Immunization Service Delivery Research Articles

Assessing the incremental costs and savings of introducing electronic immunization registries and stock management systems: evidence from the better immunization data initiative in Tanzania and Zambia.

IntroductionPoor data quality and use have been identified as key challenges that negatively impact immunization programs in low- and middle-income countries (LMICs). In addition, many LMICs have a shortage of health personnel, and staff available have demanding workloads across several health programs. In order to address these challenges, the Better Immunization Data (BID) Initiative introduced a comprehensive suite of interventions, including an electronic immunization registry aimed at improving the quality, reliability, and use of immunization data in Arusha Region, Tanzania, and Southern Province of Zambia. The objective of this study was to assess the incremental costs of implementing the BID interventions in immunization programs in these two countries.MethodsWe conducted a micro-costing study to estimate the economic costs of service delivery and logistics for the immunization programs with and without the BID interventions in a sample of health facilities and district program offices in each country. Structured questionnaires were used to interview immunization program staff at baseline and post-intervention to assess annual resource utilization and costs. Cost outcomes were reported as annual cost per facility, cost per district and changes in resource costs due to the BID interventions (i.e., costs associated with health worker time, start-up costs, etc.). Sub-group analyses were conducted by health facility to assess variation in costs by volume served and location (rural versus urban). One-way sensitivity analyses were conducted to identify influential parameters. Costs were reported in 2017 US dollars.ResultsIn Tanzania, the average annual reduction in resource costs was estimated at US$10,236 (95% confidence interval: $7,606-$14,123) per health facility, while the average annual reduction in resource costs per district was estimated at $6,542. In Zambia, reductions in resource costs were modest at an estimated annual average of $628 (95% confidence interval: $209-$1,467) per health facility and $236 per district. Resource cost reductions were mainly attributable to reductions in time required for immunization service delivery and reporting. One-way sensitivity analyses identified key cost drivers, all related to reductions in health worker time.ConclusionThe introduction of electronic immunization registries and stock management systems through the BID Initiative was estimated to result in potential time savings in both countries. Health worker time was the area most impacted by the interventions, suggesting that time savings gained could be utilized for patient care. Information generated through this work provides evidence to inform stakeholder decision-making for scale-up of the BID interventions in Tanzania and Zambia and to inform other Low-to-Middle-Income Countries (LMICs) interested in similar interventions.

Facility Readiness for Childhood Routine Immunization Services in Primary Healthcare Centres in Benin City, Edo State, Nigeria

Background and objective of study: immunization remains an essential strategy for reducing mortalities and morbidities due to vaccine preventable diseases. Immunization service delivery is dependent on planning of immunization sessions, and Supervision of the immunization process as this is very important in order to achieve immunization coverage target.Materials and Methods: A descriptive cross sectional study was utilised. This was done using an observational check list guide which was developed by the researcher and utilised for assessment of facility readiness for routine immunization service delivery. It was used to assess the facilities, amenities and logistics utilised in the immunization services process and also the functionality of the amenities. It was utilised in 35 Primary health care centres in the 3 Local Government Areas.Results: Thirty two (91.4%) had sufficient staff offering immunization and 22 (62.9%) had sufficient seats for clients. All the facilities had supervisory visits by the government. Thirty three (94.3%) had health talks before immunization and 25 (71.4%) had an alternate functional source of power supply readily availableConclusion: Only 3 of the PHCs were ready for routine immunization service delivery while 32 were partially ready for immunization

Exploring Factors Influencing Immunization Utilization in Nigeria-A Mixed Methods Study.

Background: In 2005, Nigeria adopted the Reach Every Ward strategy to improve vaccination coverage for children, 0–23 months. By 2015, Ogun state had full coverage in 12 of its 20 local government areas but eight had pockets of unimmunized children, with the highest burden (37%) in Remo-North. This study aimed to identify factors in Remo-North influencing the use of immunization services, in order to inform intervention approaches to tackle barriers to immunization utilization.Methods: We carried out a cross-sectional study using mixed methods including a survey of caregivers of 215 children, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community men and women (n = 98). Two wards (Ilara and Ipara) were purposively chosen for the study. Data was analyzed using the SAGE Working Group Vaccine Hesitancy model.Results: Only 56 children (32.6%) of the 172 children over 9 months of age had immunization cards available for inspection. Of these, 23 (59.6%) were fully immunized, noticeably higher in Ipara than Ilara. However, when immunization status was assessed by card and recall, 84.9% of the children were assessed as fully immunized. Caregivers in the more rural Ilara had less knowledge of vaccine schedules. The importance of all doses was recognized more by Ipara respondents (95.5%) than in Ilara (75.3%) (p < 0.05). Community links to immunization and household decision-making patterns influenced immunization use in both wards. Migrants and those living in hard-to-reach areas were disadvantaged in both wards. Health service factors like absence of delivery services, shortage of health workers, unavailability of vaccines at scheduled times, and indirect costs of immunization contributed to low utilization.Conclusion: Immunization utilization was influenced by interlinked community and health services issues. Intervention approaches should ensure that communities' priorities are addressed, actors at both levels involved and strategies are adjusted to suit contexts.

Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era.

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital’s public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%–45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%–107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children.

Three Waves of Data Use Among Health Workers: The Experience of the Better Immunization Data Initiative in Tanzania and Zambia.

The governments of Tanzania and Zambia identified key data-related challenges affecting immunization service delivery including identifying children due for vaccines, time-consuming data entry processes, and inadequate resources. To address these challenges, since 2014, the countries have partnered with PATH's Better Immunization Data Initiative to design and deploy a suite of data quality and use interventions. Two key aspects of the interventions were an electronic immunization registry and tools and practices to strengthen a culture of data use. As both countries deployed the interventions, 3 distinct changes in data use emerged organically. This article provides a detailed summary of these 3 phases or waves, based mostly on qualitative data or observation: (1) strengthening data collection using new data collection tools and processes and increasing efficiency of health workers; (2) improving data quality regarding accuracy and completeness; and (3) increasing use of data to take action to strengthen their work and for programmatic decision making. These waves clearly demonstrated the growing ability of health workers to move from data collectors to data analyzers who began to focus on the data quality and then the value of using the data in their day-to-day activities.

Private sector engagement and contributions to immunisation service delivery and coverage in Sudan

For more than two decades, the private sector in the Sudan (henceforth, Sudan), including non-governmental organisations and for-profit providers, has played a key role in delivering immunisation services, especially in...

Strengthening immunization service delivery post Ebola virus disease (EVD) outbreak in Liberia 2015-2017.

IntroductionThe Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system.MethodsWe conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS.ResultsThere was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017.ConclusionLiberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.

Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh

ABSTRACT Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

Ownership of mobile phones and willingness to receive childhood immunisation reminder messages among caregivers of infants in Ondo State, south-western Nigeria

Background. The timely completion of the childhood immunisation schedule for children under the age of 1 year by caregivers is key to reducing the high morbidity and mortality of vaccine-preventable diseases among infants globally. Objective. To determine the ownership of mobile phones among caregivers of children under the age of 1 year, their knowledge about immunisation service delivery and willingness to receive childhood immunisation schedule reminder messages in Ondo State, south-western Nigeria. Method. A descriptive cross-sectional study using semi-structured interviewer-administered questionnaires was conducted with 615 caregivers of infants, who brought their children to clinics conducting immunisation in 24 health facilities in rural, semi-urban and urban settlements in Ondo State in December 2014. Results. The mean (standard deviation, SD) age of respondents was 28.49 (6.01) years, 76.7% were Yoruba, 91.4% were married and living with their spouses and 4.2% were single. Mobile phone ownership was 74.5% among rural-based respondents, and 95.8% among urban-based. Forty-six percent of the respondents had good knowledge of immunisation, vaccine-preventable diseases and vaccination schedules, while 27.5% had poor knowledge. The majority of the respondents (99.7%) were willing to receive childhood immunisation reminder messages on their mobile phones. About 50% of the respondents preferred to receive reminder messages at any time, rather than specific times. The most preferred language for reminders was English (54.5%). Residing in an urban area and having post-secondary education were predictors of mobile phone ownership. Conclusion. The high mobile phone ownership level, and the willingness of caregivers of infants in this study area to receive immunisation schedule reminder messages, is encouraging, and should be optimised to improve routine immunisation uptake. However, caregivers of infants in rural areas need to be provided with mobile phone support, and trained in their usage in order to benefit from such an intervention in childhood immunisation.

