Population Council, Abuja, Nigeria.
, 4301 Connecticut Avenue, NW, Suite 280, Washington, DC, 20008, USA.
BMC Health Serv Res. 2024 Aug 20;24(1):951. doi: 10.1186/s12913-024-11403-3.
Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage.
Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates.
We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation.
Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs.
全球卫生伙伴关系正日益被用于改善协调、加强卫生系统，并激励政府为公共卫生项目做出承诺。从 2012 年到 2022 年，比尔及梅琳达·盖茨基金会（BMGF）和阿里科·丹格特基金会（ADF）与六个北方邦政府签署了谅解备忘录（MoU）伙伴关系协议，以加强常规免疫（RI）系统，并可持续地提高免疫覆盖率。本混合方法评估描述了 RI MoU 对改善项目绩效、加强能力和政府财政承诺以及提高免疫覆盖率的贡献。
我们从利益相关者访谈和桌面审查中，描述了 MoU 的投入和流程以及对设计的遵守情况。我们通过对卫生设施评估、客户退出访谈以及对服务提供者、社区领袖和项目参与者的定性访谈，评估了该计划在多大程度上实现了其目标，以及所带来的益处和挑战。最后，我们通过评估免疫覆盖率趋势来评估 MoU 的总体影响。
我们发现，六个州的 RI MoU 在加强卫生系统、改善问责制和协调以及增加 RI 服务和资金利用方面大多取得了成功。在所有六个州，五联疫苗 3 覆盖率从 2011 年到 2021 年有所增加，在一些州，增幅很大。例如，在约贝州，疫苗接种覆盖率从 2011 年的 10%增加到 2021 年的近 60%。然而，在索科托州，变化很小，从 2011 年的仅 4%增加到 2021 年的近 8%。然而，评估结果表明，与人力资源、妨碍支持性监督的不安全以及有害的社会文化规范有关的问题仍然是各州面临的持续挑战。此外，还需要一个严格的监测和评估计划，在实施之前和实施过程中收集明确的措施。
引入基于 MoU 协议的多方伙伴关系方法为解决常规免疫计划面临的卫生系统挑战提供了一个有前途的方法。
