Action Plan Research Articles

Beyond symbolism: The roles of action planning and case-making in immigrant integration policymaking

Abstract How do city-level policymakers build support for substantive action in policy domains characterized by low levels of national salience and limited local capacity, and which evidentiary resources support as well as reflect these uses? Despite much attention to policymakers’ engagement with evidence, existing work tends to focus on domains where the issues at stake attract high levels of input and influence from central governments. This limits empirical and theoretical understanding of how local efforts to implement potentially contentious policies arise, and through which means. In response, we examine how municipal actors in 12 cities and regions across the UK have devised and communicated policies on immigrant integration—an area that lacks national policy inputs yet is locally consequential—through the mechanism of “action planning.” Drawing on 6 years’ worth of documentary evidence generated through a university-initiated collaboration with these municipalities, we show how action plans gather attention for objectives and propagate examples of practice to other cities—what we call “case-making.” This serves as a micro-foundation for the action planning mechanism, which links symbolic statements about immigrant integration with substantive intended actions.

Efficient brain tumor grade classification using ensemble deep learning models

Detecting brain tumors early on is critical for effective treatment and life-saving efforts. The analysis of the brain with MRI scans is fundamental to the diagnosis because it contains detailed structural views of the brain, which is vital in identifying any of its abnormalities. The other option of performing an invasive biopsy is very painful and uncomfortable, which is not the case with MRI as it is free from surgically invasive margins and pieces of equipment. This helps patients to feel more at ease and hasten the diagnostic procedure, allowing physicians to formulate and practice action plans quicker. It is very difficult to locate a human brain tumor by manual because MRI scans produce large numbers of three-dimensional images. Complete applicability of pre-written computerized diagnostics, affords high possibilities in providing areas of interest earlier through the application of machine learning techniques and algorithms. The proposed work in the present study was to develop a deep learning model which will classify brain tumor grade images (BTGC), and hence enhance accuracy in diagnosing patients with different grades of brain tumors using MRI. A MobileNetV2 model, was used to extract the features from the images. This model increases the efficiency and generalizability of the model further. In this study, six standard Kaggle brain tumor MRI datasets were used to train and validate the developed and tested model of a brain tumor detection and classification algorithm into several types. This work consists of two key components: (i) brain tumor detection and (ii) classification of the tumor. The tumor classifications are conducted in both three classes (Meningioma, Pituitary, and glioma) and two classes (malignant, benign). The model has been reported to detect brain tumors with 99.85% accuracy, to distinguish benign and malignant tumors with 99.87% accuracy, and to type meningioma, pituitary, and glioma tumors with 99.38% accuracy. The results of this study indicate that the described technique is useful in the detection and classification of brain tumors.

Co‐production of a vulnerability assessment for aquatic and riparian ecosystems in the southwestern United States

AbstractTo address impacts of climate change and other stressors on stream ecosystems, managers must prioritize resources and locations for conservation actions to facilitate effective cross‐boundary solutions. Through a science management partnership, we co‐produced a spatially explicit landscape assessment framework for cold‐water fish habitat and riparian corridors in three large watersheds of the southwestern United States. Using literature review and stakeholder workshops, we developed indicators of vulnerability and built spatial datasets depicting areas of low to high vulnerability based on exposure, sensitivity, and adaptive capacity for each resource. We found that, in general, vulnerability was greater for cold‐water fish habitat than for riparian corridors. The Little Colorado River and San Juan River watersheds had the highest percentages of subwatersheds with high vulnerability of cold‐water fish habitat. Conversely, the Upper Rio Grande watershed had the highest percentage with high vulnerability of riparian corridors. Assessments like ours facilitate the management of water resources at the scale of watersheds or river basins and incorporate physical characteristics, land‐use history, current management practices, and status of imperiled species into actionable management plans.

