Are vaccination programmes delivered by lay health workers cost-effective? A systematic review

<p>Abstract</p> <p>Background</p> <p>A recently updated Cochrane systematic review on the effects of lay or community health workers (LHWs) in primary and community health care concluded that LHW interventions could lead to promising benefits in the promotion of childhood vaccination uptake. However, understanding of the costs and cost-effectiveness of involving LHWs in vaccination programmes remains poor. This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving LHWs.</p> <p>Methods</p> <p>Articles were retrieved if the title, keywords or abstract included terms related to 'lay health workers', 'vaccination' and 'economics'. Reference lists of studies assessed for inclusion were also searched and attempts were made to contact authors of all studies included in the Cochrane review. Studies were included after assessing eligibility of the full-text article. The included studies were then reviewed against a set of background and technical characteristics.</p> <p>Results</p> <p>Of the 2616 records identified, only three studies fully met the inclusion criteria, while an additional 11 were retained as they included some cost data. Methodologically, the studies were strong but did not adequately address affordability and sustainability and were also highly heterogeneous in terms of settings and LHW outcomes, limiting their comparability. There were insufficient data to allow any conclusions to be drawn regarding the cost-effectiveness of LHW interventions to promote vaccination uptake. Studies focused largely on health outcomes and did illustrate to some extent how the institutional characteristics of communities, such as governance and sources of financial support, influence sustainability.</p> <p>Conclusion</p> <p>The included studies suggest that conventional economic evaluations, particularly cost-effectiveness analyses, generally focus too narrowly on health outcomes, especially in the context of vaccination promotion and delivery at the primary health care level by LHWs. Further studies on the costs and cost-effectiveness of vaccination programmes involving LHWs should be conducted, and these studies should adopt a broader and more holistic approach.</p

Positive Behavior Interventions: the Issue of Sustainability of Positive Effects

During the last decade, positive behavior interventions have resulted in improvement of school behavior and academic gains in a range of school settings worldwide. Recent studies identify sustainability of current positive behavior intervention programs as a major concern. The purpose of this article is to identify future direction for effective implementation of positive behavior interventions based on a comprehensive review of the current status of positive behavior interventions in terms of sustainability. The review will also examine implementation fidelity, as a factor that impacts upon sustainability. Literature reviewed in this study demonstrates that administrator support and professional development were the most frequently cited influential factors in previous research on sustainability of positive behavior interventions. In particular, the review highlights the significance of implementation fidelity at the classroom level for sustaining positive outcomes of positive behavior interventions over time. It is argued that in order to sustain positive effects of positive behavior intervention, future implementation efforts need to emphasize administrator support for the school team, ongoing high-quality professional development, and technical assistance. Moreover, a focus on coaching classroom-level implementation fidelity is of significant importance, as is the development and validation of evaluation tools for sustainability based on large-scale longitudinal international studies and more in-depth qualitative investigations