Grundy John, Rakhimdjanov Shukhrat, Adhikari Merina
School of Health and Social Development, Deakin University, Melbourne, Australia.
United Nations Children's Fund (UNICEF) Country Office, Dhaka, Bangladesh.
WHO South East Asia J Public Health. 2016 Sep;5(2):154-163. doi: 10.4103/2224-3151.206253.
Despite success in scaling up immunization, the national immunization programme in Bangladesh remains challenged by persisting inequities in health access related to geographic location and social factors, including income and education status. In order to tackle these inequities in access, the national immunization programme has conducted a field trial of the evidence-based planning model in Bangladesh between 2011 and 2013, in 11 low-performing districts and 3 city corporations. The main elements of this intervention included bottleneck analysis in local areas, action planning and budgeting to correct the bottlenecks, and establishment of a monitoring system to track progress. Coverage improved in 8 out of 14 districts post intervention. The main success factors associated with the intervention included more analytic approaches to situation assessment and taking action on health inequities at the local level, as well as more considered use of local data to track immunization drop-outs. The main factors associated with coverage declines in trial areas (6 districts) included poor financial resourcing and supervisory support, and gaps and turnover in human resources. In order to sustain and improve coverage, it will be necessary in future to link pro-equity approaches to subdistrict planning to higher-level health-system-strengthening strategy and planning systems. This will ensure that local area planners have the required resources, comprehensive operational plans and political support to sustain implementation of corrective actions to address identified system bottlenecks and inequities in health access at the local level.
尽管在扩大免疫接种方面取得了成功，但孟加拉国的国家免疫规划仍面临挑战，与地理位置以及包括收入和教育状况在内的社会因素相关的医疗服务获取方面持续存在不平等现象。为了解决这些获取方面的不平等问题，国家免疫规划于2011年至2013年期间在孟加拉国11个表现不佳的地区和3个市辖区对循证规划模式进行了实地试验。该干预措施的主要内容包括对当地进行瓶颈分析、制定行动计划和预算以纠正瓶颈，以及建立监测系统以跟踪进展情况。干预后，14个地区中有8个地区的覆盖率有所提高。与该干预措施相关的主要成功因素包括对情况评估采用更多分析方法以及在地方层面针对健康不平等问题采取行动，以及更审慎地利用当地数据来跟踪免疫接种漏种情况。试验地区（6个地区）覆盖率下降的主要因素包括资金资源和监督支持不足，以及人力资源方面的缺口和人员流动。为了维持和提高覆盖率，未来有必要将促进公平的方法与分区规划与更高级别的卫生系统加强战略和规划系统联系起来。这将确保地方规划人员拥有所需资源、全面的运营计划以及政治支持，以持续实施纠正行动，解决已确定的系统瓶颈和地方层面医疗服务获取方面的不平等问题。
