National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia.
World Health Organization, Seoul, Republic of Korea.
Glob Health Sci Pract. 2023 Jun 21;11(3). doi: 10.9745/GHSP-D-22-00555.
Vaccination coverage is widely used to assess immunization performance but, on its own, provides insufficient information to drive improvements. Assessing the performance of underlying components of immunization systems is less clear, with several monitoring and evaluation (M&E) resources available for use in different operational settings and for different purposes. We studied these resources to understand how immunization system performance is measured.
We reviewed peer-reviewed and gray literature published since 2000 to identify M&E resources that include national-level indicators measuring the performance of immunization systems or their components (governance, financing, regulation, information systems, vaccine logistics, workforce, service delivery, and demand generation). We summarize indicators by the system components or outcomes measured and describe findings narratively.
We identified 20 resources to monitor immunization program objectives and guide national strategic decision-making, encompassing 631 distinct indicators. Indicators for immunization program outcomes comprised the majority (124/631 [19.7%]), largely vaccination coverage (110/124 [88.7%]). Almost all resources (19/20 [95%]) included indicators for vaccine logistics (83/631 [13.2%]), and those for regulation (19/631 [3.0%]) and demand generation (28/631 [4.4%]) were least common. There was heterogeneity in how information systems (92/563 [14.6%]) and workforce (47/631 [7.4%]) were assessed across resources. Indicators for vaccination coverage in adults, data use in decision-making, equity and diversity, effectiveness of safety surveillance, and availability of a public health workforce were notably lacking.
Between the resources identified in this review, we identified considerable variability and gaps in indicators assessing the performance of some immunization system components. Given the multitude of indicators, policymakers may be better served by tailoring evaluation resources to their specific context to gain useful insight into health system performance and improve data use in decision-making for immunization programs.
疫苗接种覆盖率被广泛用于评估免疫接种效果，但仅靠这一指标并不能提供足够的信息来推动改进。评估免疫接种系统的基本组成部分的效果则不那么明确，有几种监测和评估 (M&E) 资源可用于不同的运作环境和不同的目的。我们研究了这些资源，以了解如何衡量免疫接种系统的绩效。
我们回顾了 2000 年以来发表的同行评议和灰色文献，以确定包括国家层面指标的 M&E 资源，这些指标衡量免疫接种系统或其组成部分（治理、融资、监管、信息系统、疫苗物流、劳动力、服务提供和需求产生）的绩效。我们根据所测量的系统组成部分或结果对指标进行总结，并进行叙述性描述。
我们确定了 20 种资源来监测免疫规划目标并指导国家战略决策，其中包含 631 个不同的指标。免疫规划结果指标占大多数（124/631 [19.7%]），主要是疫苗接种覆盖率（110/124 [88.7%]）。几乎所有资源（19/20 [95%]）都包含疫苗物流指标（83/631 [13.2%]），而监管指标（19/631 [3.0%]）和需求产生指标（28/631 [4.4%]）则较少。各资源之间在信息系统（92/563 [14.6%]）和劳动力（47/631 [7.4%]）的评估方法上存在差异。成人疫苗接种覆盖率、决策中的数据使用、公平性和多样性、安全性监测的有效性以及公共卫生劳动力的可用性等方面的指标明显缺乏。
在本次审查中确定的资源中，我们发现一些免疫接种系统组成部分的绩效评估指标存在相当大的差异和差距。鉴于指标众多，政策制定者可能会更好地根据其特定情况来调整评估资源，以便从免疫规划的角度深入了解卫生系统的绩效并改善决策中的数据使用。
