System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

Determinants of immunisation coverage in Butere-Mumias district, Kenya

Background: Butere - Mumias district is one of the districts which performs poorly on immunisation coverage, as observed from the Kenya Expanded Programme of Immunisation reports.Objective: To identify factors that contribute to the low level of immunisation coverage in the district among children under the age of five years. Design: Cross-sectional descriptive study.Setting: Butere - Mumias district.Results: Out of the 293 mothers who were sampled, 238(80%) had attained primary level of education while, 55 (20%) attained secondary level and above. Immunisation coverage was found to be 35% in this district. Long distances to health facilities, poor states of the roads, age, attitude and knowledge regarding immunisation among mothers were significant factors that determined immunisation coverage.Conclusion: Low levels of education, long distances to the nearest health facilities, lack of knowledge on immunisations and lack of staff were responsible for the low coverage. There is therefore, need to act on these factors which hamper the immunisation coverage in order to reduce child mortality rate which are attributable to non-immunisation.East African Medical Journal Vol 82(10) 2005: 502-50