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Abstract
Objectives Vaccination averts an estimated 2–3 million deaths annually. Although vaccine coverage improvements across Africa and South Asia have remained below global targets, several countries have outperformed their peers with significant increases in coverage. The objective of this study was to examine these countries’ vaccination programmes and to identify and describe critical success factors that may have supported these improvements.
Design Multiple case study design using qualitative research methods.
Setting Three countries with high routine immunisation rates: Nepal, Senegal, and Zambia.
Participants We conducted 207 key informant interviews and 71 focus group discussions with a total of 678 participants. Participants were recruited from all levels, including government officials, health facility staff, frontline workers, community health workers, and parents. Participants were recruited from both urban and rural districts in Nepal, Senegal, and Zambia.
Results Our data revealed that the critical success factors for vaccination programmes relied on the cultural, historical, and statutory context in which the interventions were delivered. In Nepal, Senegal, and Zambia, high immunisation coverage was driven by (1) strong governance structures and healthy policy environments; (2) adjacent successes in health system strengthening; (3) government-led community engagement initiatives, and (4) adaptation considering contextual factors at all levels of the health system.
Conclusions Throughout this project, our analysis returned to the importance of defining and understanding the context, governance, financing, and health systems within a country, rather than focusing on any one intervention. This paper augments findings from existing literature by highlighting how contextual factors impact implementation decisions that have led to improvements in childhood vaccine delivery. Findings from this research may help identify transferable lessons and support actionable recommendations to improve national immunisation coverage in other settings.
- Paediatric infectious disease & immunisation
- PUBLIC HEALTH
- QUALITATIVE RESEARCH
Data availability statement
Data are available upon reasonable request. Data are not publicly available as all data are confidential. Deidentified data may be available upon request.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available upon reasonable request. Data are not publicly available as all data are confidential. Deidentified data may be available upon request.
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Footnotes
Contributors KAH, AE, SD, WK, MS, RB and MCF: project conceptualisation and methodology; KAH, ZS, AE, KR, SD, WK, MS, RB and MCF: investigation and data curation; KAH, ZS, ASE, KR, EAO, RAB and MCF: formal analysis; ZS and KAH: writing—original; KAH, ZS, ASE, EAO, KR, SD, WK, MS, RAB and MCF: writing—review and editing; all authors provided approval of the final version. MCF, as guarantor, is responsible for the overall content
Funding This work was supported by the Bill and Melinda Gates Foundation, Seattle, WA (OPP1195041) with a planning grant from Gates Ventures, LLC, Kirkland, WA.
Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the research reported in this paper.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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