Monitoring equity in vaccination coverage: A systematic analysis of demographic and health surveys from 45 Gavi-supported countries

Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Rodríguez, José M. Mendoza; Hansen, Peter M.; Johri, Mira

doi:10.1016/j.vaccine.2016.12.041

Cited by 58 publications

(48 citation statements)

References 27 publications

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“…The monitoring and tracking of equity in health intervention coverage has been the focus of major international efforts. 140 Many studies 61,140,141 have shown that some population groups are systematically less likely to have access to or use health services for several conditions. However, there has been less work done on equity in the quality of care.…”

Section: Who Receives Worse Quality Care?mentioning

confidence: 99%

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

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The Lancet Global Health Commission and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts. In this Commission, we assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. Moving to a highquality health system-one that improves health and generates confidence and economic benefits-is primarily a political, not technical, decision. National governments need to invest in high-quality health systems for their own people and make such systems accountable to people through legislation, education about rights, regulation, transparency, and greater public participation. Countries will know that they are on the way towards a high-quality, accountable health system when health workers and policymakers choose to receive health care in their own public institutions. Components Quality impacts Better health Level and distribution of patient-reported outcomes: function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering Confidence in system Satisfaction, recommendation, trust, and care uptake and retention Economic benefit Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection Processes of care Competent care and systems Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, counselling, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management Positive user experience Respect: dignity, privacy, non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use Foundations Population Individuals, families, and communities as citizens, producers of better health outcomes, and system users: health needs, knowledge, health literacy, preferences, and cultural norms Governance Leadership: political commitment, change management; policies: regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioural architecture, and public health functions; financing: funding, fund pooling, insurance and purchasing, provider contracting and payment; learning and improvement: institutions for evaluation, measurement, and improvement, learning communities, and trustworthy data; intersectoral: roads, transport, wa...

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Section: Who Receives Worse Quality Care?mentioning

confidence: 99%

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

Self Cite

2,020

2,275

View full text Add to dashboard Cite

show abstract

“…About one in three countries have substantial coverage disparities associated with income level, with at least a 20% gap for DTP and MCV coverage between the richest and the poorest quintiles [ 18 ]. The disparities in coverage vary between and within countries and WHO Regions [ 17 ],and inequities persist in a large majority of Gavi-eligible countries [ 19 ]. Over the last 10 years, there has been considerable progress in improving equity in immunization coverage as the lowest wealth quintile and the least educated have seen the largest improvements in coverage.…”

Section: Discussionmentioning

confidence: 99%

State of equity: childhood immunization in the World Health Organization African region

Casey¹,

Hampton²,

Anya³

et al. 2017

Pan Afr Med J

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IntroductionIn 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region andto assess how these trends differ by country income category.MethodsWe compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015.ResultsDTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%.ConclusionDisparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets.

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“…1 Lack of vaccination has also impacted overall infant health, mortality, and gender equity. India ranks 163 among 223 countries in the world in terms of life expectancy at birth (Arsenault et al, 2017). There was inequity in uptake also, as Oster (2009) found that about 30% of the gender imbalance in mortality could be explained by differential access to vaccination.…”

Section: Introductionmentioning

confidence: 99%

Cash‐based maternal health interventions can improve childhood vaccination—Evidence from India

Timilsina

2020

Health Economics

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Childhood vaccination has lagged in countries like India, despite its demonstrated positive effects on health outcomes like infant mortality. At the same time, many conditional cash transfer programs have been effective in improving health outcomes. We estimate the effect of the world's largest maternal health program, Janani Suraksha Yojana (JSY, maternal protection scheme), on childhood vaccination in India. We exploit exogenous variations in the expansion of the policy around the country and the fact that some key vaccines are given at or near birth to identify the effects of cash‐based maternal health policy on infant immunization. We find that JSY increased the probability of Bacillus Calmette–Guérin (BCG) and diphtheria, pertussis, and tetanus toxoid (DPT) vaccination among newborns and infants. However, we find almost no significant effects on the measles vaccine, which is administered several months after birth.

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Monitoring equity in vaccination coverage: A systematic analysis of demographic and health surveys from 45 Gavi-supported countries

Cited by 58 publications

References 27 publications

High-quality health systems in the Sustainable Development Goals era: time for a revolution

High-quality health systems in the Sustainable Development Goals era: time for a revolution

State of equity: childhood immunization in the World Health Organization African region

Cash‐based maternal health interventions can improve childhood vaccination—Evidence from India

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