scholarly journals Ensuring Sustainability of Polio Immunization in Health System Transition: Lessons from the Polio Eradication Initiative in Indonesia

2020 ◽  
Author(s):  
Luthfi Azizatunnisa’ ◽  
Utsamani Cintyamena ◽  
Yodi Mahendradhata ◽  
Riris Andono Ahmad
Keyword(s):  
Health System ◽  
National Level ◽  
Immunization Coverage ◽  
Polio Eradication ◽  
Lessons Learned ◽  
Vaccine Hesitancy ◽  
High Coverage ◽  
Frontline Workers ◽  
Polio Immunization ◽  
The Government

Abstract Background: Sustaining an effective evidence-based health intervention will maximize its impact in public health. Political and governmental reforms impact immunization program sustainability both positively and negatively. This study aims to explore sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia.Methods: We collected qualitative data through in-depth interviews with 27 key informants in from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers and NGOs at national and sub-national level. We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. Results: Competing priority was identified as the major challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at sub-national level government. The government reform has led to a more democratic society, which is also conducive for rejection and vaccine hesitancy. Multi sector partnership has been identified to play a big role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign are essential to raise awareness for the community and policy makers to maintain the high polio immunization coverage. Conclusion: Competing priority was the major factor that affected high coverage of polio immunization during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.

scholarly journals Ensuring sustainability of polio immunization in health system transition: lessons from the polio eradication initiative in Indonesia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Luthfi Azizatunnisa’ ◽  
Utsamani Cintyamena ◽  
Yodi Mahendradhata ◽  
Riris Andono Ahmad
Keyword(s):  
Health System ◽  
National Level ◽  
Immunization Coverage ◽  
Polio Eradication ◽  
Lessons Learned ◽  
Frontline Workers ◽  
Government Organizations ◽  
Raising Awareness ◽  
Polio Immunization ◽  
The Government

Abstract Background Sustaining an effective evidence-based health intervention will maximize its impact on public health. Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia. Methods We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. Results Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers to keep polio in the agenda and to maintain the high polio immunization coverage. Conclusion Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.

scholarly journals Socio-economic inequalities in timing of childhood immunizations in Scotland

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Pearce ◽  
P Henery ◽  
C Cameron ◽  
R Dundas ◽  
V Katikireddi ◽  
...  
Keyword(s):  
Quantile Regression ◽  
Herd Immunity ◽  
Disease Outbreaks ◽  
Immunization Coverage ◽  
Vaccine Hesitancy ◽  
Childhood Immunization ◽  
High Coverage ◽  
Childhood Immunizations ◽  
Barriers To Access ◽  
Recall System

Abstract In Scotland, like many other European countries, childhood immunization coverage is generally high, often exceeding levels typically required to achieve herd immunity (95%): uptake of the primary vaccines (excluding rotavirus) is ∼96% (at 12month(m)), with the 1st dose of measles, mumps and rubella (MMR) at 97% (by 5 years). However, the recommended age to receive these vaccines is 2-4m and 12-13m respectively. Delays beyond these ages may indicate vaccine hesitancy or barriers to access and can increase the likelihood of disease outbreaks, especially if clustered among certain geographical or social groups. We used quantile regression to examine the age by which 95% coverage was met in different groups. We analyzed data from the Scottish Immunisation and Recall System, for all children born in Scotland 2010-12 (n∼200,000), estimating proportions immunized ‘on time’ with the primary (by age 5m) and MMR (by 14m) vaccines. Next we used quantile regression (with 95% cut-points) to calculate the age by which 95% coverage was reached among this cohort of children, overall and according to neighbourhood deprivation (Scottish Index of Multiple Deprivation[SIMD] deciles). As in national reports, uptake of the primaries (at 12m) and MMR (at 5y) was >95%, with 91% and 89% immunized ‘on time’ (as defined above). Nationally, primary vaccines uptake reached 95% by age 7m. This varied by SIMD, from 6m in the least disadvantaged decile, to 9m in the most disadvantaged decile (difference 3m, CI: 2.7-3.3). Uptake of MMR reached 95% a year later than recommended (26m), with no discernible pattern by SIMD. In Scotland, the age by which immunization levels meet those typically required to achieve herd immunity may be suboptimal, particularly for MMR and (for primary vaccines) disadvantaged neighborhoods. This same approach might be used in other nations with high coverage to identify population groups that may be experiencing barriers to access and inform local intervention content

scholarly journals 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation

2021 ◽  
Vol 6 (8) ◽  
pp. e006002
Author(s):  
Abigail H Neel ◽  
Svea Closser ◽  
Catherine Villanueva ◽  
Piyusha Majumdar ◽  
S D Gupta ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
System Level ◽  
Vaccine Hesitancy ◽  
High Coverage ◽  
Frontline Staff ◽  
Polio Vaccination ◽  
Worker Motivation ◽  
The Impact ◽  
Over Time