Improvizing West Java MSMEs Using Quality Service Gaps Model

This study aims to understand the challenges and opportunities for the development of Micro, Small and Medium Enterprises (MSMEs) in West Java. With a very large number, MSMEs in West Java have great potential to drive economic growth. However, various obstacles such as access to capital, information, and technology are still an obstacle. This research proposes the application of the Service Science framework to map the MSME ecosystem and identify opportunities for service innovation. Thus, it is expected to increase the competitiveness of MSMEs and make a greater contribution to the regional economy. This research reveals that MSMEs in West Java face significant constraints in terms of access to capital, information, and technology. Through in-depth interviews with 8 MSME owners, this research aims to understand in-depth the challenges and opportunities faced by micro, small and medium enterprises. Thematic analysis of the interview data identified a gap between the ideal conditions that MSMEs desire and the actual conditions they experience. Using the Service Quality Gap Model, this study created four action plans to improve MSMEs in West Java. By addressing the identified gaps and encouraging collaboration between MSMEs, government, academia and industry, the Sadulur platform can catalyze the sustainable growth and development of MSMEs in West Java. These gaps, which we refer to as 'customer gaps', are manifested in four main themes: 1) the potential for MSMEs to create innovative products more easily, 2) the need to develop a strong business foundation and build sustainable brand value, 3) the importance of improving business processes and management to increase efficiency, and 4) the need to build good relationships with external parties to expand networks and business opportunities. These findings form the basis for formulating an action plan to improve the quality of services provided to MSMEs.

How to manage performance issues in nursing practice.

Addressing performance issues in nursing practice is a crucial but sensitive aspect of the role of nurse leaders and managers. This article explains how they can undertake this process by using a supportive and proactive approach that can foster a positive work environment, improve patient care and empower nurses to thrive in practice. Those involved in addressing a nurse's performance issues must have the knowledge and skills required to do so effectively with sensitivity and care, while working within their level of competence. • Where performance issues have been identified, early intervention is essential to foster constructive dialogue, preserve relationships and maintain a motivated and productive healthcare team. • The focus should be on understanding what aspects of the nurse's performance require improvement, what has been learned from the situation and how this can be applied to the nurse's future practice. • It is useful to work with the nurse to develop a collaborative action plan for improvement that establishes clear goals, timelines and resource allocation. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • A time you addressed performance issues with a colleague or team member, or how someone helped you to improve your practice. • How you could use this information to develop your knowledge and skills in addressing performance issues.

An antimicrobial resistance gene situationer in the backyard swine industry of a Philippine City

Antimicrobial resistance (AMR) as a result of antimicrobial overuse and misuse in agriculture is a growing concern, especially in the predominant but poorly regulated backyard or smallholder swine farms of the Philippines. A city-scale surveillance of antimicrobial resistance genes (ARGs) was conducted through selected backyard swine farms to obtain a comprehensive understanding of the AMR situation in the backyard sector of Davao City, Philippines. The ARGs encoding resistance to four antimicrobial classes (β-lactams: blaCTX−M, blaOXA, blaSHV, blaTEM, mecA; quinolones: qnrS and qnr-A2; macrolides: ermA and ermB; tetracycline: tetM) were quantified in swine feces via real-time PCR, and point maps were generated to visualize the ARG geographic distribution. The ARGs bla-TEM, ermB, qnrS, and tetM were detected in all farms at relatively intermediate to high levels, consistently representing the four most used antimicrobial classes in Philippine farms. All the investigated ARGs were present in some local barangay units, indicating potential emergence of AMR hotspots. A 0.5 quantile regression analysis identified specific backyard farm attributes associated with ARG occurrence and diversity, which may influence the ecological spread of the ARGs. These findings provide support for evidence-based guidelines to reinforce a One Health framework for the Philippine National Action Plan to Combat AMR.

Tourism Student Satisfaction with Extra-curricular Activities in a Public Higher Education Institution in the Philippines

Higher education institution (HEI) is viewed as a significant driver of individual and national prosperity. HEI in the Philippines like Mindoro State University (MinSU), the only university in the province, delivers student development services that are designed for the exploration, enhancement, and development of the student’s full potential for personal growth, leadership, and social responsibility through various institutional and student-initiated activities. Recognizing this, MinSU is focusing on meeting its students’ needs, expectations, and satisfaction, the ultimate beneficiaries of the educational experience. This study assessed the satisfaction of tourism management students with extra-curricular activities (ECAs) during the academic year 2023-2024. Employing a mixed-methods approach, the study utilizes a quantitative survey to gauge overall satisfaction and identify areas of strength and weakness. Additionally, qualitative interviews provide an in-depth exploration of student experiences, allowing them to articulate the “why” behind their satisfaction levels and let them make recommendations. Findings show students prioritized participation in cultural ECAs that provided opportunities to showcase their talents and creativity, contributing to reduced academic stress. Additionally, to improve student preparedness, the Council of Tourism Students Organization might consider a phased implementation of the existing SCALE program for the next semester. This study provides the factors that contribute to student satisfaction with ECAs, ultimately for the development of more engaging and enriching action plans that enhance the holistic experience towards student-initiated activities for lifelong learners as the future tourism industry workforce.

