Perceptions of the usefulness of external support to immunization coverage in Guinea-Bissau: a Delphi analysis of the GAVI-Alliance cash-based support

Abstract

Introduction: Although many countries have improved vaccination coverage in recent years, some, including Guinea-Bissau, failed to meet expected targets. This paper tries to understand the main barriers to better vaccination coverage in the context of the GAVI-Alliance (The Global Alliance for Vaccines and Immunisation) cash-based support provided to Guinea-Bissau. Methods:The analysis is based on a document analysis and a three round Delphi study with a final consensus meeting. Results: Consensus attributed about 25% of the failure to perform better to implementation problems; and about 10% to governance and also 10% to scarce resources. The qualitative analysis validates the importance of implementation issues and upgraded the relevance of the human resources crisis as an important drawback. The recommendations were balanced in their upstreamdownstream focus but were blind to health information issues and logistical difficulties. Conclusions: It is commendable that such a fragile state, with all sorts of barriers, manages to sustain a slow steady growth of its vaccination coverage. Not reaching the targets set reflects the inappropriateness of those targets rather than a lack of commitment of the health workforce. In the unstable context of countries such as Guinea-Bissau, the predictability of the funds from global health initiatives like the GAVI-Alliance seem to make all the difference in achieving small consistent health gains even in the presence of other major bottlenecks.

Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case

“…The lack of human resources, resulting in incomplete technical Cad. Saúde Pública 2023; 39(1):e00102922 teams and the closure of health centers nationwide, is a major obstacle 36 . However, our data show that maternal schooling level is a key factor that facilitates access to immunization.…”

Strategies to Reach Nomadic Children During Polio SIAs: Experience in Dadaab and Fafi Sub-Counties of Kenya after the 2013-2014 Polio Outbreak

“…In most of sub-Saharan Africa, access to health care services by nomads is poor compared to settled populations, and there is no satisfactory strategy devised yet to deliver proper health care to remote populations. Disease control programmes also often fail to reach migratory populations [4][5][6][7] . For example, a study among the settled and nomadic Rendille in Kenya revealed that all children >12 months of age in Korr village had full immunisation coverage, while among their nomadic counterparts immunisation coverage was 0% 8 .…”