Annual operational plan for immunization services

Annual operational plan for

immunization services

Guidelines for development or optimization

Finalized version August 2021

Eric Laurent (laurent.emj@gmail.com)

Ulla Griffiths (ugriffiths@unicef.org)

AOP guidelines - Finalized version August 2021

Table of content

I. Rationale for new annual operational plan guidance .................................................. 3

II. Definitions and concepts ............................................................................................... 4

Objectives, strategies, activities definitions ................................................................... 4

Operational planning definition .................................................................................... 4

Operational planning environment ................................................................................ 4

III. Principles for operational planning ........................................................................... 5

Which kind of planning “instrument” do countries need? ............................................. 5

Best practices ............................................................................................................... 5

IV. Structure of a standard AOP ..................................................................................... 6

Headings and contents .................................................................................................. 6

Software or template .................................................................................................... 6

Rolling AOP ................................................................................................................... 7

Best practices ................................................................................................................ 8

V. Planning cycle and process – actors, alignment and timetable .................................... 8

Planning cycle................................................................................................................ 8

Planning process ........................................................................................................... 8

Actors involved .............................................................................................................. 9

Alignment of plans ........................................................................................................ 9

Best practices .............................................................................................................. 10

VI. Costing and budgeting process ............................................................................... 10

Resource requirement ................................................................................................. 10

Budgeting .................................................................................................................... 11

Financing ..................................................................................................................... 11

Best practices .............................................................................................................. 11

VII. Monitoring and evaluation ..................................................................................... 12

Activities monitoring ................................................................................................... 12

Best practices .............................................................................................................. 12

Annexes .............................................................................................................................. 13

Acronyms .................................................................................................................... 13

Reference documents ................................................................................................. 14

The “Guidelines for development or optimization of annual operational plan for immunization services”

comprise the following materials:

- A planning narrative (this document)

- A planning template (an Excel template, but could be Access-based, Google Sheet, DHIS2)

AOP guidelines - Finalized version August 2021

I. Rationale for new annual operational plan guidance

- Global partners highlighted the needs for upgrading guidelines and tools for

immunization strategic and operational planning in several reports: Rapid

stocktaking and support to revising the cMYP (Mott MacDonald 2017); Strategic and

operational planning, a review of best practices (UNICEF 2018); Landscape analysis in

30 Gavi eligible countries (UNICEF 2019); Immunization Agenda 2030 (WHO 2020)

- Assessments and reports demonstrated the current fragmentation in operational

planning, with a multiplicity of plans developed in recent years, as shown in figure 1.

Immunization services are sometimes “lost in planning”

- There is no effective alignment between immunization AOP and National Health Plan

(NHP) and a lack of integration of immunization planning within MCH and PHC

services planning

- Immunization AOP budget and national health budget cycle are often not linked nor

interconnected

- The current multiplicity and diversity of plan formats make it impossible to recover

simple information (what, how, who, when, at what cost)

- There are multiple reasons for all above listed problems, but the main one is the lack

of standard AOP process and format for “driving” all immunization operational

planning, budgeting, implementation, monitoring, making it the “reference

operational plan” for all stakeholders, including partners

Figure 1: Example of fragmented planning for immunization

HSS plan

Data quality

implementation plan

TCA plan

Transition plan

CCEOP plan

EVM implementation

plan

VPD surveillance

plan

Communication plan

NIS / cMYP

New vaccine

introduction plan

Sub-national

plans

MR elimination

plan

Polio eradication

plan

COVID vaccine

roll-out plan

Annual operational

plan

AOP guidelines - Finalized version August 2021

II. Definitions and concepts

Objectives, strategies, activities definitions

To make sure strategic and operational planning are properly positioned, we need to

recall some key definitions:

- Objective is defined as “where to go”, as “what to achieve”

- Strategy is defined as “how to go, to achieve, to reach objective”, as a “series of

broad lines of action intended to achieve program goal and target”

- Activity is defined as “what to concretely do to achieve objective”, as a “series of

detailed actions to enable the strategy”

- The range of activities could be broad. Often, we find that operational plans use

“group/set of activities”, “core/key activities”, “activities”, “tasks”, “sub-tasks”. All

should be referring to concrete and detailed activity

Operational planning definition

- Operational planning is the link between the objectives and strategies of the national

strategic plan and the implementation of the program. It is about transforming the

strategic plan into actionable tasks. Operational planning will identify the activities to

be carried out to achieve the objectives of the strategic plan

- An operational plan should specify “what” needs to be done, by “whom”, at “which

cost” and “when”

- Operational planning is managerial and short term, as opposed to strategic planning,

and deals with month-by-month or quarter-by-quarter activities, and often has a

one-year time horizon (annual operational plan)

Operational planning environment

Figure 2: Example of a national planning environment

https://www.who.int/healthsystems/hss_glossary/en/

Strategizing national health in the 21st century: A handbook, WHO 2016

Immunization annual

operational plan (AOP)

MCH action plan

Family health action plan

National health action planHealth sector strategy

MCH strategy

Family health strategy

National immunization

strategy (NIS)

AOP guidelines - Finalized version August 2021

- Annual operational plan (AOP) environment:

ð Not a stand-alone document

ð Part of a planning “environment”: NHP, MCH, program plans, etc.

ð AOP connected and aligned with strategic plan

III. Principles for operational planning

Which kind of planning “instrument” do countries need?

- An instrument which is:

ð “Essential” for planning, budgeting, implementing, coordinating and monitoring

activities

ð “Central” to the immunization program and wider MCH program

ð “Active and lively” working instrument, not to “put on the shelves”

- An instrument which is in line with the national authority planning cycle, as well as

subnational operational plans developed at intermediate health levels

- An instrument which is consistent with operational plans of other communicable

disease, family, maternal and child health programs

- An instrument whose format is:

ð Simple, easy to use, saving program officers precious time

ð Structured, providing essential information, not a “shopping list”

ð Compatible, aligned and integrated with other plans

- An instrument which is developed, owned and managed by a core planning team,

e.g. MCH/NIP manager and technical staff at national and subnational levels

- An instrument which will require commitment and accountability from:

ð MCH/NIP manager and staff at national and subnational levels

ð All stakeholders involved in immunization, including development partners

Best practices

Ensure the AOP is a “central” planning instrument that all stakeholders refer too

Ensure the AOP is an “action-oriented” instrument, transforming the strategic plan into

annual activities to be carried out to achieve the objectives

Ensure the AOP is developed, owned and managed by the core planning team, at national

and subnational levels

Ensure the AOP is simple, easy to use, structured, compatible, aligned and integrated with

other plans

Planning success = Ownership + Team work + Accountability + Prioritization + Simplicity

National strategic and operational planning for immunization - A review of best practices for optimized

planning, UNICEF 2019

AOP guidelines - Finalized version August 2021

IV. Structure of a standard AOP

Headings and contents

- An annual operational plan typically includes the following headings:

ð What: Description of activities for each objective of the strategic plan

ð Who: Person(s) and/or institution(s) responsible for the activities

ð What cost: Resources required and origins of resources

ð When: Timing and sequencing of all activities

ð How: A method of measuring progress (monitoring)

- Additional important information could be included in the headings:

ð Priority levels (colour coded, e.g. red for high, yellow for medium, green for low)

ð Information and link to other plans (plans reference code)

- Standard immunization program components could be used as AOP categories

1. Program management and financing

2. Human resources management

3. Vaccine supply, quality and logistics

4. Service delivery, including new vaccine introduction

5. Immunization coverage, including AEFI monitoring

6. Disease surveillance, control and outbreak response

7. Advocacy, communication and demand generation

- Level of details of the AOP needs to be defined (set of activities, activities, tasks)

considering usage. Individual workplans could be derived from the AOP

Software or template

- In case of an existing AOP software or template already in use in the country, it

should be assessed whether it is a comprehensive AOP for immunization (it may also

be an MCH AOP or an overall MoH/Health AOP, where immunization is integrated),

and if there is a need for issuing any immunization AOP or not

- AOP could be an Excel-based or an Access-based instrument. It could also be set-up

online, like Google Sheets or DHIS2

- An AOP must be a “manageable” instrument:

ð Not a huge Excel workbook with dozens of complex worksheets

ð Should be easily printable in an A3 format for sharing/posting on NIP office walls

ð Activities should be simply described or summarized to avoid Excel cells to

become “large and unreadable”

A guide for conducting an Expanded Program on Immunization (EPI) Review, WHO 2017

AOP guidelines - Finalized version August 2021

Figure 3: Example of AOP Excel template (provided as an annex to these guidelines)

Rolling AOP

- In addition to the standard AOP, there could be a shorter description of activities that

are expected to be implemented in the period of 1-2 years beyond the AOP period

- The reason for capturing these additional activities in a “rolling AOP” is to increase the

visibility of upcoming activities and improve the planning of activities that require

sequencing of implementation over a multi-year period (e.g. vaccine introduction)

- Rolling AOP should only capture prioritised activities, both routine and non-routine,

including HSS, CCEOP, SIAs, etc. Activities that are considered low priority should not

be included in the rolling AOP

Figure 4: Example of a rolling AOP

AOP guidelines - Finalized version August 2021

Best practices

Ensure that the AOP answers the questions: Which activities? Linked to which objectives

and strategies? Who will be responsible? How much will it cost? When to be implemented?