IntroductionThe debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time.MethodsWe constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication.ResultsPursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.ConclusionIt benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate. 

scholarly journals Acceptability of contact management and care of simple cases of COVID-19 at home: a mixed-method study in Senegal

2021 ◽  
Author(s):  
Mouhamadou Faly Ba ◽  
Valéry Ridde ◽  
Amadou Ibra Diallo ◽  
Jean Augustin Diégane Tine ◽  
Babacar Kane ◽  
...  
Keyword(s):  
Health System ◽  
Mixed Method ◽  
National Level ◽  
Mixed Method Study ◽  
Quantitative Survey ◽  
Modes Of Transmission ◽  
Home Based ◽  
The Government ◽  
Home Based Care ◽  
At Home

ABSTRACTIntroductionIn mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The study’s objective was to determine the acceptability of contact management, home care of simple cases of COVID-19, and its associated factors.MethodThis was a sequential mixed-method study. We collected data from June 11, 2020, to July 10, 2020, for the quantitative survey (N=813) and from August 24 to September 16, 2020, for the qualitative survey (N=30). We carried out a sampling strategy using marginal quotas at the national level. We collected data using a structured questionnaire in a telephone interview for the quantitative survey and using an interview guide formulated from the quantitative survey’s initial results for the qualitative data. We assessed acceptability using binomial logistic regression combined with content analysis.ResultsThe care of simple cases of COVID-19 at home was well accepted (78.5%). This result was justified for some (saturation of the health system) but not for others (risk of contamination). The use of home contact management was less accepted (51.4%), with risk limitation as the main reason given. The acceptability of home-based care for simple cases was positively associated with knowledge of the modes of transmission of the virus (ORaj: 1.55 [95%CI: 1.04,2.28]), regular research into COVID-19 (ORaj: 2.12 [95%CI: 1.45,3.12]), belief in the existence of treatment (ORaj: 1.82 [95%CI: 1.19,2.83]), and confidence in institutional information (ORaj: 2.10 [95%CI: 1.43,3.10]). The acceptability of home-based contact management was positively associated with knowledge of the modes of transmission of the virus (ORaj: 1.77 [95%CI: 1.27,2.48]), regular research for information on COVID-19 (ORaj: 2.39 [95%CI: 1.76,3.26]), and confidence in the government in the fight against the epidemic (ORaj: 1.51 [95%CI: 1.10,2.08]).ConclusionRegular information on the disease, knowledge of its mode of transmission and trust in institutions are factors in accepting COVID-19 management at the community level. Authorities should take these factors into account for better communication to improve the acceptability of home-based care.

scholarly journals Vaccination During the COVID-19 Pandemic: What Nurses Need To Know

2021 ◽  
Vol 26 (2) ◽  
Author(s):  
Blima Marcus ◽  
Lindsey Danielson ◽  
Tamar Frenkel
Keyword(s):  
Vaccine Development ◽  
Healthcare Providers ◽  
Lessons Learned ◽  
Vaccine Hesitancy ◽  
Vaccination Programs ◽  
Frontline Workers ◽  
History Of ◽  
Vaccine Information ◽  
One Year ◽  
Collaborative Efforts

In late 2019 a new virus emerged from China which would become the worst pandemic the world had experienced since the flu pandemic of 1918. Over one year later, the virus has infected over 100 million people and claimed the lives of over 2 million people. In this article, we first offer a brief overview about the COVID-19 pandemic. We review efforts to slow the spread and flatten the curve to contain the disease such as mask-wearing, hand hygiene, and testing. Unprecedented funding and collaborative efforts have resulted in highly effective and safe vaccines, rolled out in December 2020. We also briefly discuss the history of vaccine development and previous outbreaks and lessons learned, followed by new vaccine technologies; barriers related to vaccination; vaccine hesitancy; successful vaccination programs; and vaccine hesitancy in healthcare providers. We conclude with implications for nurses to consider as they serve as trusted sources of vaccine information in their roles as frontline workers.

Tata kelola internal dan eksternal untuk mengatasi permasalahan pangan di Indonesia

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Reza Hendriyantore
Keyword(s):  
Good Governance ◽  
National Level ◽  
Open Government ◽  
Agricultural Cooperatives ◽  
Methodological Framework ◽  
Agricultural Cooperative ◽  
The Reformation ◽  
The Government ◽  
Good Access ◽  
Descriptive Method

The effort to put good governance in development in Indonesia is basically not new. Since the Reformation, the transformation of closed government into an open government (inclusive) has begun to be pursued. Highlighting the conflicts in the land sector that tend to strengthen lately, there are some issues that have intensified conflicts in the field, such as the lack of guaranteed land rights in various legal and policy products. In this paper, a descriptive method is considered important in identifying the applicable issue and methodological framework for addressing governance issues in Indonesia. To reduce such agrarian conflicts between farmers and the government, and as an effort to increase farmers' income, all farmers are incorporated into agricultural cooperatives. Agricultural cooperatives are structured down to the National Level. Thus, farmers participate in good access to the marketing of agricultural produce.Keywords:good governance, agrarian conflict, agricultural cooperative