IMMUNIZATION AND VACCINE DEVELOPMENT: Progress towards High and Equitable Immunization Coverage in the Africa Region from 2012 to 2016

This paper gives a brief update on the status of the immunization and vaccine development in the WHO African Region. It also highlights the progress on the control, elimination or eradication of vaccine preventable diseases in the African Region.The paper reviews national immunization programme data as well as WHO-UNICEF Estimates for Immunization Coverage (WUENIC) in the African Region from 2012-2016.It revealed that there has been considerable success with the development and introduction of new vaccines in the Region. However, uptake of these vaccines has not matched the level of success in new vaccine introduction. This has made the goal of reaching high and equitable immunization coverage a mirage in the Region. Multiple barriers have been blamed for this, chief among which are inadequate commitment of national governments and weak community engagement to immunization service delivery in the Region. Steps are taken to address these issues, including sensitization of government of the African Region to prioritize Universal Access to Immunization as a Cornerstone for Health and Development in Africa. This is because it is argued that development efforts are link to the human beings for whom progress is targeted and/or agents that bring about development.Saving human lives therefore is critical to the realization of development goals. It is important that immunization coverage is universal to achieve the control/elimination of vaccine preventable diseases.

Strengthening routine immunization through measles-rubella elimination

The 2016 mid-term review of the Global Measles-Rubella Strategic Plan 2012–20 for achieving measles-rubella elimination concluded that the full potential of strategies and activities to strengthen routine immunization (RI) service delivery had not been met. In December 2017, we contacted WHO and partner agency immunization staff in all six WHO Regions who identified 23 countries working on measles or rubella elimination that have implemented examples of recommended activities to improve RI, adapted to their needs. Among those examples, opportunities to strengthen RI through implementing supplementary immunization activities (SIAs) were reported most frequently, including advocacy for immunization and educational activities targeted at the public and skills training targeted at health professionals. The expansion of cold chain capacity to accommodate supplies required for SIAs facilitated widening RI service delivery to reach more communities, introduce new vaccines, and reduce the risk of vaccine stock-outs. Substantial numbers of under-vaccinated children, according to the national immunization schedule, have been identified during SIAs, but it is not possible to confirm whether these children actually received missing RI doses. Micro-planning exercises for SIAs have generated data that permitted the revision of catchment populations for fixed site and outreach RI services. Some countries reported using the opportunity afforded by measles/rubella elimination to strengthen overall vaccine-preventable disease surveillance and outbreak preparedness and to introduce mandatory school-entry vaccination requirements covering other vaccines in addition to measles and rubella. Unfortunately, we were unable to obtain information regarding the cost, impact or sustainability of these activities. The evaluation of the many other strategies that have been deployed in recent years to strengthen RI systems and raise vaccination coverage was beyond the scope of this survey. We conclude by providing recommendations to encourage more countries to adapt and implement a comprehensive set of RI-strengthening activities in association with the MR elimination goal.

Engagement of private providers in immunization in the Western Pacific region

Financial sustainability of national immunization programmes (NIPs) in the Western Pacific is a growing concern. In the face of decreasing donor support for public immunization programmes, the role of private providers is becoming growingly important in attaining and sustaining programme achievements. Two-thirds of Member States in the Region have engaged the private sector in their immunization programmes, however little is known about the range and type of engagement. A survey was conducted in 2016 to map the scope and characteristics of private provider involvement, in order to inform guidance for decision makers. 14 countries participated, with responses from NIPs, national regulatory agencies, national immunization technical advisory groups (NITAGs), and private providers (defined as any entity other than the government).Findings revealed that most countries have policies and regulations concerning private providers, but 50% of private provider respondents were unaware that such policies are available. In most countries private providers’ contribution is limited to less than 10% of the total target population. Private providers in only 6 countries surveyed follow the vaccination schedule recommended by the NIP, with demand by vaccine recipients being the main cause of deviation. A majority (>70%) of private provider respondents believe that clients seeks their services not because of perception of quality, but to access new vaccines unavailable through the NIP. Private providers in all countries received vaccines from the NIP at no cost, for which they only charge clients a service fee. The majority of private providers received training from the NIP, whereas only around 25% of them received training from their own institutions. Private providers from 11 countries share EPI performance data and adverse events following immunization, however, NIPs perceive this data as suboptimal. Private providers have a limited role in decision making processes, such as NITAGs. Further effective engagement of private sector providers has the potential to improve overall efficiency of immunization service delivery.

