Building leadership and management competencies of national immunization teams in 16 Gavi-eligible countries through the EPI leadership and management programme

BackgroundStrengthening leadership and management competencies among national Expanded Programme on Immunization (EPI) teams will be critical to achieving global immunization targets and other sustainable developmental goals. However, there is little empirical evidence of the effectiveness of investments in leadership and management capacity in the context of national EPI programs. Therefore, we sought to evaluate the EPI Leadership and Management Programme (EPI LAMP), a nine-month certificate program for EPI teams in national Ministries of Health from Gavi priority countries in Anglophone and Francophone Africa and Asia.MethodsWe used a mixed-methods longitudinal evaluation to describe EPI LAMP at four levels: (1) participant response to the training experience based on program administration records and satisfaction surveys; (2) change in management and leadership skill based on competency surveys and exit interviews; (3) change in behavior in the workplace based on exit interviews; and (4) impact of the training on EPI program performance based on the results of each delegate’s leadership project.ResultsIn the first three cohorts, the programme engaged 16 countries (63 participants) and achieved an 86% graduation rate (54 alumni). Participants demonstrated significant improvement in management and leadership competencies across eight domains with the largest improvement observed in the domain of governance and leadership. Women showed greater increases than men, especially in the domains of Operations Management and Political Advocacy and Dialogue. We observed no difference in the gains made by French-speaking delegates compared to English-speaking participants. Breakthrough projects developed by each team improved EPI program performance, as measured by metrics specific to each project.DiscussionOur results show that team-based leadership programs can foster improvements in management practice, collaboration, and problem-solving, and that engagement the broader policy and organizational context is needed to foster the systems thinking capacity required to address complex challenges and improve system performance.     

Integration of vaccine supply chains with other health commodity supply chains: A framework for decision making

One of the primary objectives of National Immunization Programs is to strengthen and optimize immunization supply chains so that vaccines are delivered to the end recipients effectively, efficiently and sustainably. As a result of larger investments in global health and a wider portfolio of vaccines, global agencies are recognizing the need for vaccine supply chains to operate at their most optimal levels. Integration with other supply chains is often presented as a strategy to improve efficiency. However, it remains unclear if the proposed benefits from integration of vaccine supply chains with other supply chains will outweigh the costs. This paper provides a framework for deciding where such integration offers the most significant benefits. It also cautions about the pitfalls of integration as a one size fits all strategy. It also highlights the need for systematic collection of cost and efficiency data in order to understand the value of integration and other such initiatives.     

The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains

Background

Microneedle patch (MNP) technology is designed to simplify the process of vaccine administration; however, depending on its characteristics, MNP technology may provide additional benefits beyond the point-of-use, particularly for vaccine supply chains.

检验科实施供应链管理的探讨

介绍了供应链管理的基本概念，构建了医院检验科实施供应链管理过程的总体框架，提出了其具体实施过程：分析医院市场竞争环境，识别医疗市场机会；定义临床及患者价值；确定竞争战略；分析实体竞争力，建立检验科管理流程；实施各检测步骤，评价检测质量及绩效，反馈和学习。     

The impact of making vaccines thermostable in Niger's vaccine supply chain

Objective

Determine the effects on the vaccine cold chain of making different types of World Health Organization (WHO) Expanded Program on Immunizations (EPI) vaccines thermostable.

Methods

Utilizing a detailed computational, discrete-event simulation model of the Niger vaccine supply chain, we simulated the impact of making different combinations of the six current EPI vaccines thermostable.

Findings

Making any EPI vaccine thermostable relieved existing supply chain bottlenecks (especially at the lowest levels), increased vaccine availability of all EPI vaccines, and decreased cold storage and transport capacity utilization. By far, the most substantial impact came from making the pentavalent vaccine thermostable, increasing its own vaccine availability from 87% to 97% and the vaccine availabilities of all other remaining non-thermostable EPI vaccines to over 93%. By contrast, making each of the other vaccines thermostable had considerably less effect on the remaining vaccines, failing to increase the vaccine availabilities of other vaccines to more than 89%. Making tetanus toxoid vaccine along with the pentavalent thermostable further increased the vaccine availability of all EPI vaccines by at least 1–2%.

