Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review

Abstract

<jats:title>Abstract</jats:title> <jats:p>Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.</jats:p>

Why don’t adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers

“…Thirdly, the inclusion of only girls attending public schools, limited subgroup comparison with girls attending private schools. Nevertheless, our results are consistent with findings reported by previous studies done in other low income settings [ 22 , 58 , 59 ] and raise many critical issues yet to be addressed.…”

“…We found low awareness of and knowledge about the vaccine among healthcare workers, VHTs, teachers, caregivers and the girls. Sub-optimal knowledge of the vaccine among similar stakeholders has been reported by other studies conducted in Sub-Saharan Africa [22]. What is troubling though, is that the consistently reported low knowledge levels is among healthcare workers and VHTs who have been identified as the most trusted source of vaccine information [23].…”

“…Secondly, the vaccine is newly introduced into the UNEPI and targets adolescents who are not the usual target for routine vaccination and therefore requires development of strategies and infrastructure to mobilize them. These unique characteristics call for stakeholder collaboration and resources from relevant government ministries including health, education and finance [ 22 ] and strengthening UNEPI to effectively deliver the HPV vaccine alongside infant and childhood vaccines. Also required is an intensive communication strategy with culturally appropriate messages to raise awareness about the HPV vaccine, change attitudes of communities about the vaccine and motivate caregivers to encourage their daughters to be vaccinated.…”

Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review

“…The introduction of national HPV immunization programs in countries in sub-Saharan Africa started in 2011 [ 2 ]. As of 2019, only 17 countries out of the 46 countries (37.0%) in sub-Saharan Africa had established nationwide HPV immunization [ 15 ]. Studies show that the HPV vaccine coverage is higher in Northern Africa (35.6%) than in sub-Saharan Africa (1.2%) [ 15 , 16 ].…”

“…As of 2019, only 17 countries out of the 46 countries (37.0%) in sub-Saharan Africa had established nationwide HPV immunization [ 15 ]. Studies show that the HPV vaccine coverage is higher in Northern Africa (35.6%) than in sub-Saharan Africa (1.2%) [ 15 , 16 ]. The difference in vaccine coverage between the 2 regions may account for the higher ASIR of cervical cancer in the latter than the former.…”