Essays by International Experts Working on the Immunization Program in China

Evaluation has been an important component of the global Expanded Programme on Immunization since its inception in the 1970s. China emphasized evaluation from the very beginning of the national immunization program, with concurrent and retrospective evaluations given an integral role in the EPI and polio eradication efforts in China. At the start of the EPI program, three formal comprehensive evaluations were planned to identify successes and problems at each stage of the program and to make proposals for further improving activities. The first evaluation assessed achievement of the target of 85% immunization coverage at provincial level by 1988, the second 85% coverage at county level by 1990, and the third 85% coverage at township level by 1995. These evaluations included international experts and were comprehensive reviews of the EPI, going beyond just considering coverage, to look at program quality aspects such as cold chain, safe injections, disease surveillance (to assess impact of the program on the target diseases), training, and sustainability. The evaluation methodology adopted required international teams to make visits to all levels, including township and village levels, to review the work, which provided international experts with an opportunity to review the work, and see life in China, at all levels.