Sowe Alieu, Namatovu Fredinah, Cham Bai, Gustafsson Per E
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Expanded Program on Immunization, Ministry of Health, Banjul, Gambia.
Vaccine X. 2022 Aug 17;12:100206. doi: 10.1016/j.jvacx.2022.100206. eCollection 2022 Dec.
To assess whether the implementation of a results-based financing (RBF) project in The Gambia resulted in (1) improved national vaccination coverage (2) higher coverage in intervention than non-intervention areas, and (3) improvement in rural-urban coverage inequality.
The study used a difference-in-differences design, based on repeated cross-sectional data from The Gambian Demographic and Health Surveys 2013 (N = 1650) and 2020 (N = 1456). Full vaccination (receipt of one BCG, 3 OPV, 3 DTP, and 1 measles-containing vaccine doses) and rural-urban vaccination inequality were our outcome variables. The intervention, RBF, was implemented in 5 of the 7 health regions. Covariates controlled for included child's sex, child's birth order number, socioeconomic status, ethnicity, distance from health facility, maternal education, mother's age group, mother's marital status, and mother's work status. Poisson regression with robust variance was used to estimate whether coverage changed, and difference-in-differences and difference-in-differences-in-differences were used to 'assess differences in vaccination coverage change and change in inequalities, respectively.
Total crude full vaccination coverage in The Gambia was 76% in 2013 and 84.6% in 2020. Overall vaccination significantly increased by 16% (95% CI: 9% to 24%) in 2020 compared to 2013, but with a smaller increase in intervention relative to non-intervention areas [PRR 0.88 (CI: 0.78-0.99)]. Rural-urban inequality in vaccination coverage decreased more - by 13% [0.87 (0.78-0.98)] - in RBF than non-RBF regions.
Vaccination coverage improved over the study period though we have no evidence to ascribe the coverage gains to the RBF intervention. However, our study suggests that the RBF project has contributed to reducing rural-urban inequalities in the regions it was implemented.
评估在冈比亚实施基于结果的融资（RBF）项目是否带来了以下结果：（1）提高了全国疫苗接种覆盖率；（2）干预地区的覆盖率高于非干预地区；（3）改善了城乡覆盖率不平等的状况。
本研究采用双重差分设计，基于冈比亚2013年（N = 1650）和2020年（N = 1456）人口与健康调查的重复横断面数据。全程疫苗接种（接种一剂卡介苗、3剂口服脊髓灰质炎疫苗、3剂百白破疫苗和1剂含麻疹成分疫苗）以及城乡疫苗接种不平等是我们的结果变量。RBF干预在7个卫生区域中的5个实施。控制的协变量包括儿童性别、儿童出生顺序、社会经济地位、种族、距医疗机构的距离、母亲教育程度、母亲年龄组、母亲婚姻状况和母亲工作状况。使用具有稳健方差的泊松回归来估计覆盖率是否发生变化，分别使用双重差分和三重差分来评估疫苗接种覆盖率变化的差异和不平等的变化。
冈比亚的总粗全程疫苗接种覆盖率在2013年为76%，在2020年为84.6%。与2013年相比，2020年总体疫苗接种率显著提高了16%（95%置信区间：9%至24%），但干预地区相对于非干预地区的增幅较小[PRR 0.88（置信区间：0.78 - 0.99）]。RBF地区的疫苗接种覆盖率城乡不平等下降幅度更大——下降了13%[0.87（0.78 - 0.98）]，高于非RBF地区。
在研究期间疫苗接种覆盖率有所提高，尽管我们没有证据将覆盖率的提高归因于RBF干预。然而，我们的研究表明，RBF项目有助于减少其实施地区的城乡不平等。