How to monitor the activities?

Ensure AOP will be an “easy manageable” instrument, Excel, Access, Google Sheets, DHIS2

Consider the possibility to extend the AOP to a 2-3 years rolling AOP

V. Planning cycle and process – actors, alignment and timetable

Planning cycle

- The existing planning system, process and procedures in place in the country should

be considered in order to optimize the immunization operational planning process

- Submissions and deadlines are important to be respected by all stakeholders when

developing an AOP. That annual exercise remains a “priority” for any program

- A typical planning cycle, from early start of planning to budget approval and

execution of programs AOP, covers a period of 12-15 months. Therefore, it will be

important that all submissions and deadlines be respected by the programs, as well

as donors to align with a country’s planning and budgeting cycle

Figure 5: Example of a planning and budgeting cycle in Lao PDR

Acronyms: HSDP: Health Sector Development Plan; RMNCAH: Reproductive Maternal Neonatal Child

Adolescent Health; DHHP: Department of Hygiene and Health Promotion; DPC: Department of Planning and

Cooperation; DOF: Department of Finance; MPI: Ministry of Planning and Investment

Planning process

- The AOP process could be completed, consolidated and agreed through a workshop,

however much preparation will have to take place before

January

February

March

April

May

June

July

August

September

October December

National

Assembly

Sub-national & national

NIP/MCH AOP drafting

HSDP

RMNCAH

cMYP/NIS

DHIS-2 data

Reviews &

assessments

NIP/MCH AOP

submission

DHHP

review

DPC

consolidation

DOF

Budget

MOF

Budget

Programs

AOP

revision

Submission

to DPC

Submission

to MPI

National Assembly to

approve requested budget

Programs to review AOP

based on approved budget

Budget

approval

NovemberSeptember

October December

November

Available

information

for planning

AOP guidelines - Finalized version August 2021

- The operational planning process needs to be streamlined, limited in time and

presented in a concise format. The process, including filling in the template, should

not go beyond a few weeks. The final AOP document should be limited to the Excel

instrument (or any other format), and there is no need for any Word narrative

- All existing plans, action plans, workplans specific to immunization and development

partners-driven (e.g. HSS, CCEOP, EVMIP, DQIP, NVI, TCA) should ultimately come

“under” the immunization AOP, and be considered as “annexes”

- Operational planning needs to consider the following issues:

ð Operational planning is still needed even if there is no strategic plan

ð Commitment and rigorousness are important when developing an AOP

ð Operational planning could be a bottom-up or/and top-down process

ð Consider developing sub-national AOPs for decentralized country

Actors involved

- An operational plan is best done by those who are responsible for the plan. Ideally,

all of those who are responsible for related activities in the health sector will be

involved in operational planning, either directly or through having their interests

represented by someone involved in the formal planning process

- Operational planning involves many stakeholders, and thus negotiating between

various government departments, programs, donors, and non-state actors is

important. Key stakeholders are national and sub-national health authorities and

health service providers

- The actors developing the operational plan should be organized under a “core

planning team” and should function together when drafting the AOP. Any division of

stakeholders, such as component by component, will bring the risk of a fragmented

AOP. Ultimately, people responsible for a specific component can prepare the work

upstream, but consolidation should be done together

- Leadership, management and coordination (LMC) for AOP development is essential.

Whatever the core planning team configuration, there should a “captain in the ship”

Alignment of plans

• Alignment with the national immunization strategic plan (NIS)

- The annual operational plan should follow and come from the national immunization

strategy (NIS), as it will operationalize the strategies. It is essential that all activities

of the operational plan are aligned with strategies of the NIS

• Alignment with the MCH and/or NHP operational plan

- The immunization annual operational plan should be aligned as much as possible

with the MCH operational plan and/or the overall MoH/health operational plan

• Alignment with subnational operational plans

- AOPs are often developed at the national level, but when required (e.g. decentralized

health system), subnational AOPs will be developed too. The harmonization of the

national AOP with subnational AOPs will be important as some functions still remain

at the national level (e.g. vaccine supply)

AOP guidelines - Finalized version August 2021

- At the lower levels of the health system, i.e. health facilities, microplans are a kind of

operational plan. At this level too, alignment should be respected, i.e. between

subnational AOPs and microplans

• Alignment with the immunization subsets of plans

- The annual operational plan and the immunization subsets of plans (Covid vaccine

roll-out plan, HSS, Polio & MR plans, CCEOP, EVM plan, NVI plan, etc.) should be

harmonized. Ideally all immunization subsets of plans should ultimately come

“under” the immunization AOP

Figure 6: Example of planning alignment

Best practices

Ensure all stakeholders are fully committed when developing the AOP and dedicate the

required time necessary to the exercise

Ensure AOP involves all those who will be responsible for implementation, organized in a

“core planning team” and coordinated by a leader

Ensure the AOP process be streamlined, limited in time and the AOP presented in a

concise format (Excel, Access, Google Sheet, DHIS2)

Ensure the activities of the AOP are aligned with the objectives and strategies of the

immunization strategic plan (NIS)

Ensure strong alignment of all activities between the national operational plan and the

subnational operational plans

VI. Costing and budgeting process

Resource requirement

- An AOP is an instrument to support implementation of activities and hence it is

critical for it to include the resources requirement for the activities

National Health Plan 2021-2030

National Immunization

Strategy 2021-2025

Immunization Annual

Operational Plan

Sub-National Plans

HSS plan

Data quality

plan

TCA plan

CCEOP plan EVM plan

Surveillance

VPD plan

Communica-

tion plan

New vaccine

intro. plan

Covid vaccine

roll-out plan

Polio & MR

plans

AOP guidelines - Finalized version August 2021

- However, detailed calculation of the resource requirements (e.g. unit costs, number

of staffs, of items, of days, etc.) should not be in the AOP final worksheet, but in a

separate calculation spreadsheet

- AOP budgeting process requires reasonable estimation of the cost of activities,

avoiding on one side too rough estimations, and on the other side spending days to

get accurate amounts

- "Shared costs" associated with activities at the PHC level should be estimated by

those responsible to deliver PHC and supposedly not NIP. Nonetheless, NIP may

provide support to those responsible to deliver PHC to undertake this costing

- The NIS new guidelines will have a costing, budgeting and financing instrument,

called “NIS.COST”. Wherever possible, the use of that instrument could help the AOP

resources requirement estimations

Budgeting

- As previously shown in the planning graph, the national planning and budgeting

cycle should be considered. The AOP development cycle, including budgeting, needs

to align with the broader MoH planning and budgeting

- In this regard, the AOP budget information should be fed upwards and should be

aligned with the broader budget envelope provided to the immunization program

- Ideally, the sector budget ceiling as well as the exact allocations to the budget

centers should be clear before developing an AOP. If the public budget negotiation

process is still not completely concluded at the time of operational planning, the

approximate sector budget allocation as well as the national strategic plan

disaggregated costing can be used as an approximate ceiling within which to plan

Financing

- The AOP should describe a realistic picture on how the program is financed.

Therefore, in the AOP headings, it will be important to inform the source of funding

- Beyond MoH financing, funds provided by development partners should also be

listed in the AOP

- The AOP is mainly used as a planning and managing instrument and not so much as

an accountability or grant management tool

Best practices

Ensure the AOP instrument contains a reasonable estimation of the cost of the activities

Ensure a strong alignment between the AOP and the broader MoH planning and

budgeting process, including the budget envelope provided to the NIP

Ensure the AOP describes how activities are financed, including funds from MoH, but also

development partners

AOP guidelines - Finalized version August 2021

VII. Monitoring and evaluation

Activities monitoring

- An AOP is an instrument to manage implementation of activities and hence it is

critical to include monitoring the status of activity implementation (done, not done,

in progress, percentage of achievements)

- There will be a monitoring and evaluation (M&E) framework attached to the NIS,

including, impact, outcome, output indicators, providing key information for the

performance of the program. Therefore, there is no need for another M&E

framework for the AOP. Monitoring the status of AOP activity implementation will

be sufficient

Best practices

Ensure the AOP contain a column with the status of implementation of each activity

(done, not done, in progress) and an overall estimate of percentage of activities completed

AOP guidelines - Finalized version August 2021

Annexes

Acronyms

AEFI Adverse Events Following Immunization

AFP Acute Flaccid Paralysis

AFR Acute Fever & Rash

AOP Annual Operational Plan

BCG Bacillus Calmette Guerin (TB vaccine)

bOPV Bivalent Oral Polio Vaccine

US CDC US Centres for Disease Control & Prevention

cMYP Comprehensive Multi-Year Plan

CRS Congenital Rubella Syndrome

cVDPV Circulating Vaccine Derived Poliovirus

DHIS District Health Information System

DHO District Health Office

DQA Data Quality Assessment

DQIP Data Quality Improvement Plan

DT/Td Diphtheria-Tetanus Vaccine

eIR Electronic Immunization Registry

EPI Expanded Program on Immunization

EVM Effective Vaccine Management

EVMIP Effective Vaccine Management Improvement

Plan

FETP Field Epidemiologist Training Program

Gavi Gavi, The Vaccine Alliance

GDP Gross Domestic Product

GPEI Global Polio Eradication Initiative

HepB Hepatitis B Vaccine

HIV Human Immunodeficiency Virus

HPV Human Papillomavirus Vaccine

HSS Health System Strengthening

HCW Health Care Worker

ICC Inter-agency Coordination Committee

IEC Information Education Communication

IIP Immunization in Practice

IPV Inactivated Polio Vaccine

JE Japanese Encephalitis Vaccine

JRF Joint Reporting Form

KABP Knowledge Attitude Behaviour Practice

MCH Mother and Child Health

MCV Measles Containing Vaccine

MICS Multiple Indicator Coverage Survey

MLM Mid-Level Management

MR Measles and Rubella Vaccine

MOE Ministry of Education

MOH Ministry of Health

MOF Ministry of Finance

MPI Ministry of Planning and Investment

NCC National Certification Committee

NGO Non-Governmental Organization

NHI National Health Insurance

NVC National Verification Committee

NIP National Immunization Program

NIS National Immunization Strategy

NITAG National Technical Advisory Committee

NRA National Regulatory Authority

NVI New Vaccine Introduction

OOP Out of Pocket Payment

OPV Oral Polio Vaccine

PCV Pneumococcal Conjugate Vaccine

Penta Pentavalent Vaccine (DPT-HepB-Hib)

PIE Post Introduction Evaluation

PHC Primary Health Care

QCM Quarterly Committee Meeting

RRL Regional Reference Laboratory

RV Rotavirus Vaccine

SDG Sustainable Development Goals

SIA Supplementary Immunization Activities

SOP Standard Operating Procedures

TB Tuberculosis

TOR Terms of Reference

TWG Technical Working Group

UNFPA United Nations Population Fund

UNICEF United Nations International Children's

Emergency Fund

VPD Vaccine Preventable Disease

VVM Vaccine Vial Monitor

WB World Bank Group

WHO World Health Organization

AOP guidelines - Finalized version August 2021

Reference documents

National Immunization Strategy (NIS) guidance document – WHO – May 2020

National strategic and operational planning for immunization – A review of best practices for optimized

planning – UNICEF – August 2019

Strategic and operational planning for immunization – Landscape analysis in 30 Gavi eligible countries –

UNICEF – October 2019

Afghanistan; Armenia; Benin; Burkina Faso; Burundi; Cambodia; Cameroon; Central African Republic; Chad;

Comoros; Ethiopia; Ghana; Guinea-Bissau; Honduras; Indonesia; Korea DPR; Lao PDR; Liberia; Madagascar; Mali;

Mozambique; Myanmar; Papua New Guinea; Sierra Leone; Sudan; Tanzania; Togo; Uganda; Vietnam; Zimbabwe

Optimal strategic and operational planning and budgeting for immunization – Country case study – UNICEF

- Lao PDR, November 2019

- Haiti, September 2019

Comprehensive multi-year plans assessments and roadmaps

- Roadmap for the next phase of comprehensive multi-year plans for immunization – BMGF; GAVI Secretariat;

UNICEF; WHO; World Bank – 1

December 2017

- Rapid Stocktaking and Support to Revising the cMYP – Mott MacDonald – 31 July 2017

- Report on cMYP translated into 2011 Annual Immunization Plan in GAVI eligible countries – WHO – April 2012

Guidelines on strategic and operational planning (health and immunization)

- Instructions for Developing Annual Plan of Action of Expanded Program on Immunization – PAHO – 2014

- Instructions for Costing Annual Plan of Action of Expanded Program on Immunization – PAHO – 2014

- Guidelines for Comprehensive Multi-Year Planning for Immunization – WHO-UNICEF – September 2013

- Planning for Immunization (online course) – UNICEF – 2014

- A Tool and User Guide for cMYP Costing and Financing (Excel tool) – WHO – 2014

- A guide for conducting an Expanded Program on Immunization (EPI) Review – WHO – 2017

- A framework for National Health Policies, Strategies and Plans – WHO – June 2010

- Operational Planning for HIV/AIDS: A Guidance Note – ASAP UNAIDS – May 2009

- Planning guide for the health sector response to HIV/AIDS – WHO – 2011

- Strategizing national health in the 21st century: a handbook – WHO – 2016

- Toolkit to develop a national strategic plan for TB prevention, care and control – WHO – 2015