scholarly journals Protocol: Identification and evaluation of critical factors in achieving high and sustained childhood immunization coverage in selected low- and lower-middle income countries

2021 ◽  
Author(s):  
Robert A. Bednarczyk ◽  
Kyra A. Hester ◽  
Sameer M. Dixit ◽  
Anna S. Ellis ◽  
Cam Escoffery ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods Research ◽  
Vaccine Coverage ◽  
National Level ◽  
Vaccine Delivery ◽  
Immunization Coverage ◽  
Institutional Review Boards ◽  
Local Health ◽  
Key Stakeholders ◽  
Childhood Vaccine

Introduction - Increases in global childhood vaccine delivery have led to decreases in morbidity from vaccine-preventable diseases. However, these improvements in vaccination have been heterogeneous, with some countries demonstrating greater levels of change and sustainability. Understanding what these high-performing countries have done differently and how their decision-making processes will support targeted improvements in childhood vaccine delivery. Methods and analysis - We studied three countries - Nepal, Senegal, Zambia - with exemplary improvements in coverage between 2000-2018 as part of the Exemplars in Global Health Program. We apply established implementation science frameworks to understand the how and why underlying improvements in vaccine delivery and coverage. Through mixed methods research we will identify drivers of catalytic change in vaccine coverage and the decision-making process supporting these interventions and activities. Methods include quantitative analysis of available datasets and in-depth interviews and focus groups with key stakeholders in the global, national, and sub-national government and non-governmental organization space, as well as community members and local health delivery system personnel. Ethics and dissemination - Working as a multinational and multidisciplinary team, and under oversight from all partner and national-level (where applicable) institutional review boards, we collect data from participants who provided informed consent. Findings are disseminated through a variety of forms, including peer-reviewed manuscripts related to country-specific case studies and vaccine system domain-specific analyses, presentations to key stakeholders in the global vaccine delivery space, and narrative dissemination on the Exemplars.Health website.

scholarly journals Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy

Vaccines ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 120
Author(s):  
Michela Sabbatucci ◽  
Anna Odone ◽  
Carlo Signorelli ◽  
Andrea Siddu ◽  
Andrea Silenzi ◽  
...  
Keyword(s):  
Vaccine Coverage ◽  
National Health System ◽  
P Value ◽  
Local Health ◽  
Rate Decrease ◽  
Rotavirus Vaccination ◽  
Health Authorities ◽  
Vaccine Type ◽  
Childhood Vaccine ◽  
Local Health Authorities

The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.

scholarly journals HPV vaccine introduction at the local level in a developing country: attitudes and criteria among key actors

2010 ◽  
Vol 26 (5) ◽  
pp. 900-908 ◽  
Author(s):  
Marion Piñeros ◽  
Carolina Wiesner ◽  
Claudia Cortés ◽  
Lina María Trujillo
Keyword(s):  
Decision Making ◽  
Latin American ◽  
Hpv Vaccine ◽  
Local Level ◽  
National Level ◽  
National Policy ◽  
Local Health ◽  
Political Actors ◽  
Vaccine Introduction

In most developing countries, HPV vaccines have been licensed but there are no national policy recommendations, nor is it clear how decisions on the introduction of this new vaccine are made. Decentralization processes in many Latin American countries favor decision-making at the local level. Through a qualitative study we explored knowledge regarding the HPV vaccine and the criteria that influence decision-making among local health actors in four regions of Colombia. We conducted a total of 14 in-depths interviews with different actors; for the analysis we performed content analysis. Results indicate that decision-making on the HPV vaccine at the local level has mainly been driven by pressure from local political actors, in a setting where there is low technical knowledge of the vaccine. This increases the risk of initiatives that may foster inequity. Local decisions and initiatives need to be strengthened technically and supported by national-level decisions, guidelines and follow-up.

scholarly journals A tale of two citizens: The Brey-Dano proportionality gap in UK courts and tribunals

