Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research

• Authors: Ngoc Cam Escoffery, Emory University; Emily Ogutu, Emory University; Zoe Sakas, Emory University; Kyra Alexandra Hester, Emory University; Anna Ellis, Emory University; Katie Rodriguez, Emory University; Chandni Jaishwal, Emory University; Chenmua Yang, Emory University; Sameer Dixit, Center for Molecular Dynamics Nepal; Anindya Bose, WHO Nepal; Moussa Sarr, Institut de Recherche en Santé de Surveillance Epidemiologique Et de Formation; William Kilembe, Health Research in Zambia; Robert A. Bednarczyk, Emory University; Matthew Freeman, Emory University
• Journal Title: Implementation Science Communications
• Volume: Volume 4
• Publisher: Springer Nature | 2023-09-04, Pages 109-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s43058-023-00489-1
• Subjects: Biology, Virology; Health Sciences, Public Health
• Keywords: childhood immunization; exemplars; implementation science; routine immunization; immunization coverage

Abstract

Introduction The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies — including the facilitators and barriers — contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success. Methods We conducted 278 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) constructs of inner and outer settings to identify immunization program key facilitators and barriers. Results We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of (1) networks and communications, (2) goals and feedback, (3) relative priority, and (4) readiness for implementation and outer setting constructs of (5) cosmopolitanism and (6) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients’ needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies. Conclusion Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination.