This article is part of the supplement: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. The Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants

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Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

Abel Bicaba1, Slim Haddad2*, Moussa Kabore3, Emile Taminy4, Marta Feletto2 and Pierre Fournier2

Author Affiliations

1 Société d'Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso

2 Fondation pour le Développement Communautaire, Ouagadougou, Burkina Faso

3 École Nationale de Santé Publique du Centre Ouest (Koudougou), Burkina Faso

4 Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada

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BMC International Health and Human Rights 2009, 9(Suppl 1):S12  doi:10.1186/1472-698X-9-S1-S12

Published: 14 October 2009



The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.


The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.


The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.


Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.

Abstract in French

See the full article online for a translation of this abstract in French.