2021 ◽  
pp. 138826272110049
Author(s):  
Victoria E. Hooton
Keyword(s):  
Decision Making ◽  
National Level ◽  
Case Law ◽  
Eu Law ◽  
The Law

The role of proportionality and individual assessments in EU residency and welfare access cases has changed significantly over the course of the last decade. This article demonstrates how a search for certainty and efficiency in this area of EU law has created greater uncertainty, more legal hurdles for citizens, and less consistency in decision-making at the national level. UK case law illustrates the difficulty faced by national authorities when interpreting and applying the rules relating to welfare access and proportionality. Ultimately, the law lacks the consistency and transparency that recent CJEU case law seeks to obtain, raising the question of whether the shift from the Court's previous, more flexible, case-by-case approach was desirable after all.

Capacity building in the public health field in the Tunisian medical faculties

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Coman ◽  
O Oltean ◽  
M Palianopoulou ◽  
D Plancikova ◽  
C Zedini ◽  
...  
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Health Knowledge ◽  
National Level ◽  
Training Programme ◽  
Local Health ◽  
The Public ◽  
Public Health Training ◽  
Medical Faculties ◽  
Health Field

Abstract Over the past years, Tunisia has experienced important reforms in the field of public health. The Tunisian medical faculties (Universities of Sfax, Tunis el Manar, Sousse and Monastir) play a key role in this endeavor by training public health professionals who can contribute to the modernization of the health system. Funded by the EC through Erasmus+ programme, the CONFIDE project (coordinated by Babes-Bolyai University, having as EU partners the Universities of Southern Denmark and Trnava, and the above mentioned Tunisian universities) has established the Research into Policy training programme by strengthening their capacity to provide public health training. The Research into Policy training programme has been delivered by the Centres for Evidence into Health Policy (C4EHPs) established within the Tunisian partner universities for the needs of CONFIDE. The training programme was implemented in four steps: (1) train the trainer sessions - the European experts trained 18 Tunisian trainers; (2) shadowing sessions - the trainers participated in shadowing sessions in the European partner institutions; (3) training delivery - the CONFIDE trainers, assisted by the European experts, delivered the training to an interdisciplinary group of 25 students and professionals; (4) internships - the students participated in internships in local health institutions. Three modules have been built within the Research into Policy training programme: Public health research, Health promotion policies and Evidence based public health policy. They contributed to increasing the public health knowledge and skills of the professionals trained. The training programme was well received by the Tunisian universities and the material developed so far during the project was adapted to the Tunisian context in the third step of implementation. On the long term, the project is expected to have an impact at the national level and produce updates at curricula level in the Tunisian medical faculties. Key messages Research into Policy training programme developed by the EC partners and culturally adapted by the Tunisian partners to the Tunisian public health context. Research into Policy training is a well-received tool for the high quality learning process in the public health field in Tunisian medical faculties.

scholarly journals COVID-19 Infection and Previous BCG Vaccination Coverage in the Ecuadorian Population

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 91
Author(s):  
Daniel Garzon-Chavez ◽  
Jackson Rivas-Condo ◽  
Adriana Echeverria ◽  
Jhoanna Mozo ◽  
Emmanuelle Quentin ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
National Level ◽  
Kendall Test ◽  
Amino Acid Sequences ◽  
Bcg Vaccination ◽  
High Prevalence ◽  
Health Organization ◽  
Low Coverage ◽  
Homologous Amino Acid

The Bacillus Calmette–Guérin (BCG) is a well-known vaccine with almost a century of use, with the apparent capability to improve cytokine production and epigenetics changes that could develop a better response to pathogens. It has been postulated that BCG protection against SARS-CoV-2 has a potential role in the pandemic, through the presence of homologous amino acid sequences. To identify a possible link between BCG vaccination coverage and COVID-19 cases, we used official epidemic data and Ecuadorian Ministry of Health and Pan American Health Organization vaccination information. BCG information before 1979 was available only at a national level. Therefore, projections based on the last 20 years were performed, to compare by specific geographic units. We used a Mann–Kendall test to identify BCG coverage variations, and mapping was conducted with a free geographic information system (QGIS). Nine provinces where BCG vaccine coverage was lower than 74.25% show a significant statistical association (χ2 Pearson’s = 4.800, df = 1, p = 0.028), with a higher prevalence of cases for people aged 50 to 64 years than in younger people aged 20 to 49 years. Despite the availability of BCG vaccination data and the mathematical models needed to compare these data with COVID-19 cases, our results show that, in geographic areas where BCG coverage was low, 50% presented a high prevalence of COVID-19 cases that were young; thus, low-coverage years were more affected.

