Drivers of Early Childhood Vaccination Success in Nepal, Senegal, and Zambia: A Multiple Case Study Analysis Using the Consolidated Framework of Implementation Research

Author:

Escoffery Cam1,Ogutu Emily Awino1,Sakas Zoe1,Hester Kyra A1,Ellis Anna1,Rodriguez Katie1,Jaishwal Chandni1,Yang Chenmua1,Dixit Sameer2,Bose Anindya3,Sarr Moussa4,Kilembe William5,Bednarczyk Robert A1,Freeman Matthew1ORCID

Affiliation:

1. Emory University School of Public Health

2. Center for Molecular Dynamics, Nepal

3. World Health Organisation: World Health Organization

4. Institut de Recherche en Sciences de la Santé: Institut de Recherche en Sciences de la Sante

5. Center for Family Health Research in Zambia

Abstract

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 277 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) 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 4) cosmopolitanism and 5) 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.

Publisher

Research Square Platform LLC

Reference39 articles.

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4. Critical success factors for routine immunization performance: A case study of Zambia 2000 to 2018;Micek K;Vaccine X,2022

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