Tailoring immunisation service delivery in a disadvantaged community in Australia; views of health providers and parents

In 2014 the Australian immunisation target was raised from 90% to 95% of children to be fully immunised. A national priority is to identify geographic areas of low coverage and implement strategies to improve immunisation rates. Using The World Health Organization’s Tailoring Immunization Programmes (TIP) Guidelines, the aim of this study was to identify areas of low immunisation coverage for children in the Hunter New England Local Health District, New South Wales, and to gain a deeper understanding of the factors influencing immunisation in those areas in order to develop tailored strategies for increasing immunisation coverage. Data from the Australian Immunisation Register was used to identify geographic areas of low coverage. Data from interviews and focus groups with parents and service providers were used to gain a deeper understanding of the factors influencing immunisation in those areas. The regional city of Maitland in New South Wales was identified as having a persistently high number and relatively high proportion of children not fully immunised (n = 427, 15.4% in 2016). Themes from 59 stakeholder interviews and focus groups included; (i) limited engagement with health services unless the need is urgent, (ii) multi-dimensional access barriers to immunisation services in Maitland, (iii) a flexible, supportive family centred, primary health care approach, utilising strong partnerships, is most likely to be effective in increasing childhood immunisation rates in Maitland, (iv) data can be used more effectively to inform service providers about trends and individual children not fully immunised. TIP guidelines proved useful for identifying areas of low coverage and providing an understanding of determining factors and the strategies most likely to be effective. Understanding the complex problems many parents face and the access barriers that contribute to low immunisation coverage is essential in developing appropriate solutions. Finding ways to support parents and remove those barriers can contribute to higher coverage. In Maitland, targeted outreach and home visiting has been implemented in consultation with community and health service representatives to ensure that the children from socially disadvantaged populations identified do not miss out on vaccination.

An evaluation of immunization services, using the reaching every district criteria, in two districts of Gujarat, India

BackgroundImmunizations are considered the most successful and cost-effective public health interventions employed today. While immunization coverage in India has improved dramatically in the last decade, areas of very low coverage persist. The University of Michigan School of Public Health and the Indian Institute of Public Health Gandhinagar collaborated to document strengths and weaknesses of immunization service delivery in two districts in India.MethodsThis report describes a qualitative assessment of clinic level immunization service delivery in ten primary health centers (PHCs) located in two districts of Gujarat, India. Assessment criteria were derived from the Reaching Every District (RED) strategy that is intended to provide a framework for delivering childhood immunizations. Staff from the PHCs were interviewed in April 2013.ResultsInterviews revealed several barriers to immunization service delivery including: 1) Vaccine and supply stockouts; 2) Hard to reach communities; 3) Unreliable Internet access; 4) Cold chain equipment malfunctions; 5) Inconsistently maintained and utilized immunization records and registries.ConclusionsImmunization service delivery is a complex process that can encounter barriers at many stages. A RED-based evaluation of the vaccine delivery system in Gujarat, India identified several points where the system was performing sub-optimally and possible solutions to successfully address these challenges.

Characteristics of wild polio virus outbreak investigation and response in Ethiopia in 2013\u20132014: implications for prevention of outbreaks due to importations

BackgroundEthiopia joined the Global Polio Eradication Initiative (GPEI) in 1996, and by the end of December 2001 circulation of indigenous Wild Polio Virus (WPV) had been interrupted. Nonetheless, the country experienced multiple importations during 2004–2008, and in 2013. We characterize the 2013 outbreak investigations and response activities, and document lessons learned.MethodThe data were pulled from different field investigation reports and from the national surveillance database for Acute Flaccid Paralysis (AFP).ResultsIn 2013, a WPV1 outbreak was confirmed following importation in Dollo zone of the Somali region, which affected three Woredas (Warder, Geladi and Bokh). Between July 10, 2013, and January 5, 2014, there were 10 children paralyzed due to WPV1 infection. The majorities (7 of 10) were male and below 5 years of age, and 7 of 10 cases was not vaccinated, and 72% (92/129) of < 5 years of old children living in close proximity with WPV cases had zero doses of oral polio vaccine (OPV). The travel history of the cases showed that seven of the 10 cases had contact with someone who had traveled or had a travel history prior to the onset of paralysis. Underserved and inaccessibility of routine immunization service, suboptimal surveillance sensitivity, poor quality and inadequate supplemental immunization were the most crucial gaps identified during the outbreak investigations.ConclusionPrior to the 2013 outbreak, Ethiopia experienced multiple imported polio outbreaks following the interruption of indigenous WPV in December 2001. The 2013 outbreak erupted due to massive population movement and was fueled by low population immunity as a result of low routine immunization and supplemental Immunization coverage and quality. In order to avert future outbreaks, it is critical that surveillance sensitivity be improved by establishing community-based surveillance systems and by assigning surveillance focal points at all level particularly in border areas. In addition, it is vital to set up in hard to reach areas a functional immunization service delivery system using the “Reaching Every Child” approach, including periodic routine immunization intensification and supplemental immunization activities.