scholarly journals Uganda’s increasing dependence on development partner’s support for immunization – a five year resource tracking study (2012 – 2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carol Kamya ◽  
Christabel Abewe ◽  
Peter Waiswa ◽  
Gilbert Asiimwe ◽  
Faith Namugaya ◽  
...  
Keyword(s):  
Vaccine Coverage ◽  
National Level ◽  
Health Financing ◽  
Health Facilities ◽  
Development Partner ◽  
National Medical ◽  
External Sources ◽  
Lower Health ◽  
Health Accounts ◽  
The Government

Abstract Background In Uganda, there are persistent weaknesses in obtaining accurate, reliable and complete data on local and external investments in immunization to guide planning, financing, and resource mobilization. This study aimed to measure and describe the financial envelope for immunization from 2012 to 2016 and analyze expenditures at sub-national level. Methods The Systems of Health Accounts (SHA) 2011 methodology was used to quantify and map the resource envelope for immunization. Data was collected at national and sub-national levels from public and external sources of immunization. Data were coded, categorized and disaggregated by expenditure on immunization activities using the SHA 2011. Results Over the five-year period, funding for immunization increased fourfold from US$20.4 million in 2012 to US$ 85.6 million in 2016. The Ugandan government was the main contributor (55%) to immunization resources from 2012 to 2014 however, Gavi, the Vaccine Alliance contributed the majority (59%) of the resources to immunization in 2015 and 2016. Majority (66%) of the funds were managed by the National Medical Stores. Over the five-year period, 80% of the funds allocated to immunization activities were spent on facility based routine immunization (expenditure on human resources and outreaches). At sub-national level, districts allocated 15% of their total annual resources to immunization to support supervision of lower health facilities and distribution of vaccines. Health facilities spent 5.5% of their total annual resources on immunization to support outreaches. Conclusion Development partner support has aided the improvement of vaccine coverage and increased access to vaccines however, there is an increasing dependence on this support for a critical national program raising sustainability concerns alongside other challenges like being off-budget and unpredictable. To ensure financial sustainability, there is need to operationalize the immunization fund, advocate and mobilize additional resources for immunization from the Government of Uganda and the private sector, increase the reliability of resources for immunization as well as leverage on health financing reforms like the National Health Insurance.

scholarly journals Business Lobbying: Mapping Policy Networks in Brazil in Mercosur

2018 ◽  
Vol 7 (10) ◽  
pp. 198
Author(s):  
Galia Benítez
Keyword(s):  
Decision Making ◽  
Trade Policy ◽  
National Level ◽  
Executive Branch ◽  
Policy Networks ◽  
Policy Network ◽  
Common External Tariff ◽  
Policy Structure ◽  
Business Lobbying ◽  
The Government

In the creation of trade policy, business actors have the most influence in setting policy. This article identifies and explains variations in how economic interest groups use policy networks to affect trade policymaking. This article uses formal social network analysis (SNA) to explore the patterns of articulation or a policy network between the government and business at the national level within regional trade agreements. The empirical discussion herein focuses on Brazil and the setting of exceptions list to Mercosur’s common external tariff. It specifically concentrates on the relations between the Brazilian executive branch and ten economic subsectors. The article finds that the patterns of articulation of these policy networks matter and that sectors with stronger ties to key government decision-makers have a structural advantage in influencing trade policy and obtaining and/or maintaining their desired, privileged trade policies, compared with sectors that are connected to government actors with weak decision-making power, but might have numerous and diversified connections. Therefore, sectors that have a strong pluralist–clientelist policy structure with connections to government actors with decision-making power have greater potential for achieving their target policies compared with more corporatist policy networks.

