Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda.
PLoS One. 2024 Aug 28;19(8):e0303998. doi: 10.1371/journal.pone.0303998. eCollection 2024.
Lower-level urban private-for-profit health service providers are actively engaged in the delivery of immunization services. However, not much is known about their everyday endeavours to improve data quality and ensure the submitted data meets the quality and timeliness requirements as per established guidelines. The objective of this paper was to examine the coping mechanisms and strategies adopted to improve the quality and timeliness of immunization data among lower-level private-for-profit service providers in Kampala Capital City, Uganda.
A qualitative study design was adopted with in-depth interviews (n = 17) and key informant interviews (n = 8) completed among frontline health workers, district health managers and immunization implementing partners. Analysis followed a thematic approach with coding conducted using Atlas. ti, a qualitative data management software.
Overall, coping mechanisms and strategies adopted to improve the data quality among lower-level urban private-for-profit immunization service providers included; Experiential attachment for practical skills acquisition in data management, data quality peer-to-peer learning among private-for-profit immunization service providers, registration using cohort system for easy tracking of records during subsequent visits, separation of visiting service user records from regular attendants, service delivery modifications such as reward for better performance, engagement of Village Health Teams (VHTs) in outreaches and data completion, and data quality checks through review of monitoring charts to identify gaps in data quality.
Within the urban context, the delivery of immunization services by lower-level private-for-profit services faces data quality challenges some of which stem from the implementation context. Different coping strategies focusing on frontline health worker skills, enhanced experience sharing through peer-to-peer learning, modifications to registration and routine review of monitoring charts. However, these efforts were often faced with chronic barriers such as the high staff turnover calling for dedicated efforts to optimize the available implementation opportunities like guidelines mandating the public health facilities to supervise the lower-level private immunization service providers within their catchment areas to respond to the identified gaps.
低级别城市私立营利性卫生服务提供者积极参与免疫服务的提供。然而，对于他们在日常工作中为提高数据质量并确保提交的数据符合既定准则的质量和及时性要求而采取的努力，我们知之甚少。本文的目的是探讨乌干达坎帕拉首都城市低级别私立营利性服务提供者为提高免疫数据的质量和及时性而采用的应对机制和策略。
采用定性研究设计，对一线卫生工作者、地区卫生管理人员和免疫实施伙伴进行了 17 次深入访谈和 8 次关键知情人访谈。分析采用主题方法，使用 Atlas.ti 进行编码，这是一种定性数据管理软件。
总体而言，为提高低级别城市私立营利性免疫服务提供者的数据质量而采用的应对机制和策略包括：经验依附以获取数据管理方面的实践技能、私立营利性免疫服务提供者之间的数据质量同行学习、使用队列系统进行注册，以便在后续访问期间轻松跟踪记录、将访问服务使用者记录与普通就诊者分开、通过奖励更好的绩效来修改服务交付、让村卫生团队（VHT）参与外展和数据完成、以及通过审查监测图表来检查数据质量以识别数据质量差距。
在城市环境中，低级别私立营利性服务提供的免疫服务面临数据质量挑战，其中一些挑战源于实施环境。不同的应对策略侧重于一线卫生工作者的技能，通过同行学习加强经验分享、对注册和常规监测图表审查进行修改。然而，这些努力经常面临长期存在的障碍，例如员工高流动率，需要做出专门努力来优化现有的实施机会，例如规定公共卫生机构在其服务范围内监督低级别私立免疫服务提供者的准则，以应对已确定的差距。
