Critical success factors for high routine immunization performance: A case study of Senegal

Sakas, Zoe; Hester, Kyra A; Rodriguez, Katie; Diatta, Saly Amos; Ellis, Anna; Gueye, Daouda; Matapano, Dawn; Mboup, Pr Souleymane; Ogutu, Emily Awino; Yang, Chenmua; Bednarczyk, Robert A.; Freeman, Matthew C.; Sarr, Moussa; Zunino, Francisco Castillo; Darwar, Roopa; Dounebaine, Bonheur; Dudgeon, Matthew R.; Escoffery, Cam; Isett, Kimberley R.; Jaishwal, Chandni; James, Hanleigh; Keskinocak, Pınar; Montagnes, B. Pablo; Nazzali, Dima; Orenstein, Walter A.; Robayo, Miguel Rueda; Rosenblum, Simone; Smalley, Hannah K.

doi:10.1016/j.jvacx.2023.100296

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…Female community health volunteers (FCHVs) and other community health workers lead a powerful community-based approach to demand generation, health education and vaccine delivery, which was supported by cultural values including collective responsibility and community ownership of vaccine coverage. 16 In Senegal, a strong political will supported the prioritisation of vaccination programming, including urgent allocation of resources and cold chain improvements. Long-term partnerships between government agencies and external partners allowed for innovation, capacity building and efficiency within the health system.…”

Section: Resultsmentioning

confidence: 99%

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

Sakas,

Hester,

Ellis

et al. 2023

BMJ Open

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ObjectivesVaccination 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.DesignMultiple case study design using qualitative research methods.SettingThree countries with high routine immunisation rates: Nepal, Senegal, and Zambia.ParticipantsWe 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.ResultsOur 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.ConclusionsThroughout 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.

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Section: Resultsmentioning

confidence: 99%

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

Sakas,

Hester,

Ellis

et al. 2023

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…All studied countries exhibited cultural norms that related to collective responsibility , with participants from the community and health sector alike stressing the importance of the collective health of their communities. Vaccinations were considered critical to children’s health by these populations, and in Nepal and Senegal, laws were codified to ensure all have access to vaccines; through codification, the governments legally confirmed the importance of community health and their responsibility in ensuring access [13] , [14] . Although collective responsibility was the most prominent construct seen across the countries, interventions that utilized this construct may be the most difficult to replicate due to differences in culture and values.…”

Section: Discussionmentioning

confidence: 99%

“…The purpose of this study was to review interventions that key informant interviewers (KIIs) attributed to increased vaccine uptake in Zambia, Nepal, and Senegal, and assess how these interventions affected the community vaccination behaviors as seen on the 5C model. We observed innovative approaches to generating demand as part of our research in Zambia, Nepal, and Senegal [12] , [13] , [14] . Interventions were often implemented from existing global guidelines and further refined to country context [15] .…”

Section: Introductionmentioning

confidence: 86%

“…While components of vaccine demand and intent are present in this model, we sought the use of the 5C model to further assess the demand environment of our selected countries. The protocol of the primary analysis, along with individual case studies of exemplar countries and a synthesis case study are published separately [12] , [13] , [14] , [16] .

Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Methods for country, region, and district selection are detailed elsewhere [12] , [13] , [14] , [16] . Countries were selected based on DTP1 and DTP3 coverage estimates, which served as proxies for the evaluation of the vaccine delivery system in these countries, with DTP1 as a proxy of access and DTP3 as a proxy of continued utilization of immunization services ( Fig.…”

Section: Methodsmentioning

confidence: 99%

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Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

et al. 2023

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Factors associated with vaccine coverage improvements in Senegal between 2005-2019: A quantitative retrospective analysis

Smalley

Castillo-Zunino

Keskinocak

et al. 2023

Preprint

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Introduction: Senegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared to other low and lower-middle income countries. Understanding factors associated with historical changes in childhood vaccine coverage in Senegal, as well as heterogeneities across its 14 regions, can highlight effective practices that might be adapted to improve vaccine coverage elsewhere. Methods: Childhood vaccination coverage rates, demographic information, and health system characteristics were identified from Senegal's Demographic and Health Surveys (DHS) and Senegal national reports. Multivariate logistic and linear regression analyses were performed to determine statistical associations of demographic and health system characteristics with respect to childhood vaccination coverage rates. Results: Factors associated with childhood vaccination coverage include urban residence, female literacy, skilled prenatal care, and self-reported ease of access to care when sick, considering travel distance to a healthcare facility and concerns over traveling alone. Higher coverage with less variability over time was reported in urban regions near the capital and the coast, with increased coverage in recent years in more rural and landlocked regions. Conclusion: Childhood vaccination was more likely among children whose mothers had higher literacy, received skilled prenatal care, and had perceived ease of access to care when sick. Overall, vaccination coverage is high in Senegal and disparities in coverage between regions have decreased significantly in recent years.

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Critical success factors for high routine immunization performance: A case study of Senegal

Cited by 6 publications

References 24 publications

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

Factors associated with vaccine coverage improvements in Senegal between 2005-2019: A quantitative retrospective analysis

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