Country ownership as a guiding principle for IA2030: A case study of the measles and rubella elimination programs in Nepal and Nigeria.

Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to "leave no one behind" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.

Ensuring accountability in implementation of supplementary immunisation activities: A case study of the 2017/2018 measles vaccination campaign in Nigeria.

INTRODUCTION: Globally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. METHODS: We identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013-2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. FINDINGS: We found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. CONCLUSION: We have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.

Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions.

INTRODUCTION: Healthcare systems in Africa suffer from neglect and underfunding, leading to severe challenges across the six World Health Organization (WHO) pillars of healthcare delivery. We conducted this study to identify the principal challenges in the health sector in Africa and their solutions for evidence-based decisions, policy development and program prioritization. METHODS: The study was conducted as part of a recent African Epidemiological Association Meeting in Maputo, Mozambique with participants drawn from 11 African countries, Cuba, Portugal and the United Kingdom. Participants were divided into 10 groups, consisting of 7 to 10 persons each. Brainstorming approaches were used in a structured, modified nominal group process exercise to identify key challenges and strategies to mitigate healthcare service challenges in Africa. Identified challenges and solutions were prioritised by ranking 1-5, with 1 most important and 5 being least important. RESULTS: The first three challenges identified were inadequate human resources (34.29%), inadequate budgetary allocation to health (30%) and poor leadership and management (8.45%). The leading solutions suggested included training and capacity building for health workers (29.69%), increase budgetary allocation to health (20.31%) and advocacy for political support and commitment (12.31%). CONCLUSION: The underdeveloped healthcare systems in Africa need radical solutions with innovative thought to break the current impasse in service delivery. For example, public-private initiatives should be sought, where multinational companies extracting resources from Africa might be encouraged to plough some of the profits back into healthcare for the communities providing the workforce for their commercial activities. Most problems and their solutions lie within human resources, budget allocation and management. These should be accorded the highest priority for better health outcomes.