Shearer Jessica C, Nava Olivia, Prosser Wendy, Nawaz Saira, Mulongo Salva, Mambu Thérèse, Mafuta Eric, Munguambe Khatia, Sigauque Betuel, Cherima Yakubu Joel, Durosinmi-Etti Olawale, Okojie Obehi, Hadejia Idris Suleman, Oyewole Femi, Mekonnen Dessie Ayalew, Kanagat Natasha, Hooks Carol, Fields Rebecca, Richart Vanessa, Chee Grace
PATH USA, Seattle, WA 98102, USA.
Independent Consultant, Oakland, CA 94608, USA.
Vaccines (Basel). 2023 Mar 17;11(3):689. doi: 10.3390/vaccines11030689.
The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses.
This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework.
Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning.
Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation.
免疫接种对儿童生存至关重要，这凸显了消除免疫接种不平等现象的必要性。现有的关于不平等现象的研究很少采用从照料者角度看待挑战和潜在解决方案的方法。本研究旨在通过参与式行动研究、交叉性和以人为本的设计视角，与照料者、社区成员、卫生工作者及其他卫生系统行为者深入合作，确定障碍和适合具体情况的解决方案。
本研究在刚果民主共和国、莫桑比克和尼日利亚开展。在快速定性研究之后，与研究参与者共同举办共创研讨会以确定解决方案。我们使用联合国儿童基金会健康与免疫接种之旅框架对数据进行了分析。
零剂量和未充分免疫儿童的照料者面临与性别、贫困、地理可及性和服务体验相关的多重相互交织且相互作用的障碍。由于推广疫苗接种等促进公平战略实施欠佳，免疫接种计划与最脆弱群体的需求不一致。照料者和社区通过共创研讨会确定了可行的解决方案，应尽可能采用这种方法为地方规划提供信息。
政策制定者和管理人员可将以人为本的设计和交叉性思维融入现有的规划和评估流程，并专注于克服实施欠佳的根本原因。