Planning national potential: Israel defense forces and the question of the Arab minority during wartime

ABSTRACT Since modern warfare is not only tanks, planes and soldiers, but also a total war between nations, their current and potential economies, their material forces and mental capacities, planning a war comes down to the creation and organization of the country’s overall combatant potential for military use. After the end of the War of Independence and the establishment of the State of Israel, approximately 160,000 Arabs remained in its territory. This minority was perceived as a fifth column at that time that could endanger the security of the State. To devise proactive countermeasures, the IDF Planning Department began discussing what steps should be taken regarding the Arab minority in the case of future war to neutralize this potential threat. The basic principles, which were later formulated into strategic and operative plans of action, were also influenced by the understanding that Israel is a democratic State, and that there are constraints and political considerations bounding these steps. The Planning Department also considered that in some ways this minority could be used to strengthen the national potential.

Multi-modal scene graph inspired policy for visual navigation

Visual navigation needs the agent locate the given target with visual perception. To enable robots to effectively execute tasks, combining large language models (LLMs) with multi-modal inputs in navigation is necessary. While LLMs offer rich semantic knowledge, they lack specific real-world information and real-time interaction capabilities. This paper introduces a Multi-modal Scene Graph (MMSG) navigation framework that aligns LLMs with visual perception models to predict next steps. Firstly, a multi-modal scene dataset is constructed, containing triplets of object-relations-target words. We provide target words and lists of existing objects in the scene to generate a large number of instructions and corresponding action plans for GPT-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}3.5. The generated data is then utilized for pre-train LLM for path planning. During inference, we discover objects in the scene by extending the DETR visual object detector to multi-view RGB image collected from different reachable positions. Experimental results show that path planning generated from MMSG outperforms state-of-the-art methods, indicating its feasibility in complex environments. We evaluate our methods on the ProTHOR dataset and show superior navigation performance.

An integrated dataset of ground hydrothermal regimes and soil nutrients monitored in some previously burned areas in hemiboreal forests in Northeast China during 2016–2022

Abstract. Under a warming climate, the occurrence of wildfires has been becoming increasingly more frequent in boreal forests and Arctic tundra over the last few decades. Wildfires can cause radical changes in forest ecosystems and the permafrost environment, such as the irreversible degradation of permafrost, succession of boreal forests, rapid and massive losses of soil carbon stock, and increased periglacial geohazards. Since 2016, we have gradually and more systematically established a network for studying soil nutrients and monitoring the hydrothermal state of the active layer and near-surface permafrost in the northern Da Xing'anling Mountains in Northeast China. Soil moisture content (depth of 0–9.4 m), soil organic carbon content (0–3.6 m), total nitrogen content (0–3.6 m), and total phosphorus and potassium content (0–3.6 m) datasets were obtained in 2016 via field sampling and subsequent laboratory tests. Ground temperature (0–20 m) and active layer thickness (2017–2022) datasets were obtained using thermistor cables that were permanently installed in boreholes or interpolated with these temperatures. The present data can be used to simulate changes in permafrost features under a changing climate and wildfire disturbances and to explore the changing interactive mechanisms of the fire–permafrost–carbon system in hemiboreal forests. Furthermore, they can provide baseline data for studies and action plans to support the carbon neutralization initiative and assessment of the ecological safety and management of the permafrost environment. These datasets can be easily accessed via the National Tibetan Plateau/Third Pole Environment Data Center (https://doi.org/10.11888/Cryos.tpdc.300933, Li and Jin, 2024).

On-Farm Production of Renewable Energy in 2014–2022

The main purpose of this study is to present family farms as consumers and producers of renewable energies which provide them with an opportunity to reduce operating costs. The time scope of the study is 2014–2022, and the Farm Accountancy Data Network is used as the data source. The following research methods were employed: comparative and descriptive analysis, intensity indicators, ranking assignment and panel regression. Based on the values of energy output and energy costs, the rankings revealed a strong position of the Netherlands and Germany. As demonstrated by the study, energy production and consumption volumes depend on the farms’ economic size, but are not impacted by production type. Another finding is that energy production covers only one-third of its costs. Also, both production volumes and costs were on a growth path on a year-over-year basis, with similar growth ratios. The European Union’s leaders in energy consumption and production are the Netherlands, Germany, Belgium, Denmark, Czech Republic, Hungary, Luxembourg, Slovakia and Sweden. The study included the structuring of panel models for energy output and costs and identified their determinants. Energy output depends on total inputs and grows as they grow. Energy costs, in turn, are related to utilized agricultural area, total output and family farm income. An important limitation of this study is that FADN is a provider of high-level data. Hence, it is impossible to tell what specific sources of renewable energy are used by farms, and how they are affected by such exogenous factors as climate, earmarked subsidies or energy policy. The findings from this study are discussed in the context of the European Commission’s recommendations laid down in the Bioeconomy Strategy of the EU (2013), the Seventh Environment Action Program, the New Innovation Agenda of the European Union, the Report “Transforming Our World: the United Nations 2030 Agenda for Sustainable Development” and the Circular Economy Action Plan.

A metamodel for sensitivity and uncertainty analysis in the modeling of loss of life due to dam failures

ABSTRACT Estimating the loss of life resulting from dam failures is required for devising emergency action plans and strategies for alert issuance and evacuation. However, current models for simulating fatalities are computationally expensive, forced by highly uncertain variables, and not readily interpretable, which may limit their use in engineering and research. For circumventing these problems, we utilize the polynomial chaos expansion technique (PCE) for approximating the loss of life as obtained from the agent-based model LifeSim and propagating uncertainty of inputs, namely, alerted population, mobilized population, alert issuance, and hazard identification, to the model responses. We also benefit from the PCE spectral representation for assessing the effects of each input in the loss of life associated with the dam failure in an urban area in Brazil, considering efficient and inefficient scenarios for alert and evacuation. The PCE error ranged from 10–3 to 10–2, and the mean squared error between the metamodel output and LifeSim was between two fatalities. In global sensitivity analysis, the variables alert issuance and hazard identification contributed the most to the number of fatalities. These findings provide objective guidelines for implementing more effective safety measures, potentially reducing loss of life resulting from a dam break in the study area.

Assessment of Socioeconomic Vulnerability in Selected Villages of Gosaba Block, Sundarban, India Using an Artificial Neural Network

The Indian Sundarban represent an endangered ecosystem with a distinct biogeographical composition. It is susceptible to natural disasters like storms, floods, and cyclones, hence jeopardizing its socioeconomic systems due to environmental stresses. This study aimed to evaluate the present socioeconomic vulnerability, identify key factors that exacerbate this vulnerability, and validate these factors using an Artificial Neural Network (ANN) prediction model. Researchers also wanted to validate this evaluation with ANN to promote substantive discussions between researchers, local authorities, and stakeholders. Comprehensive reviews and successful adaption plans will improve. The study conducted in selected villages with 160 households in the Gosaba Block, located on the periphery of the Sundarban. The present study employed an integrated vulnerability approach, calculating the exposure, adaptive capacity, and sensitivity index by weighting the initial eigenvalues of each indicator with a variance percentage through principal components analysis (PCA). Based on this criterion, 156 households (97.5%) exhibited an extremely high vulnerability score, while 4 households (2.5%) displayed a moderate vulnerability grade. The villages of Pakhiralay and Lahiripur exhibit significant vulnerability, with a markedly deficient adaptive capacity. The villages of Mathurakhand, Kumirmari, and Satjelia exhibit vulnerability alongside moderate adaptation capacity. All are priority villages, however, Villages with moderate adaptive capacity may become less vulnerable with adequate interventions Proximity to market strongly affects MLP neural networks' assessment of environmental, economic, and social variables' effects on exposure, sensitivity, and adaptive capacity. Respondent age, family size, social network, storm surges, supplementary sources of household income Dwelling years, temperature, embankment failure, and income greatly affect model performance. A policy initiative should prioritize the enhancement existing social and financial capital, facilitate access to local government, and promote community-oriented activities. National disaster, social welfare, and resource management strategies need separate action plans. The national government is also encouraged to decentralize governance to enable local governments to achieve their goals.

