Deventer Hospital, Deventer, Netherlands.
Research for Health System Strengthening in northern Syria (R4HSSS), The Centre for Conflict & Health Research (CCHR), King's College London, Strand, WC2R 2LS, London, UK.
BMC Health Serv Res. 2024 Sep 12;24(1):1056. doi: 10.1186/s12913-024-11413-1.
Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability.
Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance.
The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns.
The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs.
The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability.
在受冲突影响的地区，有效的疫苗接种治理面临着独特的挑战。本研究评估了叙利亚西北部疫苗接种项目的治理情况，重点关注有效性、效率、包容性、数据可用性、愿景、透明度、问责制和可持续性。
采用混合方法，借鉴 Siddiqi 的卫生治理框架，通过 14 次关键知情人访谈（KII）、一次验证性研讨会和民族志观察收集数据。研究结果进行了三角验证，以全面了解疫苗接种治理情况。
该研究强调了为应对复杂的卫生治理格局而采取的创新方法，这些方法加强了国家以下各级的疫苗接种结构，如叙利亚免疫小组（SIG）。分析揭示了几个关键主题。冷链的可靠性和广泛的外展活动证明了疫苗接种的有效性和效率，但正式报告缺乏对疫苗损失的详细分析，也没有将疾病爆发数据与覆盖统计数据联系起来。疫苗接种战略得到了关键知情人和研讨会参与者的积极评价，但由于资金不规律和官僚作风，他们认为存在效率低下的问题。包容性和数据可用性被优先考虑，外展活动针对弱势群体。然而，人口统计数据存在重大差距，并且依赖纸质系统，这阻碍了全面覆盖分析。注意到数字化工作，但需要进一步支持。SIG 展示了明确的战略愿景，得到了世界卫生组织等国际组织的支持，但合作伙伴在战略规划中的参与有限，引起了对更广泛的所有权和参与的关注。虽然 SIG 被认为是可接近的，但缺乏公共文件和财务披露限制了透明度。内部信息共享很普遍，但公共沟通策略不足。问责制和可持续性因分散的结构和对多种捐助者的依赖而面临挑战。尽管存在权力下放和财政连续性等稳定因素，但分散的监督和对捐助者资金的依赖仍然是重大关切。
该研究强调了受冲突影响地区疫苗接种治理的复杂性。与其他冲突地区的比较突出了地方组织和国际支持的重要性。SIG 的作用至关重要，但它的合法性、透明度和包容性需要改进。叙利亚向早期恢复阶段的过渡给 SIG 的可持续性和融入国家计划带来了额外的挑战。
叙利亚西北部的疫苗接种治理是多方面的，涉及多个利益相关者，缺乏合法的政府。提高透明度、地方所有权和参与式决策对于改善治理至关重要。国际机构的作用至关重要，需要建立结构化的反馈机制和透明的监测过程，以确保该计划的成功和可持续性。
