Efficiency of immunization service in the Gambia: Results of a stakeholder analysis

Sarr, Francis

doi:10.4314/eajph.v7i1.64688

Cited by 3 publications

(3 citation statements)

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“…One general class of approaches can be considered 'program review', involving observation and interviews with program personnel, consultation of stakeholders, and detailed record review. These approaches are able to draw on a wide range of evidence, and produce qualitative findings that may cover a much wider scope than just technical efficiency [3][4][5][6]. Intensive approaches such as the WHO's National Immunization Programme Reviews [7] may reveal areas where resources are being wasted, or where underinvestment in some program components is hampering overall performance.…”

Section: Introductionmentioning

confidence: 99%

The efficiency of routine infant immunization services in six countries: a comparison of methods

Menzies

Suharlim²,

Resch³

et al. 2020

Health Econ Rev

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Background: Few studies have systematically examined the efficiency of routine infant immunization services. Using a representative sample of infant immunization sites in Benin, Ghana, Honduras, Moldova, Uganda and Zambia (316 total), we estimated average efficiency levels and variation in efficiency within each country, and investigated the properties of published efficiency estimation techniques. Methods: Using a dataset describing 316 immunization sites we estimated site-level efficiency using Data Envelopment Analysis (DEA), Stochastic Frontier Analysis (SFA), and a published ensemble method combining these two approaches. For these three methods we operationalized efficiency using the Sheppard input efficiency measure, which is bounded in (0, 1), with higher values indicating greater efficiency. We also compared these methods to a simple regression approach, which used residuals from a conventional production function as a simplified efficiency index. Inputs were site-level service delivery costs (excluding vaccines) and outputs were total clients receiving DTP3. We analyzed each country separately, and conducted sensitivity analysis for different input/ output combinations. Results: Using DEA, average input efficiency ranged from 0.40 in Ghana and Moldova to 0.58 in Benin. Using SFA, average input efficiency ranged from 0.43 in Ghana to 0.69 in Moldova. Within each country scores varied widely, with standard deviation of 0.18-0.23 for DEA and 0.10-0.20 for SFA. Input efficiency estimates generated using SFA were systematically higher than for DEA, and the rank correlation between scores ranged between 0.56-0.79. Average input efficiency from the ensemble estimator ranged between 0.41-0.61 across countries, and was highly correlated with the simplified efficiency index (rank correlation 0.81-0.92) as well as the DEA and SFA estimates. Conclusions: Results imply costs could be 30-60% lower for fully efficient sites. Such efficiency gains are unlikely to be achievable in practicesome of the apparent inefficiency may reflect measurement errors, or unmodifiable differences in the operating environment. However, adapted to work with routine reporting data and simplified methods, efficiency analysis could triage low performing sites for greater management attention, or identify more efficient sites as models for other facilities.

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Section: Introductionmentioning

confidence: 99%

The efficiency of routine infant immunization services in six countries: a comparison of methods

Menzies

Suharlim²,

Resch³

et al. 2020

Health Econ Rev

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“…Based on principles of stakeholder analysis approach [19][20][21], twelve in-depth interviews (IDIs) were conducted across four geographic regions in Burkina Faso, comprising both rural and urban areas in four districts purposefully selected based on 2016 administrative MCV2 coverage (Table 1). Two districts with low coverage (Koupela and Baskuy, < 50% MCV2 coverage) and two districts with high coverage (Mangodara and Ouahigouya, > 90% MCV2 coverage) were purposively selected based on administrative data collected by the Burkina Faso Ministry of Health.…”

Section: Methodsmentioning

confidence: 99%

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

et al. 2020

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Background: Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. Methods: Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. Results: Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15-to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage.

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“…To fully understand HRH policy making in Bangladesh, it is important to analyze the range of stakeholders involved and their potential influence, letting us assess the "behavior, intentions, interrelations, agendas, interests, and the influence or resources" of relevant actors concerning a particular policy or issue (Varvasovszky and Brugha 2000). In recent years, such stakeholder analysis has been applied to understand the politics of policy design and implementation in the context of health insurance premiums in Ghana, alcohol control policy in a Russian region, and maternal and child health programs in Uganda (Abiiro and McIntyre 2013;Gil et al 2010;Gilson et al 2012;Namazzi et al 2013;Sarr 2010).…”

Section: A Range Of Powerful Stakeholders Some With Competing Interestsmentioning

confidence: 99%

The Path to Universal Health Coverage in Bangladesh: Bridging the Gap of Human Resources for Health

El-Saharty¹,

Sparkes²,

Barroy³

et al. 2015

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World Bank Studies are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

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Efficiency of immunization service in the Gambia: Results of a stakeholder analysis

Cited by 3 publications

References 0 publications

The efficiency of routine infant immunization services in six countries: a comparison of methods

The efficiency of routine infant immunization services in six countries: a comparison of methods

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

The Path to Universal Health Coverage in Bangladesh: Bridging the Gap of Human Resources for Health

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