The Proposal of Integrated Actions in Transport as Part of a Climate Action Plan for UNICAMP

Since 2019, the State University of Campinas (UNICAMP) has been collecting data, preparing, and annually monitoring sustainability indicators submitted to the UI GreenMetric ranking, which guide improvement projects at the university in alignment with the Sustainable Development Goals (SDGs). This article aims to propose sustainable practices for managing urban mobility on its campuses, drawing inspiration from the experiences of national and international universities that ranked highest in the 2023 edition of the aforementioned ranking. The study employed both qualitative and quantitative research methods, using a descriptive approach combined with Deductive Content Analysis (DCA). This analysis was further validated by the Multi-Criteria Decision-Making (MCDM) method known as Fuzzy SWARA. Through this process, the study identified the most commonly adopted actions by universities: promoting the use of electric and/or conventional bicycles on campus (11.8%); projects in partnership with government, state, or municipal entities to develop express cycle paths and encourage bicycle use both on campus and in the city (9.2%); conventional bicycle rental on campus (9.2%); and electric car sharing on campus (9.2%). The proposals suggested for UNICAMP include encouraging carpooling, implementing a public transportation exemption or half-fare program for employees, promoting the use of bicycles while ensuring increased campus security, among other initiatives. This research is part of a proposal for a Climate Action Plan for the university, which aims to effectively integrate sustainability into the university's agenda and support the fight against the climate emergency through necessary adaptations.

Assessing community awareness and participation in health facility governing committees in two districts of Tanzania: a cross-sectional study

BackgroundTanzania has been promoting community participation in health, either directly or through health facility governing committees (HFGCs), as part of its wider, ongoing health system reforms since the 1990s. Although some studies have assessed the functioning of the HFGCs, little is known about community knowledge and involvement in their activities.MethodsA cross-sectional survey assessing community awareness and participation in HFGCs was conducted between July and October 2022, involving two rural districts of Tanzania, which were selected based on their performance: Handeni, showing low performance and Mbarali, high performance. A total of 1,184 household heads living in the catchment areas of diverse facilities were involved. Frequencies and percentages were calculated overall and by district. The Chi-squared test was applied to assess statistically significant differences in knowledge, awareness, and participation between the districts.ResultsThe results revealed that 85.3% of the participants were unaware of the presence of the HFGCs and 91.7% did not know their roles. Additionally, 87% had neither heard nor seen any announcement about the selection of committee members. Only 14.5% considered that HFGCs were accountable to the community. While 96.7% of the respondents said they had never received any feedback from the HFGCs, only 8.1% reported that HFGCs were collecting views from the community. Regarding participation, 79.9% believed that the community had not been supporting their activities; however, 44.7% believed that the committees were important in improving health service delivery. Feedback and support were more common in Handeni.ConclusionThe level of community awareness of and participation in HFGCs was very low in both districts. The Ministry of Health and the President’s Office of Regional Administration and Local Government should implement an action plan to raise community awareness of the role of the HFGCs and their significance in promoting social accountability within the Tanzanian health system.

An action plan to improve organizational health literacy in hospitals in the Czech Republic

Abstract Background The National Institute for Health Literacy conducted in 2023 as part of the M-POHL network and in close collaboration with the team of the Klaudian Hospital a survey on the level of organizational health literacy using the OHL-Hos tool. The OHL-Hos tool was proven by the project implementation team as suitable for initiating and monitoring organizational change. Methods Based on the self-assessment and the results of the consensus workshop, the project implementation team identified development priorities that were submitted and approved by the hospital management. To keep the sustainability of the implementation, the hospital management decided to formulate an action plan, with the time horizon 2025. Results The proposed action plan, approved by hospital management, focuses on feasible measures within a given time horizon. For each development goal, responsible teams, time frames, and expected results were formulated. The implementation project team evaluated as the most innovative standard the standard dealing with internal communication with patients and their family after discharge and thus to ensure the continuity in supporting personal health literacy of patients and relatives. In addition, as further important standards, easy navigation and access to documents, materials, and services for patients and healthcare professionals were recognized. Interventions focusing on public education, especially for children and students of all school levels, have been proposed to enhance external communication and increase health knowledge in the region. Conclusions The process of regular OHL assessment of set up measures has been considered as a way how to ensure the long-term fulfilment of the newly adopted action plan by the hospital.

