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 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.

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

“…This qualitative study employed a descriptive content analysis approach to study key themes and patterns emerging from the EGH studies [ 37 – 47 ]. EGH studies used the positive deviance approach as described above; methods details have been published elsewhere [ 7 ] and in respective studies[ 9 – 14 , 21 , 22 , 24 – 26 , 28 , 36 ] We used purposive sampling, considering all completed EGH studies (N = 31) from June 2020 to May 2023 for inclusion in this analysis. Studies were excluded if validation of final results was ongoing or if research partners requested to independently publish findings prior to this study.…”

“…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…”