Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA.
BMJ Open. 2023 Oct 4;13(10):e070541. doi: 10.1136/bmjopen-2022-070541.
Vaccination averts an estimated 2-3 million deaths annually. Although vaccine coverage improvements across Africa and South Asia have remained below global targets, several countries have outperformed their peers with significant increases in coverage. The objective of this study was to examine these countries' vaccination programmes and to identify and describe critical success factors that may have supported these improvements.
Multiple case study design using qualitative research methods.
Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.
We conducted 207 key informant interviews and 71 focus group discussions with a total of 678 participants. Participants were recruited from all levels, including government officials, health facility staff, frontline workers, community health workers, and parents. Participants were recruited from both urban and rural districts in Nepal, Senegal, and Zambia.
Our data revealed that the critical success factors for vaccination programmes relied on the cultural, historical, and statutory context in which the interventions were delivered. In Nepal, Senegal, and Zambia, high immunisation coverage was driven by (1) strong governance structures and healthy policy environments; (2) adjacent successes in health system strengthening; (3) government-led community engagement initiatives, and (4) adaptation considering contextual factors at all levels of the health system.
Throughout this project, our analysis returned to the importance of defining and understanding the context, governance, financing, and health systems within a country, rather than focusing on any one intervention. This paper augments findings from existing literature by highlighting how contextual factors impact implementation decisions that have led to improvements in childhood vaccine delivery. Findings from this research may help identify transferable lessons and support actionable recommendations to improve national immunisation coverage in other settings.
疫苗接种每年可预防 200 万至 300 万人死亡。尽管非洲和南亚的疫苗接种覆盖率提高仍低于全球目标，但一些国家的覆盖率显著提高，表现优于同行。本研究的目的是检查这些国家的疫苗接种计划，并确定和描述可能支持这些改进的关键成功因素。
使用定性研究方法进行多案例研究设计。
三个常规免疫接种率较高的国家：尼泊尔、塞内加尔和赞比亚。
我们对来自尼泊尔、塞内加尔和赞比亚的总共 678 名参与者进行了 207 次关键知情人访谈和 71 次焦点小组讨论。参与者来自各级政府官员、卫生机构工作人员、一线工作者、社区卫生工作者和家长。参与者来自尼泊尔、塞内加尔和赞比亚的城市和农村地区。
我们的数据显示，疫苗接种计划的关键成功因素取决于干预措施实施的文化、历史和法定背景。在尼泊尔、塞内加尔和赞比亚，高免疫覆盖率的驱动因素包括：（1）强有力的治理结构和健康的政策环境；（2）在卫生系统强化方面的相邻成功；（3）政府主导的社区参与举措；以及（4）在卫生系统各级考虑到背景因素的适应性调整。
在整个项目过程中，我们的分析一再回到定义和理解一个国家的背景、治理、融资和卫生系统的重要性，而不是关注任何一项干预措施。本文通过强调背景因素如何影响实施决策，从而提高儿童疫苗接种服务，补充了现有文献的发现。本研究的结果可能有助于确定可转移的经验教训，并为改善其他环境下的国家免疫接种覆盖率提供可行的建议。
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