Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia
Objectives Vaccination 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 e...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/10/e070541.full |
| _version_ | 1797634671542009856 |
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| author | William Kilembe Matthew C Freeman Anna Ellis Robert Bednarczyk Zoe Sakas Moussa Sarr Kyra A Hester Sameer Dixit Emily A Ogutu Katie Rodriguez |
| author_facet | William Kilembe Matthew C Freeman Anna Ellis Robert Bednarczyk Zoe Sakas Moussa Sarr Kyra A Hester Sameer Dixit Emily A Ogutu Katie Rodriguez |
| author_sort | William Kilembe |
| collection | DOAJ |
| description | Objectives Vaccination 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.Design Multiple case study design using qualitative research methods.Setting Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.Participants We 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.Results Our 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.Conclusions Throughout 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. |
| first_indexed | 2024-03-11T12:10:54Z |
| format | Article |
| id | doaj.art-9381298f8dbc44e3af36ff7c8cf4580a |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T12:10:54Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-9381298f8dbc44e3af36ff7c8cf4580a2023-11-07T13:45:08ZengBMJ Publishing GroupBMJ Open2044-60552023-10-01131010.1136/bmjopen-2022-070541Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and ZambiaWilliam Kilembe0Matthew C Freeman1Anna Ellis2Robert Bednarczyk3Zoe Sakas4Moussa Sarr5Kyra A Hester6Sameer Dixit7Emily A Ogutu8Katie Rodriguez9Rwanda Zambia HIV Research Group, Emory University, Lusaka, ZambiaGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAInstitut de Recherche en Santé de Surveillance Epidemiologique et de Formation, Dakar, SenegalGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USACenter for Molecular Dynamics Nepal, Kathmandu, NepalGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAObjectives Vaccination 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.Design Multiple case study design using qualitative research methods.Setting Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.Participants We 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.Results Our 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.Conclusions Throughout 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.https://bmjopen.bmj.com/content/13/10/e070541.full |
| spellingShingle | William Kilembe Matthew C Freeman Anna Ellis Robert Bednarczyk Zoe Sakas Moussa Sarr Kyra A Hester Sameer Dixit Emily A Ogutu Katie Rodriguez Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia BMJ Open |
| title | Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia |
| title_full | Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia |
| title_fullStr | Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia |
| title_full_unstemmed | Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia |
| title_short | Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia |
| title_sort | critical success factors for high routine immunisation performance a qualitative analysis of interviews and focus groups from nepal senegal and zambia |
| url | https://bmjopen.bmj.com/content/13/10/e070541.full |
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