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首页> 外文期刊>BMC International Health and Human Rights >System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study
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System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

机译：布基纳法索卫生区之间免疫覆盖率差异的系统级决定因素：多案例研究

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BackgroundDespite 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.MethodsA 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.ResultsThe 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).ConclusionThe 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.in FrenchSee the full article online for a translation of this in French.
机译：背景尽管在撒哈拉以南非洲地区疫苗接种覆盖率和过早死亡率取得了切实的进展，但获取的不平等现象依然根深蒂固，大量的低疫苗接种覆盖率仍然存在，并且覆盖率在不同地区，地区和医疗机构的区域之间经常有很大差异责任。本文着重探讨与系统有关的因素，这些因素可以解释布基纳法索各地区之间的免疫覆盖率差异。方法对六个地区进行了多例研究，这些地区代表了不同的免疫趋势和总体表现。当地专家和主要参与者的参与过程导致了对可能决定地区疫苗接种服务效率和功效的关键因素的关注：疾病暴发和免疫日的发生，地区总体管理绩效，疫苗接种服务可用的资源以及制度要素。该方法旨在重建2000年至2006年疫苗服务绩效的演变，该方法基于六个卫生区中每个区的文件数据以及个人和团体访谈。结果的解释过程使现场人员和研究团队聚集在一起。结果表现最佳的地区是那些集合了一系列有利条件的地区。但是，地区医务人员（DMO）的领导似乎是这些情况的主要渠道和聚集点。通常，由现场团队认可的强有力的领导才能确保疫苗接种服务的平稳运行，促进新计划的出现，并提供一定的保护措施，以防止与流行病或补充活动的爆发有关的风险，这些风险可能会阻碍常规功能。护士管理者及其团队应对新情况的能力也是如此（流行病，某些存货短缺）。结论关于决定中低收入国家当地医疗体系绩效或崩溃的因素的讨论仍然很大集中于技术官僚和财政方面的考虑，针对机构改革，资源的可获得性或卫生服务的可及性。在本地区医疗保健系统的绩效中，仅小部分提及了负责该地区的人员以及我们更广泛地称为“人为因素”的人员的领导作用。这项研究表明，即使他们只能有限地获得外部合作伙伴提供的支持，强大而坚定的领导才能促进团队的有效动员，并为在地区取得良好绩效创造条件。法国人

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