Conclusion

Our study shows the potential benefits of making any of Niger's EPI vaccines thermostable and therefore supports further development of thermostable vaccines. Eliminating the need for refrigerators and freezers should not necessarily be the only benefit and goal of vaccine thermostability. Rather, making even a single vaccine (or some subset of the vaccines) thermostable could free up significant cold storage space for other vaccines, and thereby help alleviate supply chain bottlenecks that occur throughout the world.     

The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia

In 2012, Saving Mothers, Giving Life (SMGL), a multi-level health systems initiative, launched in Kalomo District, Zambia, to address persistent challenges in reducing maternal mortality. We assessed the impact of the programme from 2012 to 2013 using a quasi-experimental study with both household- and health facility-level data collected before and after implementation in both intervention and comparison areas. A total of 21,680 women and 75 non-hospital health centres were included in the study. Using the difference-in-differences method, multivariate logistic regression, and run charts, rates of facility-based birth (FBB) and delivery with a skilled birth provider were compared between intervention and comparison sites. Facility capacity to provide emergency obstetric and newborn care was also assessed before and during implementation in both study areas. There was a 45% increase in the odds of FBB after the programme was implemented in Kalomo relative to comparison districts, but there was a limited measurable change in supply-side indicators of intrapartum maternity care. Most facility-level changes related to an increase in capacity for newborn care. As SMGL and similar programmes are scaled-up and replicated, our results underscore the need to ensure that the health services supply is in balance with improved demand to achieve maximal reductions in maternal mortality.     

The people factor: An analysis of the human resources landscape for immunization supply chain management

Human resources is the backbone of any system and the key enabler for all other functions to effectively perform. This is no different with the Immunization Supply Chain, more so in todays’ complex operating environment with the increasing strain caused by new vaccines and expanding immunization programmes (Source: WHO, UNICEF).In order to drive the change that is required for sustainability and continuous improvement, every immunization supply chain needs an effective leader. A dedicated and competent immunization supply chain leader with adequate numbers of skilled, accountable, motivated and empowered personnel at all levels of the health system to overcome existing and emerging immunization supply chain (ISC) challenges. Without an effective supply chain leader supported by capable and motivated staff, none of the interventions designed to strengthen the supply chain can be effective or sustainable (Source: Gavi Alliance SC Strategy 2014).This landscape analysis was preceded by an HR Evidence Review (March 2014) and has served to inform global partner strategies and country activities, as well as highlight where most support is required. The study also aimed to define the status quo in order to create some form of baseline against which to measure the impact of interventions related to HR going forward.The analysis was comprised of a comprehensive desk review, a survey of 40 respondents from 32 countries and consultations with ISC practitioners in several forums.The findings highlight key areas that should inform the pillars of a HR capacity development plan. At the same time, it revealed that there are some positive examples of where countries are actively addressing some of the issues identified and putting in place mechanisms and structures to optimize the SC function.     

人力资源的精细化管理在消毒供应中心的应用与探讨

目的利用精细化的人力资源管理,提高工作效率、培养优秀专科操作人员,提高消毒供应专业技术含量,建立专业化消毒供应队伍。方法建立人力资源有效管理措施,运用现代管理理论,创造性地调动人员潜能,提出应用现代管理理论,建立适合临床实际情况的护理供应人力资源管理模式,做到合理、有效地使用有限的人力资源。结果通过人力资源的有效调整,促使各级人员思考自己的价值和位置,明确自己的职责和任务,树立竞争、服务和质量意识,调动了各级人员的积极性,优质、高效地完成各项供应保障任务,提高了临床满意度。结论有效的人力资源管理措施使各级人员各尽其责、各施其能,保证医院临床物品及时有效地消毒供应。     

风险管理在供应室管理中的应用

目的 探讨供应室的风险管理,保证供应室的护理质量.方法 通过识别和运用风险管理理论,分析供应室在回收、分类、清洗、消毒、包装和灭菌等各个环节进行控制风险成因,正确识别和评估可能存在的、潜在的风险因素,提出防范措施,强化风险意识.结果 提高了供应室工作人员的责任心及质量意识,降低了差错率,减少了医疗风险的发生.结论 通过风险管理能有效降低风险隐患,严把质量关,为临床提供安全的消毒灭菌物品,为预防医院感染及保证医疗安全起到重要作用.     

精细化管理在供应室的应用

目的 探索一种小型供应室落实卫生部3项强制性管理标准的新模式,提高供应室工作质量,有效规避医疗风险.方法 制定一整套精细化管理办法并组织实施,通过检查检测和临床调研无菌物品使用情况,评价精细化管理在供应室管理中的作用.结果 清洗后物品质量一次合格率＞98.0％;灭菌后物品抽检细菌培养合格率、压力蒸汽灭菌化学检测合格率、压力蒸汽灭菌生物监测合格率均为100.0％;临床无菌物品过期率由原来的1.0％下降至0.2％.结论 供应室管理精细化,能有效提高工作质量,确保无菌物品质量和医疗安全.     

射频识别技术在供应链管理中的应用

目的:了解无线射频识别技术(RFID)在供应链管理中的应用,使其作为一种新兴的识别技术在各领域得到更广泛的使用.方法:通过介绍RFID在供应链管理中的应用,进一步阐述RFID今后的发展趋势.结果:RFID在供应链管理中的应用,减少了人工干预,在管理中实现了对物体的识别和跟踪,回答了“是什么”、“在哪里”、“怎么样”的问题.结论:电子标签核心技术急需突破,商业模式有待创新和完善,只有核心问题得到有效解决.     

我院实施人力资源价值链管理的实践

介绍了医院人力资源价值链体系的组成,其包括人力资源引进链、配置链、开发链、绩效链、薪酬链等人力资源业务链,描述了由人力资源战略、人力资源文化、人力资源制度、人力资源信息技术组成的价值链管理支持系统.指出医院实施人力资源价值链管理,可以充分调动医务人员的主动性和创造性,提高医院的医疗服务质量及科研水平,增强医院的竞争力.     

National logistics working groups: A landscape analysis study

Several countries have acknowledged the contributions made by national logistics working groups (NLWG) to ensure equitable access to the expanded program on immunization’s (EPI) vaccines against preventable diseases. In order to provide key insights to the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) supply chain hub – as well as other players, including national EPI – a landscape analysis study was conducted from September 2015 to February 2016.This is a cross-sectional survey taken by 43 countries that combines qualitative and quantitative approaches. Data was collected through a desk review, consultation, interviews, and distance questioning. References and guidance were used to determine and specify the underlying mechanisms of NLWGs.The key findings are:

• •Mandate of NLWG commonly declared by countries is improving immunization logistics and supply chain.
• •Of the 43 countries surveyed, 10 have formal NLWGs, 8 have informal or ad hoc NLWGs, and 25 have none.
• •The immunization supply chain and logistics (iSCL) decision-making process in countries, regardless of NLWG status, mainly depends on the EPI manager.
• •In countries with an NLWG, members with logistics and supply chain backgrounds are relatively common; they are mostly from EPI, UNICEF, and WHO.
• •Almost all NLWGs have terms of reference and primarily operate under EPI governance; however, three NLWGs have standard operation procedures (SOP), and four use monitoring and evaluation tools.
• •The coordination mechanism of these iSCL activities is mainly built into the immunization Comprehensive Multi-Year Plan (cMYP) and annual EPI plans, and organized by EPI/Immunization Coordination Committee (ICC).
• •Most countries that participated in this survey expressed their technical requirement for improving the function, positioning and influence of the immunization logistics working group, and capacity building for the group’s members.

This study has provided a general overview of the status of NLWGs for immunization in various countries. Based on the key insights of the study, technical assistance needs have been identified, and immunization partners will be required to help countries create and reinforce their NLWGs.     

The impact of new vaccine introduction on the coverage of existing vaccines: A cross-national,multivariable analysis

Background

A surge of new and underutilized vaccine introductions into national immunization programmes has called into question the effect of new vaccine introduction on immunization and health systems. In particular, countries deciding whether to introduce a new or underutilized vaccine into their routine immunization programme may query possible effects on the delivery and coverage of existing vaccines. Using coverage of diphtheria–tetanus–pertussis (DTP) vaccine as a proxy for immunization system performance, this study aims to test whether new vaccine introduction into national immunization programs was associated with changes in coverage of three doses of DTP vaccine among infants.

Methods and findings

DTP3 vaccine coverage was analyzed in 187 countries during 1999–2009 using multivariable cross-national mixed-effect longitudinal models. Controlling for other possible determinants of DTP3 coverage at the national level these models found minimal association between the introduction of Hepatitis-, Haemophilus influenzae type b-, and rotavirus-containing vaccines and DTP3 coverage. Instead, frequent and sometimes large fluctuations in coverage are associated with other development and health systems variables, including the presence of armed conflict, coverage of antenatal care services, infant mortality, the percent of health expenditures that are private and total health expenditures per capita.

Conclusions

Introductions of new vaccines did not affect national coverage of DTP3 vaccine in the countries studied. Introductions of other new vaccines and multiple vaccine introductions should be monitored for immunization and health systems impacts.     

Strengthening the immunization supply chain: A time-to-supply based approach to cold chain network optimization & extension in Madhya Pradesh

Expansion of immunization coverage is dependent in part on delivering potent vaccines in an equitable and timely manner to immunization outreach session sites from Cold Chain Points (CCPs). When duration of travel between the last CCP and the session site (Time-to-Supply) is too long, three consequences may arise: decreased potency due to exposure to heat and freezing, beneficiary dropouts due to delayed session starts, and, increased operational costs for the Health Facility (HF) conducting the outreach sessions. Guided by the Government of India’s recommendation on cold chain point expansion to ensure that all session sites are within a maximum of 60 min from the last CCP, CHAI and the State Routine Immunization Cell in the state of Madhya Pradesh collaborated to pilot a novel approach to cold chain network optimization and expansion in eight districts of Madhya Pradesh. Opportunities for realignment of remote sub-health centers (SHCs) and corresponding session sites to alternative existing CCPs or to HFs which could be converted to new CCPs were identified, and proposed using a greedy adding algorithm-based optimization which relied on health facility level geo-location data. Health facility geo-coordinates were collected through tele-calling and site visits, and a Microsoft Excel based optimization tool was developed.This exercise led to an estimated reduction in the number of remote SHCs falling beyond the permissible travel time from CCPs by 56.89 percent (132 remote sites), from 232 to 100. The 132 resolved sites include 73 sites realigned to existing CCPs, and 59 sites to be attached to 22 newly proposed CCPs. Both the network optimization approach and the institutional capacity built during this project will continue to be useful to India’s immunization program. The approach is replicable and may be leveraged by developing countries facing similar challenges due to geographical, institutional, and financial constraints.     

浙江省预防接种门诊人力资源现况及配置标准研究

目的了解浙江省预防接种门诊人力资源配置状况,为科学配置预防接种人力资源提供依据。方法对浙江省预防接种门诊接种人员配置情况进行调查,通过理论测算、焦点组访谈等方法,研究预防接种门诊理论配置标准。结果浙江省每个接种日平均有5人参加预防接种工作,所有调查乡镇的预防接种门诊人员配置水平达到0.90人/万服务人口,但各地配置水平差距较大。测算预防接种门诊人员理论配置的最低标准不应少于4人,每名接种人员接种平均工作量大致可保持在30针次/0.5天的水平;若预防接种门诊工作量超过该水平,则需要在原最低配置标准基础上,按每增加50针次增加1名预防接种人员的比例来增加人员配置。结论浙江省预防接种门诊人员配置水平不足,分布不均衡,需按接种工作量和服务人口增加人员编制,以满足工作需求。     

我国甲型H1N1流感疫苗免疫效果评估系统综述*

目的 通过对甲型H1N1流感疫苗免疫学效果和保护效果的系统回顾,为完善甲型流感免疫策略提供依据。方法 采用系统评价方法,“甲型H1N1流感疫苗”或“甲型流感疫苗”“评估”或“效果”或“效果评估”为检索词,全面检索中国知识资源总库期刊全文数据库（2009~2014年6月）和万方学术期刊数据库（2009~2014年6月）,对纳入文献进行系统分析。结果 符合纳入标准的文献12篇,免疫学效果和保护效果系统评价显示：抗体阳转率为61％~100％,GMT为1:200~1:736.23,甲流发病率<8.5%,疫苗的保护率为 45.15%~100%。结论 甲流疫苗具有较好的免疫保护作用。     

Impact,cost-effectiveness,and budget implications of HPV vaccination in Kenya: A modelling study

BackgroundSub-Saharan Africa has the highest rate of cervical cancer cases and deaths worldwide. Kenya introduced a quadrivalent HPV vaccine (GARDASIL, hereafter referred to as GARDASIL-4) for ten-year-old girls in late 2019 with donor support from Gavi, the Vaccine Alliance. As Kenya may soon graduate from Gavi support, it is important to evaluate the potential cost-effectiveness and budget impact of the current HPV vaccine, and potential alternatives.MethodsWe used a proportionate outcomes static cohort model to evaluate the annual budget impact and lifetime cost-effectiveness of vaccinating ten-year-old girls over the period 2020–2029. We included a catch-up campaign for girls aged 11–14 years in 2020. We estimated cervical cancer cases, deaths, disability adjusted life years (DALYs), and healthcare costs (government and societal perspective) expected to occur with and without vaccination over the lifetimes of each cohort of vaccinated girls. For each of the four products available globally (CECOLIN©, CERVARIX©, GARDASIL-4©, and GARDASIL-9 ©), we estimated the cost (2021 US$) per DALY averted compared to no vaccine and to each other. Model inputs were obtained from published sources, as well as local stakeholders.ResultsWe estimated 320,000 cases and 225,000 deaths attributed to cervical cancer over the lifetimes of the 14 evaluated birth cohorts. HPV vaccination could reduce this burden by 42–60 %. Without cross-protection, CECOLIN had the lowest net cost and most attractive cost-effectiveness. With cross-protection, CERVARIX was the most cost-effective. Under either scenario the most cost-effective vaccine had a 100 % probability of being cost-effective at a willingness-to-pay threshold of US$ 100 (5 % of Kenya’s national gross domestic product per capita) compared to no vaccination. Should Kenya reach its target of 90 % coverage and graduate from Gavi support, the undiscounted annual vaccine program cost could exceed US$ 10 million per year. For all three vaccines currently supported by Gavi, a single-dose strategy would be cost-saving compared to no vaccination.ConclusionHPV vaccination for girls is highly cost-effective in Kenya. Compared to GARDASIL-4, alternative products could provide similar or greater health benefits at lower net costs. Substantial government funding will be required to reach and sustain coverage targets as Kenya graduates from Gavi support. A single dose strategy is likely to have similar benefits for less cost.     

The effect of vaccine mandate announcements on vaccine uptake in Canada: An interrupted time series analysis

IntroductionIn 2021, the ten provinces in Canada enacted COVID-19 vaccine mandates that restricted access to non-essential businesses and services to those that could provide proof of full vaccination to decrease the risk of transmission and provide an incentive for vaccination. This analysis aims to examine the effects of vaccine mandate announcements on vaccine uptake over time by age group and province.MethodsAggregated data from the Canadian COVID-19 Vaccination Coverage Surveillance System (CCVCSS) were used to measure vaccine uptake (defined as the weekly proportion of individuals who received at least one dose) among those 12 years and older following the announcement of vaccination requirements. We performed an interrupted time series analysis using a quasi-binomial autoregressive model adjusted for the weekly number of new COVID-19 cases, hospitalizations, and deaths to model the effect of mandate announcements on vaccine uptake. Additionally, counterfactuals were produced for each province and age group to estimate vaccine uptake without mandate implementation.ResultsThe times series models demonstrated significant increases in vaccine uptake following mandate announcement in BC, AB, SK, MB, NS, and NL. No trends in the effect of mandate announcements were observed by age group. In AB and SK, counterfactual analysis showed that announcement were followed by 8 % and 7 % (310,890 and 71,711 people, respectively) increases in vaccination coverage over the following 10 weeks. In MB, NS, and NL, there was at least a 5 % (63,936, 44,054, and 29,814 people, respectively) increase in coverage. Lastly, BC announcements were followed by a 4 % (203,300 people) increase in coverage.ConclusionVaccine mandate announcements could have increased vaccine uptake. However, it is difficult to interpret this effect within the larger epidemiological context. Effectiveness of the mandates can be affected by pre-existing levels of uptake, hesitancy, timing of announcements and local COVID-19 activity.