Table 1.

Framework approach for in-depth interviews with mid-level managers.

Components	Key points
Service delivery	Coverage rate Drop-out rate Existence of a national plan for immunization
Vaccine supply, quality, and logistics	Availability and continuity of services Existence of guidelines on vaccine management, transport management, cold chain, and waste disposal and destruction Cold-chain equipment operating and in good repair Completion and display of cold-chain monitoring charts Existence of inventory of immunization equipment that includes date-of-purchase, functional status, maintenance schedule, and evidence that equipment that has been maintained. Availability and sustainable access to other immunization equipment Vaccine forecasting, vaccine utilization, and wastage monitoring Quality of vaccines, including fully functional National Regulatory Authority or other independent assessment of quality performed, manufacturer viable or vaccines procured from prequalified Implementation of a multi-dose vial policy Completion of a standardized immunization injection safety survey Existence and implementation of policy, plan, and budget on injection safety assessment Type of injection equipment in use Method of injection equipment disposal
Surveillance and monitoring	Completeness and timeliness of routine reporting Completion and display of coverage/drop-out monitoring charts Vaccine-preventable disease (VPD) incidence rate Proportion of cases confirmed by laboratory Mortality rate and case fatality rate System for detecting, investigating, and reporting adverse events following immunization (AEFI) Notified and investigated AEFI Case/outbreak investigation initiated within 48 h of notification Percentage of reported VPD cases with information on age and vaccination status Feedback of data to sub-national levels Supervisory checklists complete Development of monitoring indicators Staff monitor status and stock of supplies, equipment, and consumables
Advocacy and communication	Availability of social mobilization, advocacy, or overall communication plan Availability of specific strategy for hard-to-reach population in immunization policy Existence of clinician advocacy and community mobilization Existence of active community health committees Planning meetings conducted with communities Community mobilizers involved in immunization sessions and outreach Engagement of sectors other than the MoH (e.g., Information, Education, Finance, Development, and Planning) Commitment of a broad range of high-level decision makers (demonstrated by active support and public promotion) Budget for activities, staffing, and materials Availability of adequate and appropriate information, education, and communication (ICE) materials
Program management	Government funding of vaccines for routine immunization and program-recurrent costs for supplies and operations Multiple-year commitment to financing Proportion of planed supportive supervision visits conducted Adequacy of personnel to carry out tasks Adequacy of personnel training Reports on implementation of the plans Assessment of services conducted