Manajemen Sekolah Adiwiyata (Green School)

2020 ◽  
pp. 37-43
Author(s):  
Asep Priatna
Keyword(s):  
Junior High School ◽  
National Level ◽  
Educational Institutions ◽  
School Program ◽  
West Java ◽  
World Community ◽  
Strategic Issue ◽  
Green School ◽  
The Government ◽  
Environmentally Sound

The issue of environmental pollution has come to the attention of the world community and has become a strategic issue in sustainable development, so it needs to have the support of all parties, including the government, the private sector and educational institutions. Integrated Junior High School Lampang, Subang Regency West Java Indonesia has been implementing the green school program since 2008 and in 2019 it was entrusted by the West Java Education Office to be proposed as a national level green school program. Some achievements as a green school implementing school are private schools that have obtained "A" (exellent) accreditation with a beautiful environment and are able to fulfil 4 (four) components, namely (1) environmentally sound policies, (2) implementation of environment-based curriculum, (3) participatory-based environmental activities and (4) management of environmentally friendly supporting facilities Keywords : Management, green school Isu pencemaran lingkungan hidup telah menjadi perhatian masyarakat dunia dan menjadi isu strategis dalam pembangunan berkelanjutan, sehingga perlu mendapat dukungan semua pihak baik pemerintah, sector swasta maupun lembaga pendidikan. SMPS Terpadu Lampang Kabupaten Subang telah melaksanakan program adiwiyata sejak tahun 2008 dan pada tahun 2019 diberi kepercayaan oleh Dinas Pandidikan Jawa Barat diusulkan sebagai Sekolah Adiwiyata (green school program)  tingkat nasional. Beberapa capaian sebagai sekolah pelaksana green shcool  adalah sekolah swasta yang telah memperoleh akreditasi “A” (Unggul) dengan lingkungan asri dan mampu memenuhi 4 (empat) komponen yaitu (1) kebijakan berwawasan lingkungan, (2) pelaksanaan kurikulum berbasis lingkungan, (3) kegiatan lingkungan berbasis partisipatif dan (4) pengelolaan sarana pendukung ramah lingkungan Kata Kunci : Manajemen, Sekolah Adiwiyata

scholarly journals Private Forests in Nepal: Status and Policy Analysis

2017 ◽  
Vol 15 (1) ◽  
pp. 120-130 ◽  
Author(s):  
Swoyambhu M. Amatya ◽  
Prakash Lamsal
Keyword(s):  
Present Status ◽  
National Level ◽  
Timber Harvesting ◽  
Lessons Learned ◽  
Private Land ◽  
Private Forest ◽  
Community Forest ◽  
Private Forest Owners ◽  
Forest Owners ◽  
Private Forests

 This paper reviews and analyses the present status of private forests and tenure administration in light of existing legal, policy, and regulatory frameworks in Nepal. Additionally, the present status of private forests, as well as the scenarios of timber harvesting, transportation, marketing, and their administration are thoroughly revised. Provisions regarding forests and trees on private land and their basis are examined and implications are articulated for potential policy improvements for enhanced tenure security. It is shown that robust national-level policies and legal frameworks exist, and that there is an increasing trend of timber flows to markets from private forests over the past five years. However, there is still skepticism, mistrust and fear amongst private forest owners, saw millers, and forest administration that prevents the full use of the bundle of rights that legal and policy provisions have promised. An unusually slow pace of private forest registration, lengthy and multi stage processes for obtaining harvesting and transportation permits, and official bans on important commercial species, among others, are found to be the factors that most hinder the private forest owners’ and tree growers’ interests, and their rights and obligations with respect to the management and use of their private forest resources. It is concluded that a simplified permitting process along with programmatic support would promote and help to grow private forestry and that Nepal’s experience and lessons learned from community forest implementation would be a great asset to move towards this end. Connecting community forest user groups for organised and cooperative action, and mobilising their institutional strength and accumulated funds for pro-farmer technical and regulatory support would allow farmers to intensify tree plantations and forest management. Further steps are required to convince policymakers and secure necessary budgetary support to this end..

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

scholarly journals Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

2021 ◽  
Vol 6 (6) ◽  
pp. e005833
Author(s):  
Leena N Patel ◽  
Samantha Kozikott ◽  
Rodrigue Ilboudo ◽  
Moreen Kamateeka ◽  
Mohammed Lamorde ◽  
...  
Keyword(s):  
Health Facility ◽  
Healthcare Workers ◽  
National Level ◽  
Lessons Learned ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Health Facility Level ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

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