Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

Dadari, Ibrahim; Higgins-Steele, Ariel; Sharkey, Alyssa; Charlet, Danielle; Shahabuddin, Asm; Nandy, Robin; Jackson, Debra

doi:10.1016/j.vaccine.2021.03.044

Cited by 25 publications

(41 citation statements)

References 27 publications

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“…3 ). Nine publications identified potential interventions for recommendation, however they were not evaluated to determine their effectiveness (n = 9) [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] . In summary, the most frequently mentioned interventions involved training community members as vaccination advocates (n = 8); engaging hard-to-reach communities (n = 8); reminders for follow-up appointments (n = 5); and health education to increase vaccine awareness (n = 4).…”

Section: Resultsmentioning

confidence: 99%

Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges

Mahachi

Kessels²,

Boateng

et al. 2022

Vaccine

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Section: Resultsmentioning

confidence: 99%

Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges

Mahachi

Kessels²,

Boateng

et al. 2022

Vaccine

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“…Gender transformative approaches, therefore, must focus on shifting power imbalances and addressing social norms, beliefs, and attitudes which create and sustain discriminatory policies and practices across sectors. Gender-transformative approaches can include supporting interventions that distribute household responsibilities among both parents, supporting fathers to be engaged in child care and seeking health services for children, ensuring equitable payments among health professionals, ensuring equitable access to and utilization of educational opportunities, ensuring equal representation of women and men in decision making positions, and prevention of sexual assault and harassment in the health sector [ 10 , 51 ]. These approaches are described in detail in the report Why Gender Matters: Immunization Agenda 2030 [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

The Association between Childhood Immunization and Gender Inequality: A Multi-Country Ecological Analysis of Zero-Dose DTP Prevalence and DTP3 Immunization Coverage

et al. 2022

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This study explores the association between childhood immunization and gender inequality at the national level. Data for the study include annual country-level estimates of immunization among children aged 12–23 months, indicators of gender inequality, and associated factors for up to 165 countries from 2010–2019. The study examined the association between gender inequality, as measured by the gender development index and the gender inequality index, and two key outcomes: prevalence of children who received no doses of the DTP vaccine (zero-dose children) and children who received the third dose of the DTP vaccine (DTP3 coverage). Unadjusted and adjusted fractional logit regression models were used to identify the association between immunization and gender inequality. Gender inequality, as measured by the Gender Development Index, was positively and significantly associated with the proportion of zero-dose children (high inequality AOR = 1.61, 95% CI: 1.13–2.30). Consistently, full DTP3 immunization was negatively and significantly associated with gender inequality (high inequality AOR = 0.63, 95% CI: 0.46–0.86). These associations were robust to the use of an alternative gender inequality measure (the Gender Inequality Index) and were consistent across a range of model specifications controlling for demographic, economic, education, and health-related factors. Gender inequality at the national level is predictive of childhood immunization coverage, highlighting that addressing gender barriers is imperative to achieve universal coverage in immunization and to ensure that no child is left behind in routine vaccination.

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“… Relevant countries included in both studies were primarily conflict-affected, with significant and ongoing disruption to health service delivery. [ 55 , 56 ] Service integration Mobile Health Teams Adaptive Improvements in coverage for selected antigens over time but with variations across population groups. Both interventions applied in conflict-affected settings.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies considered health financing interventions that ranged in focus from adaptive capacity building, to potentially transformative activities. These included two that looked at macro-level financing -specifically the value or otherwise of development aid in promoting improved health outcomes, including for vaccination, and system-strengthening in Gavi supported countries [55,56]; one study that considered private sector provider engagement in RI provision [54]; and four that considered in one way or another improvements to local level incentives for vaccination delivery [50][51][52][53]. Of these four, three studies considered explicit incentivisation to facilities or health workers via pay for performance (P4P) [50][51][52]; and one considered improvements to disbursement of programme funds to local level to promote vaccination delivery as a means of reducing the risk of delayed payment to healthcare workers (HCWs) [53].…”

Section: Health Financingmentioning

confidence: 99%

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

Ismail

Lam

Bell

et al. 2022

BMC Health Serv Res

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Background Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises. Methods Realist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised. Results 50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited. Conclusion A number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge.

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Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

Cited by 25 publications

References 27 publications

Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges

Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges

The Association between Childhood Immunization and Gender Inequality: A Multi-Country Ecological Analysis of Zero-Dose DTP Prevalence and DTP3 Immunization Coverage

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

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