Vaccine Coverage Across the Life Course in Michigan During the COVID-19 Pandemic: January–September 2020

2021 ◽  
pp. e1-e9
Author(s):  
Angela K. Shen ◽  
Cristi A. Bramer ◽  
Lynsey M. Kimmins ◽  
Robert Swanson ◽  
Patricia Vranesich ◽  
...  
Keyword(s):  
Life Course ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Childhood Vaccination ◽  
Local Health ◽  
Immunization Registry ◽  
Immunization Services ◽  
Vaccines For Children ◽  
The Life Course ◽  
The Impact

Objectives. To assess the impact of the COVID-19 pandemic on immunization services across the life course. Methods. In this retrospective study, we used Michigan immunization registry data from 2018 through September 2020 to assess the number of vaccine doses administered, number of sites providing immunization services to the Vaccines for Children population, provider location types that administer adult vaccines, and vaccination coverage for children. Results. Of 12 004 384 individual vaccine doses assessed, 48.6%, 15.6%, and 35.8% were administered to children (aged 0–8 years), adolescents (aged 9–18 years), and adults (aged 19–105 years), respectively. Doses administered overall decreased beginning in February 2020, with peak declines observed in April 2020 (63.3%). Overall decreases in adult doses were observed in all settings except obstetrics and gynecology provider offices and pharmacies. Local health departments reported a 66.4% decrease in doses reported. For children, the total number of sites administering pediatric vaccines decreased while childhood vaccination coverage decreased 4.4% overall and 5.8% in Medicaid-enrolled children. Conclusions. The critical challenge is to return to prepandemic levels of vaccine doses administered as well as to catch up individuals for vaccinations missed. (Am J Public Health. Published online ahead of print October 7, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306474 )

A Procedural Idea of Environmental Democracy: the 'Débat Public' Paradigm within the EU Framework

2021 ◽  
Vol 14 (2) ◽  
pp. 85-106
Author(s):  
Alberto Nicòtina
Keyword(s):  
Decision Making ◽  
Environmental Governance ◽  
National Level ◽  
Research Subject ◽  
Environmental Decision Making ◽  
Legislative Framework ◽  
Débat Public ◽  
Environmental Democracy ◽  
The Eu ◽  
Environmental Decision

The aim of this paper is to analyse the 'débat public' procedure, which finds its roots in the Canadian legal system and its most defined formulation in France, and which more recently has been circulating to Italy – first at the regional level and, since 2016, at the national level. The first part of the paper will thus be devoted to a historical overview of the débat public and to how it is implemented in each of the two legal systems. The second part will subsequently distil the 'paradigm', i. e. those distinctive traits that make the débat public an autonomous research subject, within the multi-layered legislative framework of environmental governance in Europe. Three main features of the paradigm will be pointed out (Participation, Effectiveness, Authority), thus highlighting how it can respond to the needs in light of which it has been designed, namely dealing with proximity conflicts and providing a forum for the construction of shared rational decisions in environmental decision-making. The paper eventually leads to the conclusion that the débat public, with its codified rules and procedures, represents the first and probably the most noticeable attempt towards the institutionalisation and generalisation of deliberative practices in environmental decision-making, thus towards developing a procedural stance in environmental democracy.

scholarly journals Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Fabio Mozzarelli ◽  
Stefano Nani ◽  
Enrica Rossi ◽  
Mario Pizzamiglio
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Observational Study ◽  
Electronic Device ◽  
Local Health ◽  
Trauma Patients ◽  
Medical Facility ◽  
Provincial Hospital ◽  
Trauma Algorithm ◽  
Data Context

Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the <em>Piacenza trauma algorithm</em> has been applied. The data shows a 9.5% (P&gt;0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

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