Yawson A E, Bonsu G, Senaya L K, Yawson A O, Eleeza J B, Awoonor-Williams J K, Banskota H K, Agongo E E A
Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana.
National Expanded Programme on Immunization, Public Health Directorate, Ghana Health Service, Accra, Ghana.
Arch Public Health. 2017 Mar 13;75:10. doi: 10.1186/s13690-017-0179-7. eCollection 2017.
Immunization is considered one of the most cost effective public health interventions for reducing child morbidity, mortality and disability. The aim of this work is to describe the application of the Bottleneck analysis (BNA) process to assess gaps in immunization services in Ghana and implications for sustaining the gains in Immunization coverage.
A national assessment was conducted in May 2015, through use of desk reviews, field visits and key informant interviews. Quantitative data were analysed with the BNA Tool (an excel-based tool) based directly on service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators; supply side/health system factors (commodities, human resource and access), demand side (service utilisation) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators.
In all, only 50% of regions and districts had health facilities with at least 80% of health care workers training provided in-service training on routine immunization; only 40% of district had communities with functional fixed or outreach EPI service delivery point and over 70% of regions and districts had challenges with effective coverage of infants aged 0-11 months fully immunized during the past year. Other key health system bottlenecks included, limited number of fixed and outreach sites, difficult to reach island communities along the Volta Basin, inadequate storage facilities for vaccines at lower levels, stock out of vaccines and auto destruct syringes and absence of updated policies/field guides at services delivery points/facilities. In addition, inadequate in-service training in routine Immunization and absence of good quality data were major challenges. Demand side bottlenecks included fear of mothers on the safety of multiple vaccines and limited active involvement of communities in Immunization service delivery.
The BNA tool and approach provided data driven planning of health service in Ghana. This resulted in the development of regional and national operational plans for immunization and will be the baseline for evaluating the national programme in three years.
免疫接种被认为是降低儿童发病率、死亡率和残疾率最具成本效益的公共卫生干预措施之一。本研究旨在描述瓶颈分析（BNA）流程在评估加纳免疫接种服务差距方面的应用，以及对维持免疫接种覆盖率所取得成果的影响。
2015年5月进行了一次全国性评估，采用了案头审查、实地考察和关键 informant 访谈。定量数据使用BNA工具（一个基于Excel的工具）进行分析，该工具直接基于加纳的服务覆盖率数据以及项目监测和审查报告。根据服务覆盖率指标、供应方/卫生系统因素（商品、人力资源和可及性）、需求方（服务利用情况）以及质量/有效覆盖率生成了结果。以国家目标为基准评估覆盖率指标方面的差距。
总体而言，只有50%的地区和行政区的卫生设施为至少80%的医护人员提供了常规免疫接种方面的在职培训；只有40%的行政区的社区设有功能正常的固定或外展扩大免疫规划服务点，超过70%的地区和行政区在过去一年中，0至11个月龄婴儿的全程免疫有效覆盖率方面存在问题。其他关键的卫生系统瓶颈包括固定和外展服务点数量有限、难以到达沃尔特河流域的岛屿社区、较低层级的疫苗储存设施不足、疫苗和自毁注射器缺货以及服务点/设施缺乏更新的政策/现场指南。此外，常规免疫接种方面在职培训不足以及缺乏高质量数据也是主要挑战。需求方瓶颈包括母亲们对多种疫苗安全性的担忧以及社区在免疫接种服务提供方面的积极参与有限。
BNA工具和方法为加纳的卫生服务提供了数据驱动的规划。这促成了区域和国家免疫接种运营计划的制定，并将成为三年后评估国家计划的基线。
