Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

Abstract

ObjectivesVaccination 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.DesignMultiple case study design using qualitative research methods.SettingThree countries with high routine immunisation rates: Nepal, Senegal, and Zambia.ParticipantsWe 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.ResultsOur 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.ConclusionsThroughout 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.

Drivers of success in global health outcomes: A content analysis of Exemplar studies

“…To date, the EGH program has studied, or is currently studying, 14 major global health topics, which are determined through an inclusive, consultative process to identify information needs from country governments, norm-setting bodies, and donors. These topics include under-five mortality reduction, childhood stunting reduction [8][9][10][11][12][13][14][15], community health workers, vaccine delivery [16][17][18][19][20][21][22][23][24][25][26], neonatal and maternal mortality reduction [27,28], COVID-19 response [29][30][31][32][33][34][35][36], primary health care, anemia among women of reproductive age, family planning, adolescent sexual and reproductive health and rights, women's health and wellbeing, digital health, diagnostics, and early warning systems for diseases with epidemic or pandemic potential (Fig 1). Each topic's consortium defines its own set of research questions about how its Exemplars https://doi.org/10.1371/journal.pgph.0003000.g001…”