Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Ghana.
Health Policy Plan. 2023 Jan 6;38(1):28-37. doi: 10.1093/heapol/czac077.
Interventions such as antimalarial drugs, bed nets and insecticides have helped curb the burden of malaria in the past decade, yet malaria remains a leading cause of morbidity and mortality in children below the age of 5 years. In 2019, Ghana, Malawi and Kenya in sub-Saharan Africa (countries with moderate to high transmission areas of malaria and deaths) started piloting the RTS,S/AS01E malaria vaccine in selected regions. Using qualitative methods, this study examined the main factors (forces) that will influence or hinder the nationwide implementation of the malaria vaccine, if approved, in Ghana. We conducted in-depth interviews with 12 key individuals (national, research/academia and programme implementing partners) in the public health sector in Ghana from October 2018 to February 2019. Results were analysed using Kurt Lewin's force field analysis to understand how organizations interact with their external environment in the delivery of health policies such as the implementation of the malaria vaccine. We found that the disease burden of malaria deaths in Ghana, the efficacy of the vaccine, stakeholder involvement and evidence for the feasibility of vaccine delivery generated by the consortium of researchers (body of researchers) that can track the implementation were the driving forces to scale up the vaccine into a routine health system. On the other hand, the needed logistics, funding, administration of the four-dose vaccine and follow-up were identified as potential barriers. The most influential force collectively highlighted by the respondents was the disease burden, and the most influential barrier was the logistics of delivering the vaccine. Our findings provide decision makers with key barriers and facilitators to guide policy and decision-making for malaria control in Ghana and other similar settings in low- and middle-income countries.
干预措施，如抗疟药物、蚊帐和杀虫剂，在过去十年中帮助遏制了疟疾的负担，但疟疾仍然是 5 岁以下儿童发病和死亡的主要原因。2019 年，撒哈拉以南非洲的加纳、马拉维和肯尼亚（疟疾中度至高度传播地区和死亡地区）开始在选定地区试点 RTS,S/AS01E 疟疾疫苗。本研究采用定性方法，考察了如果该疫苗获得批准，在加纳全国范围内实施该疫苗的主要因素（力量），这些因素将影响或阻碍疫苗的实施。我们于 2018 年 10 月至 2019 年 2 月在加纳公共卫生部门对 12 名关键人员（国家、研究/学术界和方案执行伙伴）进行了深入访谈。使用 Kurt Lewin 的力场分析来分析结果，以了解组织如何在实施卫生政策（如实施疟疾疫苗）方面与外部环境相互作用。我们发现，加纳疟疾死亡的疾病负担、疫苗的功效、利益相关者的参与以及研究人员联盟（研究人员群体）为疫苗推广提供的可行性证据，是将疫苗扩大到常规卫生系统的驱动力。另一方面，需要后勤、资金、四剂疫苗的管理和后续工作被确定为潜在的障碍。受访者集体强调的最具影响力的力量是疾病负担，最具影响力的障碍是疫苗的后勤工作。我们的研究结果为决策者提供了关键的障碍和促进因素，以指导加纳和其他低收入和中等收入国家类似环境中疟疾控制的政策和决策。
