Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research
Abstract Introduction The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies — including the facilitators and barriers — contribute to improvements in childhood vaccination coverage. The pu...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-023-00489-1 |
| _version_ | 1797559433215082496 |
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| author | Cam Escoffery Emily Awino Ogutu Zoe Sakas Kyra A. Hester Anna Ellis Katie Rodriguez Chandni Jaishwal Chenmua Yang Sameer Dixit Anindya Bose Moussa Sarr William Kilembe Robert A. Bednarczyk Matthew C. Freeman |
| author_facet | Cam Escoffery Emily Awino Ogutu Zoe Sakas Kyra A. Hester Anna Ellis Katie Rodriguez Chandni Jaishwal Chenmua Yang Sameer Dixit Anindya Bose Moussa Sarr William Kilembe Robert A. Bednarczyk Matthew C. Freeman |
| author_sort | Cam Escoffery |
| collection | DOAJ |
| description | Abstract Introduction The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies — including the facilitators and barriers — contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success. Methods We conducted 278 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) constructs of inner and outer settings to identify immunization program key facilitators and barriers. Results We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of (1) networks and communications, (2) goals and feedback, (3) relative priority, and (4) readiness for implementation and outer setting constructs of (5) cosmopolitanism and (6) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients’ needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies. Conclusion Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination. |
| first_indexed | 2024-03-10T17:45:23Z |
| format | Article |
| id | doaj.art-de3e972aee7042a2b67ed35f639833d1 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-03-10T17:45:23Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-de3e972aee7042a2b67ed35f639833d12023-11-20T09:34:45ZengBMCImplementation Science Communications2662-22112023-09-014111410.1186/s43058-023-00489-1Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation ResearchCam Escoffery0Emily Awino Ogutu1Zoe Sakas2Kyra A. Hester3Anna Ellis4Katie Rodriguez5Chandni Jaishwal6Chenmua Yang7Sameer Dixit8Anindya Bose9Moussa Sarr10William Kilembe11Robert A. Bednarczyk12Matthew C. Freeman13Rollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityCenter for Molecular Dynamics NepalWHO Nepal Immunization Preventable Disease DivisionInstitut de Recherche en Santé de Surveillance Epidemiologique Et de Formation (IRESSEF)Center for Family, Health Research in ZambiaRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityAbstract Introduction The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies — including the facilitators and barriers — contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success. Methods We conducted 278 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) constructs of inner and outer settings to identify immunization program key facilitators and barriers. Results We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of (1) networks and communications, (2) goals and feedback, (3) relative priority, and (4) readiness for implementation and outer setting constructs of (5) cosmopolitanism and (6) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients’ needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies. Conclusion Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination.https://doi.org/10.1186/s43058-023-00489-1Childhood immunizationExemplarsImplementation scienceRoutine immunizationImmunization coverage |
| spellingShingle | Cam Escoffery Emily Awino Ogutu Zoe Sakas Kyra A. Hester Anna Ellis Katie Rodriguez Chandni Jaishwal Chenmua Yang Sameer Dixit Anindya Bose Moussa Sarr William Kilembe Robert A. Bednarczyk Matthew C. Freeman Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research Implementation Science Communications Childhood immunization Exemplars Implementation science Routine immunization Immunization coverage |
| title | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
| title_full | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
| title_fullStr | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
| title_full_unstemmed | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
| title_short | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
| title_sort | drivers of early childhood vaccination success in nepal senegal and zambia a multiple case study analysis using the consolidated framework for implementation research |
| topic | Childhood immunization Exemplars Implementation science Routine immunization Immunization coverage |
| url | https://doi.org/10.1186/s43058-023-00489-1 |
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