Pre-Service Science Teachers’ Conceptual Integration Understandings in Explaining the Subject of Metabolism with the Concepts of Physics and Chemistry

This study focuses on exploring pre-service science teachers’ conceptual integration understandings in explaining the subject of metabolism with the concepts of physics and chemistry. Action research was employed in this study. Nine pre-service science teachers taking the General Biology II course participated. Participants were taught metabolism considering conceptual integration. Data were collected via paper-and-pencil questionnaire administered before and after the intervention. The results showed that the pre-service science teachers could not understand physics and chemistry concepts at a sufficient level while explaining metabolism. Although the activities and practices were executed for conceptual integration in the action plan, only three participants achieved complete conceptual understanding for better conceptual integration at the end of the course in the first question. Thus, future studies could design interventions to be effective in conceptual integration. Further research could also design experimental investigations to examine how conceptual integration is necessary for establishing the relationship between science and other fields.

How to improve the inclusion of the elderly in the local community for better mental health?

Abstract Issue/problem Social exclusion, ageism and low health/digital literacy intertwine with growing trends in mental disorders, including abuse in Slovenian elderly. To cope with these issues, besides rising competencies, there is a need for stable and continuous partnerships of all relevant stakeholders in the local communities. Description of the problem Despite previous efforts of the Interdisciplinary Working Group (IWG) for mental health promotion in the elderly (established according to the Resolution of the National Mental Health Program, 2018-2028), there was a need for reconsidering approaches in the next Action plan (2024-2028). A national conference on decreasing social exclusion in the elderly contributed as a road map. Results Previous activities (events in the local communities, supported materials) were upgraded with a broad destigmatization campaign, (recruitment of the >>ambassadors <<) and collection of culturally adapted good practices. Better availability of information through >>info-spots << and easier participation of the elderly in cultural events was enabled. Activities of the reinforced IWG were promoted. Lessons Empowerment of key actors and their continuous cooperation could improve information flow, competencies, the inclusion of the elderly in the local community, and decrease ageism and discrimination. Developing local strategies with the crucial involvement of elderly representatives is the opportunity for more intensive and better cooperation between local policy/stakeholders, public health experts, and the target population. Regular financial support will prevent additional inequities. Key messages • The empowered, connected, and proactive community is key to preventing the elderly’s exclusion. • Approaches should be fresh, accessible, and tailored to the heterogeneous population.

A guide for policy and decision makers on health literacy policies

Abstract Supported by supranational organizations such as the WHO or the European Union, governments across the world have begun to work systematically on developing and implementing action plans, strategies and policies to improve the health literacy of their citizens and the health literacy friendliness/responsiveness of health organizations. In 2023, a first project on evidence-based policies and practices was initiated by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and financially supported by the Swiss Ministry of Health. In this project a guide on how health literacy policies can be developed and implemented was developed by an international working group. This guide brings together insights from existing literature on national health literacy strategies, action plans and interventions, including an expert snowball search within the M-POHL network and among other partners, experiences and case examples collected from M-POHL members and other countries. Feedback on the guide was collected in interactive webinars with policy representatives and decision-makers and addressed. The structure of the guide follows an adapted version of the Public Health Action Cycle model, assisting step-by-step action on health literacy policy development: situation analysis; agenda setting; developing policies, strategies and interventions; implementation; evaluation and monitoring. Each phase is described, and best practices and recommendations provided. The guide closes with a checklist for self-assessment which follows the structure of this document. It supports reflection on the state of policies in a country. This innovative guide contributes to supporting evidence-informed policies and practice. This can be of interest to experts and practitioners who have data on challenges relating to the health literacy levels of population groups and who wish to develop or adjust their policies, services and communications accordingly.

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.