J HEALTH POPUL NUTR 2007 Mar;25(1):37-46 ISSN 1606-0997 $ 5.00+0.20 © 2007 International Centre for Diarrhoeal Disease Research, Bangladesh Performance of the Lot Quality Assurance Sampling Method Compared to Surveillance for Identifying Inadequately-performing Areas in Matlab, Bangladesh Abbas Bhuiya, S.M.A. Hanifi, Nikhil Roy, and P. Kim Streatfield ICDDR,B GPO Box 128, Dhaka 1000, Bangladesh ABSTRACT This paper compared the performance of the lot quality assurance sampling (LQAS) method in identify- ing inadequately-performing health work-areas with that of using health and demographic surveillance system (HDSS) data and examined the feasibility of applying the method by field-level programme supervisors. The study was carried out in Matlab, the field site of ICDDR,B, where a HDSS has been in place for over 30 years. The LQAS method was applied in 57 work-areas of community health work- ers in ICDDR,B-served areas in Matlab during July-September 2002. The performance of the LQAS method in identifying work-areas with adequate and inadequate coverage of various health services was compared with those of the HDSS. The health service-coverage indicators included coverage of DPT, measles, BCG vaccination, and contraceptive use. It was observed that the difference in the proportion of work-areas identified to be inadequately performing using the LQAS method with less than 30 respon- dents, and the HDSS was not statistically significant. The consistency between the LQAS method and the HDSS in identifying work-areas was greater for adequately-performing areas than inadequately-per- forming areas. It was also observed that the field managers could be trained to apply the LQAS method in monitoring their performance in reaching the target population. Key words: Lot quality assurance sampling; Immunization; Health; Family planning; Comparative studies; Bangladesh INTRODUCTION Health-programme personnel always aim to increase the level of use of the services they provide. Despite all- out efforts, the use of services often remains lower than expected and/or the level of use is not same for all areas or for all the service components. Focusing attention on deficient areas can help improve the situation. A pre- requisite for focusing attention is the identification of deficient areas with a known degree of reliability. Data from surveillance and cross-sectional surveys are com- monly used for assessing the level of use of services. Sur- Correspondence and reprint requests should be addressed to: Dr. Abbas Bhuiya Head, Social and Behavioural Sciences Unit ICDDR,B GPO Box 128, Dhaka 1000 Bangladesh Email: abbas@icddrb.org veillance being very resource-intensive is not practical for this purpose. The cross-sectional survey, especially the 30 cluster-sampling scheme with 210 respondents, is considered to be reasonably practical and has been in use for monitoring the coverage of services under the Expanded Programme for Immunization (EPI) for quite some time (1). In fact, the task of covering 210 res- pondents per estimation area, if one looks carefully, is not so small a task when the performance of areas cov- ered by the lowest-level workers—quite often large in numbers—is to be assessed. In addition, the task of data analysis and their interpretation also become technical, requiring expertise beyond the domain of programme management. In this respect, the lot quality assurance sampling (LQAS) method is simpler, resource- and time-efficient for it is based on a much smaller sample size and easy to apply (2,3). The LQAS method is also effective in improving public-health services, like im-