The use of the protection-at birth (PAB) method to assess tetanus-diphtheria (Td) vaccination status of mothers in the routine immunization program is not yet introduced in Ghana. PAB is rather estimated using the WHO-UNICEF model which is currently at 88%. As part of efforts to introduce the PAB method in the routine immunization reporting system in the country, WHO supported the Ghana Health Service (GHS) to pilot the PAB method in two districts (Wassa East and Mpohor) in the Western region

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... tween April and September 2014. The pilot was not to evaluate the WHO-UNICEF model of estimation but to explore the feasibility of introducing and implementing the natural PAB process of data collection and analysis into the country's routing monthly data collection process. Objective: The main objective was to document the process, challenges and cost implications for introducing the PAB method as a primary data source at the health facility level in the country. Method: Six month exploratory study conducted in the two districts to determine the feasibility and challenges such as training needs of staff and cost implications that may be associated with the introduction and implementation of the PAB method in the country. Td vaccination status of mothers attending post-natal clinic (PNC) and whether the newborn child was protected from neonatal tetanus before delivery was assessed using a checklist by trained health staff which was later compiled and analyzed. Results: Of 2455 mothers interviewed in the two districts during the six month period, 2015 (representing 82.1%) received Td vaccination in their last pregnancy. History (81.7%) formed the main source of information. Children protected at birth from the assessment totalled 2027 (82.6%) which is close to WHO-UNICEF annual estimates (now at 88%). Conclusions: PAB can be implemented as a routine monthly activity at the facility level when the reporting forms are revised and the field staff are adequately trained and supervised effectively. Once capacity has been built for PAB determination through the routine system at country level, the use of WHO-UNICEF estimation method may not be very much required as a regular activity. Other countries with similar challenges can draw on the lessons from this pilot programme and introduce the routine process.