Joseph F. Naimoli, ScD, Health Nutrition and Population, World Bank Group, 1818 H Street, Room G7-041 MS G7-701, Washington DC, DC 20433, 202-458-2539, jnaimoli@worldbank.org and Shilpa Challa, Health Nutrition and Population, George Washington University, School of Public Health, Apt 607 1010 25th Street, Washington, DC 20037.

The Africa Region of the World Bank recently concluded the first phase of a comprehensive performance benchmarking exercise, which is intended to stimulate strategic thinking on immunization, optimize investment plans, and enhance collaboration with partners in the region. DTP3 coverage is often used as a trigger for measuring social sector progress in many Poverty Reduction Strategy Papers (PRSP), and is an excellent proxy measure of the quality of basic health services. We evaluated the effectiveness of immunization services in 43 African countries over time (1997-2002) using WHO/UNICEF Best Estimates and a matrix to classify countries’ performance along two dimensions: program stability and directionality. Africa is characterized by substantial variation in performance. The analysis classified approximately 1/3 (14/43) of countries as strong performers, 1/3 (15/43) as weak performers, and 1/3 (14/43) as “mixed” performers. Among the strong performers, only a few are outstanding; among the weak, where there is some progress, it is modest; and, among the mixed, some historically weak performers are making moderate to substantial progress, while some historically strong performers appear to be losing ground. Although there are some limitations with both the data and the classification process, the findings suggest that recent efforts in Africa to revitalize immunization programs are necessary but not sufficient. The performance matrix has proven to be a useful tool for raising awareness within the Bank. Phase II of the exercise is now underway, which seeks to understand the reasons for this variation. The results will be used to help struggling countries improve their programs.

Learning Objectives:

• 1. Classify African countries according to three categories of immunization performance as defined by DTP3 coverage over time
• 2. Describe how performance benchmarking can be applied to improve public health decision making

Keywords: Immunizations, Performance Measurement

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment as Senior Health Specialist