Abstract
BackgroundGavi, the Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January–February 2014.MethodsWe conducted a mixed-method process evaluation to understand the successes and challenges in implementation of the MRC. We reviewed documents for the MRC and the immunization programme in Bangladesh; observed meetings, vaccination sessions, and health facilities; and conducted 58 key informant interviews, 574 exit interviews with caregivers and 156 brief surveys with stakeholders involved in immunization. Our theory of Change for vaccination delivery guided our assessment of ideal implementation milestones and indicators to compare with the actual implementation processes.ResultsWe identified challenges relating to country-wide political unrest, administrative and budgetary delays, shortage of transportation, problems in registration of target populations, and fears about safety of the vaccine. Despite these issues, a number of elements contributed to the successful launch of the MRC. These included: the comprehensive design of the campaign; strong partnerships between immunization authorities in the government system, Alliance partners, and civil society actors; and motivated and skilled health workers at different levels of the health system.ConclusionsThe successful implementation of the MRC in spite of numerous contextual and operational challenges demonstrated the adaptive capacity of the national immunization programme and its partners that has positive implications for future introductions of Gavi-supported vaccines.
Highlights
Gavi, the Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January–February 2014
Process tracking, which was the primary means of monitoring the progress of the MRC implementation activities, compared the actual processes with the ideal processes defined in the Theory of Change
Political commitment for the MRC came from the highest levels of governance, as evidenced by the initiative taken by the Minister of the Ministry of Health and Family Welfare (MoHFW) in adjusting the MRC budget and releasing funds, which enabled minimum interruption campaign launch
Summary
The Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January–February 2014. Prior evaluations of MRCs in different countries have estimated vaccine coverage [2, 7], described immunization settings, and waste disposal procedures [5], assessed the quality of vaccine [12], and documented campaign outputs [4]. They called attention to a number of areas for improvement in campaign operations, including the need for pre-campaign meetings to foster strong coordination between national and district levels; timely training, workshops, and post-campaign review; planning for adequate logistics; micro-planning for sub-district and district levels; and types and duration of vaccination sessions [1, Sarma et al BMC Public Health (2019) 19:925. Some studies suggested that successful implementation of MRCs can be hampered by systemic challenges that include vaccine availability, political unrest, and inadequate training for health workers [2, 3, 13]
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