In-Depth Country Case study: Identified drivers

To date, comparative country analysis identified six common performance drivers across the 12 study districts within the three study countries.  They were:

1.  “Community Engagement”:  This driver involves not only educating community members about the importance of immunization, but involving the community in service provision decisions, strategies, and activities which promotes community ownership of immunization, and ultimately results in the community becoming an important and active member of the immunization team.  All types of community members were important, but community volunteers played a particularly essential role in each of the districts where coverage improved.

2. “Community-focused service delivery”:  this is defined in two parts: the autonomy provided to district health teams to adapt to global and national strategies to local needs; and, the use of local knowledge and understanding of the community’s needs to better tailor services to the needs and conditions of the community.

3. ” Community centered-health workforce”:  This driver brings immunization systematically close to the community.  It relates closely to the community -focused service delivery driver.  In all districts there were community based health workers who deliver immunizations services within the community on a regular basis.  The primary contributions of this community-based health workforce are made in improving access to and availability of services, with the important factors being predictability of services from the community perspective, and the rational distribution of services so that distances and waiting times are reduced.  The ARISE research is indicating more and more that the health workers have to be not only competent and supported, but critically, they have to be strategically recruited and placed so as to minimize barriers to forging a close partnership with the community.