan?
Are houses being marked correctly?
Are teams asking for all mothers and all children?
Are teams working morning and afternoon according to plan?
High-risk communities
Are teams visiting high-risk communities?
Are community leaders and volunteers involved in house-to-house operations?
Are local leaders engaging the community appropriately?
House revisiting
Are teams revisiting houses at the end of the day where children were previously absent?
 ANNEX 4
TALLY SHEET

Figure A4.1. Daily tally sheet of vaccinated children for teams

Region ___________ Province/City ___________ District ___________ Village/Location ___________ Date ___________ Team Number: ____
Number of households to be visited for OPV_____ Total vaccinated ___________ Start house number ____ End house number ____
Instructions: Put a check mark (√) in each box appropriate for the child’s age.

46
NUMBER OF CHILDREN IMMUNIZED WITH OPV
0–11 months 12–59 months

POLIO ERADICATION
BEST PRACTICES IN MICROPLANNING FOR
Total number __________ Total number __________ Grand total __________
OPV vials received ………. OPV vials used ………… AFP cases found………..
A LIST OF HOUSES TO BE REVISITED IS ON THE BACK OF THIS FORM Signature of supervisor and time of visit
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