Critical success factors for high routine immunization performance: A case study of Senegal

• Authors: Zoe Sakas, Emory University; Kyra A Hester, Emory University; Katie Rodriguez, Emory University; Saly A Diatta, Institut de Recherche en Santé de Surveillance Epidemiologique et de Formations; Anna S Ellis, Emory University; Daouda Malick Gueye, Institut de Recherche en Santé de Surveillance Epidemiologique et de Formations; Dawn Mapatano, Emory University; Pr Souleymane Mboup, Institut de Recherche en Santé de Surveillance Epidemiologique et de Formations; Emily Awino Ogutu, Emory University; Chenmua Yang, Emory University; Robert Bednarczyk, Emory University; Matthew Freeman, Emory University; Moussa Sarr, Institut de Recherche en Santé de Surveillance Epidemiologique et de Formations
• Journal Title: Vaccine: X
• Volume: Volume 14
• Publisher: Elsevier Inc | 2023-08-01, Pages 100296-100296
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jvacx.2023.100296
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Childhood vaccination; Health systems strengthening; Implementation research; Vaccine policy; Vaccine programming

Abstract

Background: The essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on how policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019. Methods: We identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health facility, and community-level, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data. Results: The following success factors emerged: 1) Strong political will and prioritization of resources for immunization programming supported urgent allocation of funding and supplies; 2) Collaboration between the Ministry of Health and Social Action and external partners fostered innovation, capacity building, and efficiency; 3) Improved surveillance, monitoring, and evaluation allowed for timely and evidence-based decision making; 4) Community ownership of vaccine service delivery supported tailored programming and response to local needs; and 5) Community health workers spearheaded vaccine promotion and demand generation for vaccines. Conclusion: The vaccination program in Senegal was supported by evidence-based decision making at the national-level, alignment of priorities between governmental entities and external partners, and strong community engagement initiatives that fostered local ownership of vaccine delivery and uptake. High routine immunization coverage was likely driven by prioritization of immunization programming, improved surveillance systems, a mature and reliable community health worker program, and tailored strategies for addressing geographical, social, and cultural barriers.