The GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunisation) is a public-private partnership focused on increasing children’s access to vaccines in poor countries. Partners include the GAVI Fund, national governments, UNICEF, WHO, The World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, public health institutions and nongovernmental organizations (NGOs). The GAVI Fund provides resources for the Alliance programs. The Alliance provides a forum for partners to agree upon mutual goals, share strategies, and coordinate efforts.
In 2004, The GAVI Alliance commissioned a data quality audit of the North Korean immunisation system to facilitate future collaboration. The audit was designed to assist countries receiving support to improve their information systems, and aid with accuracy in reporting.
The results of the audit are not surprising given the centrally-planned nature of the North Korean health bureaucracies combined with their penchant for secrecy. I recommend reading the full report to get an idea of how efficient of how socialist institutions are with data, but here are some points I considered interesting:
-District immunization information is not passed on to the national level, but combined at the county level.
-Out of 206 counties, 168 were audited. The rest were excluded for “security reasons”.
-The Ministry of population and Health contains a National Hygeing Control Committee, which controls the National Hygeine and Anti-Epidemic Institute which is responsible for the Expanded Programme on Immunization. This program was supported by UNICEF and the WHO.
-Officially, immunizations are offered in all 206 counties to children under one year old. Records are suposed to be made on an individual’s Child Health Card, and in the doctor’s own ledgers. These health cards are stored at local health facilities and are supposed to move with the child. Immunizations are distributed by the national government and are carried out one day per month.
-Outside of the national level, where one computer was used to for entering data, no computers were seen (all done by hand).
-In cases of county data, many errors were detected in the addition of monthly subtotals which could not be explained by the district staff. The auditors concluded that the district used the 2003 figures rather than admit to missing 2002 data to meet the criteria of the audit.
-County managers do not take the previous year’s achievements into account in order to set realistic targets for the next year.
-Supervision of immunization activities was weak. Only two counties could provide a written schedule of supervision.
-One health unit destroyed its records.