Immunisation program reviews in East and Southern Africa (2012-2018): key lessons

Introduction

the World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation program reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets.

Methods

we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the sub-region in the course of 2012-2018. We generated descriptive analysis of the findings across the sub-region.

Results

the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stock out of vaccines and supplies was documented in 9 countries during the review. The full components of the RED strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews.

Conclusion

the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into coasted multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

Immunisation program reviews in East and Southern Africa: 2012-2018; key lessons

Introduction

World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation programme reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets.

Methods

we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the subregion in the course of 2012-2018. We generated descriptive analysis of the findings across the subregion.

Results

the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stockout of vaccines and supplies was documented in 9 countries during the review. The full components of the Reaching Every District (RED) Strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews.

Conclusion

the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into costed multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

Using behavior change approaches to improve complementary feeding practices

This paper applies an implementation framework, based on a behavior change model, to compare four case studies of complementary feeding programs. It aims to expand our understanding of how to design and implement behavior change interventions aimed at improving complementary feeding practices. Four programs met the selection criteria of scale and documented improvements: Bangladesh, Malawi, Peru, and Zambia. We examined commonalities and differences in the design and implementation of social and behavior change approaches, use of program delivery platforms, challenges encountered, and lessons learned. We conclude that complementary feeding practices, in particular dietary diversity, can be improved rapidly in a variety of settings using available program platforms if interventions focus on specific constraints to food access and use effective strategies to encourage caregivers to prepare and feed appropriate foods. A five-step process is presented that can be applied across a range of complementary feeding programs to strengthen their impacts.

Optimizing the post-graduate institutional program evaluation process

BACKGROUND

Reviewing program educational efforts is an important component of postgraduate medical education program accreditation. The post-graduate review process has evolved over time to include centralized oversight based on accreditation standards. The institutional review process and the impact on participating faculty are topics not well described in the literature.

METHODS

We conducted multiple Plan-Do-Study-Act (PDSA) cycles to identify and implement areas for change to improve productivity in our institutional program review committee. We also conducted one focus group and six in-person interviews with 18 committee members to explore their perspectives on the committee's evolution. One author (MLL) reviewed the transcripts and performed the initial thematic coding with a PhD level research associate and identified and categorized themes. These themes were confirmed by all participating committee members upon review of a detailed summary. Emergent themes were triangulated with the University of Michigan Medical School's Admissions Executive Committee (AEC).

RESULTS

We present an overview of adopted new practices to the educational program evaluation process at the University of Michigan Health System that includes standardization of meetings, inclusion of resident members, development of area content experts, solicitation of committed committee members, transition from paper to electronic committee materials, and focus on continuous improvement. Faculty and resident committee members identified multiple improvement areas including the ability to provide high quality reviews of training programs, personal and professional development, and improved feedback from program trainees.

CONCLUSIONS

A standing committee that utilizes the expertise of a group of committed faculty members and which includes formal resident membership has significant advantages over ad hoc or other organizational structures for program evaluation committees.

Forewarning of poliovirus outbreaks in the Horn of Africa: an assessment of acute flaccid paralysis surveillance and routine immunization systems in Kenya

BACKGROUND

Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process.

METHODS

Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance.

RESULTS

Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level.

CONCLUSIONS

Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.

External reviews, internal influences: consultations and the undergraduate neuroscience curriculum

In 2007 FUN established the FUN Program and Department Consultations Service, or FUN-PDCS. Since that founding, the service has provided numerous consultation recommendations to undergraduate programs seeking assistance with external program reviews, designing and improving courses and many other programmatic needs. FUN-PDCS, like FUN, is primarily a grassroots organization and draws on the expertise of the FUN membership to aid programs in their more personalized pursuit of the FUN mission: to promote and improve undergraduate neuroscience education and research.

Research productivity among recipients of AAFP foundation grants

PURPOSE

This study examines research productivity generated by the American Academy of Family Physicians (AAFP) Foundation and the AAFP Joint Grant Awards Program (JGAP) based upon projects funded during the period 1990 through 2000.

METHODS

A structured questionnaire was mailed to all JGAP applicants who were funded between 1990 and 2000 (N = 95). The cross-sectional questionnaire included items reflective of research productivity: (1) numbers of publications, (2) numbers of presentations, and (3) numbers and types of subsequent grants. An additional comparison examined publication productivity among a subset of funded (n = 17) and nonfunded applicants (n = 36).

RESULTS

The 69 funded respondents reported 91 publications and 129 presentations deriving from JGAP-supported research; 26 subsequent grants were funded ($9.6 million total costs). Funded and nonfunded applicants showed a significant increase in the overall number of publications during the 5-year period after their application when compared with the 5-year period before their application. Funded applicants had a greater number of publications during both the 5 years before and the 5 years after their JGAP grant submission.

CONCLUSION

Projects supported by the JGAP have generated a considerable body of publications and presentations, as well as subsequent grant activity. This program appears to be important in supporting the early career development of family medicine researchers.