Part 1 · What is Coincidence Analysis?
Module 1 · Why does CNA exist?
The mystery of the 100 facilities
- State why single-factor thinking fails in immunization programs.
- Explain, with an example, how the same input can produce different outcomes.
- Recognise the kind of problem CNA is designed to solve.
You supervise 100 health facilities. A handful keep missing children, quarter after quarter, no matter what you try. The question that keeps you up at night is simple: why does coverage stay low in these places?
Most of us answer that question by rounding up the usual suspect. "It's the training." Or "it's the fridge." We pick one lever, pull it, and wait for coverage to climb. Then it doesn't, and we're baffled, because on paper that facility had the training. The trouble is that low coverage rarely has one cause sitting alone in a room. It usually shows up when a few things go wrong at the same time, and a facility can survive one weak spot but not a particular combination of them.
A cake flops for a reason, and "not enough flour" is only sometimes the reason. Maybe the flour was fine but the oven was cold. Maybe the oven was hot but someone forgot the sugar. If you ask "does flour cause a flopped cake?" the honest answer is "it depends what else went wrong in the bowl." Low coverage is a flopped cake. You have to look at the whole bowl.
Here are two facilities that sat through the exact same training. One does fine. One keeps falling short. Watch what's actually different.
| Condition | Facility A | Facility B |
|---|---|---|
| Trained vaccinators | Yes | Yes |
| Functional cold chain | Yes | No |
| Monthly supportive supervision | Yes | Yes |
| Community mobilisation | Yes | Yes |
| Coverage stays low? | No | Yes |
Same training, very different lives. The broken cold chain is what tipped Facility B into low coverage, but only because of the company it was keeping.
Both facilities had trained staff, so "more training" was never going to rescue Facility B. The training was fine. It just isn't worth much when the vaccines spoiled before they reached an arm. Diagnosing that correctly, instead of ordering another training, is exactly the kind of problem Coincidence Analysis was built to solve.
Picture one facility in your area that keeps missing children.
- Have you ever 'fixed' the obvious factor and seen no change? What else might have been going wrong at the same time?
- If you listed everything that was in place there, would the real gap stand out?