Examining the structure and behavior of Afghanistan’s routine childhood immunization system using system dynamics modeling

Abstract

Purpose-The purpose of this paper is to demonstrate how public health and systems science methods can be combined to examine the structure and behavior of Afghanistan's routine childhood immunization system to identify the pathways through which health system readiness to deliver vaccination services may extend beyond immunization outcomes. Design/methodology/approach-Using findings from an ecological study of Afghanistan's immunization system and a literature review on immunization program delivery, the routine immunization system was mapped using causal loop diagrams. Next, a stock-and-flow diagram was developed and translated to a system dynamics (SD) model for a system-confirmatory exercise. Data are from annual health facility assessments and two cross-sectional household surveys. SD model results were compared with measured readiness and service outcomes to confirm system structure. Findings-Readiness and demand-side components were associated with improved immunization coverage. The routine immunization system was mapped using four interlinking readiness subsystems. In the SD model, health worker capacity and demand-side factors significantly affected maternal health service coverage. System readiness components affected their future measures mostly negatively, which may indicate that the reinforcing feedback drives current system-structured behavior.

Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health

“…Of the works identified focusing on early and middle childhood, obesity and nutrition was most studied. Other examples of early and middle childhood literature included studies on developmental disorders (Bernard et al, 1977 ; Lee et al, 2016 ; Sheldrick et al, 2016 ) and immunization (Rwashana et al, 2009 ; Schuh et al, 2017 ). Of those works addressing access to health services literature, several specifically spoke to workforce needs (Barber & Lopez-Valcarcel, 2010 , Ishikawa et al, 2013 , Wu et al, 2013 , Crettenden, McCarty et al 2014, McKibben et al, 2016 , De Silva, 2017 ) and STI-related services (Evenden et al, 2006 ; Hontelez et al, 2016 ; Kok et al, 2015 ; Viana et al, 2014 ; Zou et al, 2018 ).…”

“…Childhood obesity has also been a fruitful area for research crossover between MCH and SD; in this case, researchers may have been more comfortable using SD models because they are more common in the biomedical sciences. Collectively, these two fields of research (STI and childhood obesity) have only contributed thirty-five Pieters et al, 2011;Munar et al, 2015;Hernandez et al, 2016;Semwanga et al, 2016;Nadkarni et al, 2018, Pieters, van Oorschot et al 2018) End preventable deaths (Goal #3.2) 26 (Anderson & Anderson, 1998, Rwashana et al, 2009, Kumar & Kumar, 2014, Rwashana, Nakubulwa et al 2014, Munar et al, 2015, Batchelder & Lounsbury, 2016, Goncalves & Kamdem, 2016, Hontelez et al, 2016, Ozawa et al, 2016, Semwanga et al, 2016, Soler et al, 2016, Carrete et al, 2017, Page et al, 2017, Schuh et al, 2017, Shariatpanahi et al, 2017, Weeks et al, 2017, Meisel et al, 2018, Nadkarni et al, 2018, Owen et al, 2018, Tebbens & Thompson, 2018, Yourkavitch et al, 2018, Zou et al, 2018) End disease epidemics (Goal #3.3) 26 (Anderson & Anderson, 1998;Batchelder & Lounsbury, 2016;Batchelder et al, 2015;Evenden et al, 2006;Goncalves & Kamdem, 2016;Grove, 2015;Heidenberger & Flessa, 1993;…”

Using systems perspectives in evidence synthesis: A methodological mapping review

“…Sixteen included reviews used systems dynamics to build models to represent the dynamic complexity of a system. [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] In the included papers, the number of systems dynamics steps described to produce a systems model ranged from three to five. For most of the reviews using systems dynamics, the findings from the literature were generally useful for problem identification, hypothesis, and model formulation.…”

Dynamic Performance Management: An Approach for Managing the Common Goods

“…Childhood immunization [167] public health to examine the childhood immunization system to identify pathways of delivering vaccination…”

“…Childhood immunization [167] public health to examine the childhood immunization system to identify pathways of delivering vaccination Children overweight [168] micro (family) and macro (governmental policies) levels that need for reducing obesity and overweight Eco-friendly vans [169] eco-friendly vans for urban freight distribution…”