Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews

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dc.contributor.authorWiysonge, Charlesen_ZA
dc.contributor.authorNgcobo, Nthombenhleen_ZA
dc.contributor.authorJeena, Prakashen_ZA
dc.contributor.authorMadhi, Shabiren_ZA
dc.contributor.authorSchoub, Barryen_ZA
dc.contributor.authorHawkridge, Anthonyen_ZA
dc.contributor.authorShey, Mukien_ZA
dc.contributor.authorHussey, Gregoryen_ZA
dc.date.accessioned2015-11-23T11:44:09Z
dc.date.available2015-11-23T11:44:09Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals. METHODS: Between September 2009 and September 2010 we requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. We collated their responses and searched for systematic reviews on the effectiveness of the proposed solutions; in the Health Systems Evidence, Cochrane Library, and PubMed electronic databases. We screened the search outputs, selected systematic reviews, extracted data, and assessed the quality of included reviews (using AMSTAR) and the quality of the evidence (using GRADE) in duplicate; resolving disagreements by discussion and consensus. RESULTS: Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes, respectively. The findings from reliable systematic reviews indicate that interactive educational meetings, audit and feedback, and supportive supervision improve healthcare worker performance. Structured and interactive communication tools probably increase parents' understanding of immunisation; and reminders and recall, use of community health workers, conditional cash transfers, and mass media interventions probably increase immunisation coverage. Finally, a national social health insurance scheme is a potential EPI financing mechanism; however, given the absence of high-quality evidence of effects, its implementation should be pilot-tested and the impacts and costs rigorously monitored. CONCLUSION: In line with the Millennium Development Goals, we have to ensure that our children's right to health, development and survival is respected, protected and promoted. EPI is central to this vision. We found numerous promising strategies for improving EPI performance in South Africa. However, their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation. The strength of our approach comes from having a strong framework for interventions before looking for systematic reviews. Without a framework, we would have been driven by what reviews have been done and what is easily researchable; rather than the values and preferences of key immunisation stakeholders.en_ZA
dc.identifier.apacitationWiysonge, C., Ngcobo, N., Jeena, P., Madhi, S., Schoub, B., Hawkridge, A., ... Hussey, G. (2012). Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews. <i>BMC Public Health</i>, http://hdl.handle.net/11427/15240en_ZA
dc.identifier.chicagocitationWiysonge, Charles, Nthombenhle Ngcobo, Prakash Jeena, Shabir Madhi, Barry Schoub, Anthony Hawkridge, Muki Shey, and Gregory Hussey "Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews." <i>BMC Public Health</i> (2012) http://hdl.handle.net/11427/15240en_ZA
dc.identifier.citationWiysonge, C. S., Ngcobo, N. J., Jeena, P. M., Madhi, S. A., Schoub, B. D., Hawkridge, A., ... & Hussey, G. D. (2012). Advances in childhood immunisation in South Africa: where to now? Programme managers’ views and evidence from systematic reviews. BMC Public Health, 12(1), 578.en_ZA
dc.identifier.ris TY - Journal Article AU - Wiysonge, Charles AU - Ngcobo, Nthombenhle AU - Jeena, Prakash AU - Madhi, Shabir AU - Schoub, Barry AU - Hawkridge, Anthony AU - Shey, Muki AU - Hussey, Gregory AB - BACKGROUND: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals. METHODS: Between September 2009 and September 2010 we requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. We collated their responses and searched for systematic reviews on the effectiveness of the proposed solutions; in the Health Systems Evidence, Cochrane Library, and PubMed electronic databases. We screened the search outputs, selected systematic reviews, extracted data, and assessed the quality of included reviews (using AMSTAR) and the quality of the evidence (using GRADE) in duplicate; resolving disagreements by discussion and consensus. RESULTS: Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes, respectively. The findings from reliable systematic reviews indicate that interactive educational meetings, audit and feedback, and supportive supervision improve healthcare worker performance. Structured and interactive communication tools probably increase parents' understanding of immunisation; and reminders and recall, use of community health workers, conditional cash transfers, and mass media interventions probably increase immunisation coverage. Finally, a national social health insurance scheme is a potential EPI financing mechanism; however, given the absence of high-quality evidence of effects, its implementation should be pilot-tested and the impacts and costs rigorously monitored. CONCLUSION: In line with the Millennium Development Goals, we have to ensure that our children's right to health, development and survival is respected, protected and promoted. EPI is central to this vision. We found numerous promising strategies for improving EPI performance in South Africa. However, their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation. The strength of our approach comes from having a strong framework for interventions before looking for systematic reviews. Without a framework, we would have been driven by what reviews have been done and what is easily researchable; rather than the values and preferences of key immunisation stakeholders. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2458-12-578 DP - University of Cape Town J1 - BMC Public Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews TI - Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews UR - http://hdl.handle.net/11427/15240 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15240
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2458-12-578
dc.identifier.vancouvercitationWiysonge C, Ngcobo N, Jeena P, Madhi S, Schoub B, Hawkridge A, et al. Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews. BMC Public Health. 2012; http://hdl.handle.net/11427/15240.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2012 Wiysonge et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Public Healthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpublichealth/en_ZA
dc.subject.otherExpanded Programme on Immunisation (EPI)en_ZA
dc.subject.otherpublic health programmesen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleAdvances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviewsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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