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Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

Resource type
Authors/contributors
Title
Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies
Abstract
There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance.
Publication
Health Policy and Planning
Pages
czu011
Date
2014-03-10
Journal Abbr
Health Policy Plan.
Language
en
DOI
10.1093/heapol/czu011
ISSN
0268-1080, 1460-2237
Short Title
Drivers of routine immunization coverage improvement in Africa
Accessed
2014-10-07T09:54:28Z
Library Catalog
Extra
PMID: 24615431
Citation
LaFond, A., Kanagat, N., Steinglass, R., Fields, R., Sequeira, J., & Mookherji, S. (2014). Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies. Health Policy and Planning, czu011. https://doi.org/10.1093/heapol/czu011