Cold Chain Status and Knowledge of Vaccine Providers at Primary Health Care of Units Bale Zone, Southeast Ethiopia: Cross-sectional Study

Background: Despite of long history of Expand program of immunization service delivery and most countries in the world achieved immunization coverage of around 90% for DPT3 in 2010, still there is child mortality attributed to vaccine preventable disease which accounts 29% of world-wide. This problem is attributed to reduced vaccine potency due to failure in cold chain monitoring system. Cold chain monitoring is still a major challenge in developing countries including Ethiopia. The aim of this study was to assess cold chain status and knowledge of vaccine providers at primary health care units.Methods: Institution based cross-sectional study design employed among 183 randomly selected primary health care units of Bale Zone, Southeast Ethiopia in November 2015. Data were collected by using observational checklist and interviewer administered questionnaire for vaccine providers. The data were entered into Epi-data 3.1 versions and transferred to SPSS version 21 for analysis. Descriptive analysis was used.Results: Among 189 health facilities selected, 183 (96.83%) health facilities were visited during the period of data collection of which majority 146 (79.8%) were health posts. Only 56 (30.6%) health facilities had refrigerator. During data collection, out of 35 functional refrigerators, 20 (57.1%) had national cold chain monitoring guideline and only 14 (40%) were properly store vaccines. In 29 (82.86%) refrigerators thermometer showed temperature readings within the standard range (2-8°C). About 124 (67.8%) vaccine providers were responded correctly the recommended range of temperature for storage vaccine.Conclusions: In general the study indicated that there were gap in maintaining cold chain system and improper storage of vaccine were observed at study area, which compromise the potency of the vaccines and quality of the immunization services. Hence, regular supportive supervision, training and distribution of at least one refrigerator per health facility with adequate kerosene provided with the concerned body to maintain the system.

Effect of mobile-based supportive supervision on cold chain point management and routine immunization service delivery

Background: Supportive supervision (SS) as a public health strategy has gathered much consideration in cold chain anagement and effective service delivery of routine immunization (RI). Objectives: In this study, an attempt was made to assess the effect of mobile-based SS strategy on cold chain point’s (CCPs) management and RI service delivery. Materials and Methods: UNICEF supported mobile-based software was used to carry out the SS in Golaghat district of Assam. A total of 15 CCPs and 18 session sites were visited 2 times each in the year 2017. Data collected in the first visit were compared with the second visit to find out whether there was any improvement in cold chain management in CCPs and at routine immunization session sites following SS. Results: We observed a significant improvement in vaccine management and infrastructure handling at CCPs from initial to the second visit. Knowledge and skills of cold chain handlers regarding cold chain management at session site were improved adequately. This substantiates successful transfer of knowledge and skills during SS. Conclusion: The observed improvements in the CCP management practices and service delivery indicate positive influence of mobile-based SS. The improvement in the skills and knowledge of health workers on different components related to CCP management could be due to successful real-time hand holding of cold chain handlers and workers through SS.

Considerations for the development and implementation of electronic immunization registries in Africa.

While paper-based immunization registries are the prevalent form of documenting individual-level immunization service delivery in Africa, some countries are interested in transitioning to electronic immunization registries (EIRs) which have the potential to transform immunization data into useable information for decision making to optimize the performance of immunization programs. This report discusses opportunities and challenges in the adoption of EIRs in the African continent.

A Guide to the California Immunization Registry and Its Use to Enhance the Delivery of Immunization Services

Pharmacists in California are assuming a greater role as independent providers of immunizations for children and adults under Senate Bill 493 (SB 493). One of the requirements for pharmacists as independent providers of immunizations in California is that they must report their administered doses to the California immunization registry system (CAIR). The National Vaccine Advisory Committee Standards for Immunization Practice also supports this practice by recommending that all immunizing providers report vaccinations to their local and state immunization information systems (IIS). This document presents background and specific features of CAIR; best practice recommendations for the use of IIS lookup, forecasting, follow-up, and recall; and documentation features to enhance the delivery of immunization services.

Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India

BackgroundIndia is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. MethodsWe used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. ResultsThe response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. ConclusionsQuality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services delivered and working through professional societies to adopt standards of practice.