3. Status of Missed Opportuni1es for

Transcription

1 3. Status of Missed Opportuni1es for Vaccina1on Assessments in the Americas Martha Velandia MD, MSc Regional Advisor 1

2 Outline 1. Why has PAHO implemented Missed Opportuni1es for Vaccina1on (MoV) studies? 2. Results of MoV country studies to date 3. Lessons learned 4. The way forward 2

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4 Propor1on of Municipali1es by Range of Coverage with DTP3 in Children < 1 year of age, LAC, 2014 Range of coverage 95% 80 94% <80% Source: Reports from the countries in the joint report form (JRF) for no7fica7on of the PAHO- WHO/UNICEF, 2014.

5 117 ar1cles/ grey literature Regional Literature Review, ar1cles reviewed from 19 countries care workers Immuniza?on card not reviewed No advice given to vaccinate- lack of communica?on False contraindica?ons Main reasons for MoV Parents Immuniza?on card not available Lack of?me Fear of AEFI vaccines/ mul?ple vaccina?on 5 Services Lack of vaccines Poor communica?on Lack of follow up of children

6 Analysis of Recent Studies 6

7 Analysis of Recent Studies 7

8 Methodology Type of study Cross- sec?onal evalua?on of MOVs in primary and secondary health care facili?es that offer vaccina?on Target popula1on Children aged <5 years and their caregivers workers at the selected facili?es with an emphasis on general medicine and certain special?es Sample design This is an opera?onal tool The sample is only representa?ve of children aged <5 years visi?ng health services in the geographic area surveyed on the day of the study 8

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10 MOV Studies Conducted in Selected Countries, Dominican Republic Level 14 subna?onal Panama 10 subna?onal City of Bogota Peru 20 subna?onal facili1es Interviews conducted Children w/ card # % 92 1, , local ,488 1, Preliminar data

11 Step 1: Planning the assessment 11 Preliminar data Step 2: Data collec?on Step 3: Analyzing & interpre1ng Step 4: Results Step 5: taking ac1on

12 Propor1on of Children Interviewed, Eligible and with Missed Opportuni1es. Selected Countries, DOR PER PAN BOG # % # % # % # % Children interviewed 1,500 3,488 1, Children with card % 1,751 50% % % Children up to the date Missed opportuni?es % 1,377 78% % % % % 75 17% 28 5% Preliminar data * Child aged 12 <5 years with vaccination card, who has not begun or completed the vaccination schedule for his or her age; who has no real contraindications for receiving one or more vaccine doses; and who, given the date of administration of a previous dose or doses, is eligible to be vaccinated by the health personnel during the visit to the health facility on the day of the study

13 Primary Reason for Bringing the Child to the Center, MOV Studies Selected Countries, % 100 Dominican R. Panama Bogota city Peru Medical consulta?on Vaccina?on Acompanying family y child visit Other 13 Preliminar data

14 Reasons for No Vaccina1on, MOV Studies in Selected Countries, % 100 Dominican R. Panama Bogota city Peru workers Caregivers Services 14 Preliminar data

15 Reasons for No Vaccina1on: Workers MOV Studies in Selected Countries, Asked for the vaccina?on card The professional said that the child is already vaccinated False contraindica?on Dominican Republic Peru Panama Bogota 34% 11% 85% 62% % 42% 94% 88% 56% 86% 84% 15 Preliminar data

16 Reasons for No Vaccina1on: Caregiver I didn t bring the child for vaccina?on I forgot/i didn t have?me Dominican Republic Peru Panama Bogota 82% 49% 85% 51% 6% 11% 5% 6% Reasons for No Vaccina1on: Services There are no vaccines (stock outs) Today is not a vaccina?on 16 day Dominican Republic Peru Panama Bogota 80% 71% 85% 51% 6% 16% 5% 6% Preliminar data

17 Quality of Service, perceived by caregiver MOV Studies in Selected Countries, % Dominican R Panama Bogota city Peru 0 17 Preliminar data Vaccine received Next appointment scheduled Poten?al reac?ons Sa?sfied with the care explained received

18 Outline 1. Why has PAHO implemented MoV studies? 2. Results of MoV country studies to date 3. Lessons learned 4. The way forward 18

19 Lessons Learned: Poli1cal Support, Adapta1on, Implementa1on and Analysis 1. The EPI should lead and inform all the stakeholders involved in a MOV study 2. The survey must be adapted to take into account differences in culture, local language and EPI schedule 3. Need to establish algorithms/syntaxes for determining MOV 4. Need to pilot the tools prior to the implementa?on 5. Train interviewers and explain to them the importance of the data collected 6. Use of new technology 7. Polling company? University? workers? 8. Supervision is key 9. Professionals in different disciplines should be part of the analysis 19

20 4. More financial assistance is required for interven?ons and measurement post interven?on. Lessons Learned: Dissemina1on of MoV Results 1. Par?cipa?on of subna?onal level EPI officers Dominican Republic Panama Peru 2. Par?cipa?on of other partners (i.e. Peru: civil society) 3. Countries have iden?fied the results as real problems at the local level

21 Outline 1. Why has PAHO implemented MoV studies? 2. Results of MoV country studies to date 3. Lessons learned 4. The way forward 21

22 The Way Forward for MoV 1) Synthe?c analysis of the completed assessments 2) Dissemina?on of Missed Opportuni?es for Vaccina?on Best Buys" Manual: a) Systema?c review of strategies to reduce MoV b) Monitoring system for MoV c) Guidelines to reduce MoV for the local levels d) Validate the manual with EPI focal points, EPI managers and others field experts 3) Future assessments in other countries: a) Caribbean Region (Bri?sh Virgin Islands) b) Costa Rica c) Ecuador 22

23 23 Thank you