TY  - THES
AU  - Morgan, Christopher John
Y2  - 2021/02/02
Y1  - 2020
UR  - http://hdl.handle.net/11343/258895
AB  - Background
Integrating immunization and other health services during infancy could dramatically expand access to health care. During the first year after childbirth, immunisation  services reach over 115 million families globally, at a point in the life-course where  disease prevention, nutrition, and other preventive services can have high impact. Immunisation coverage could also benefit from integration, when catch-up vaccination is incorporated into illness or other care. There is encouraging evidence for malaria, HIV, or family planning programs and many global strategies advocate integrated services, especially for resource-constrained settings. However there are significant unresolved implementation questions, such as how best to link services, avoid staff overload, and maintain quality. Some attempts at integration fail to achieve expected benefits due to
difficulties in re-organisation of services, or unexplained gaps in demand for and uptake of new arrangements.

Methods
This researched focused on low- and middle-income countries, using methods from health policy and systems research. Firstly, a new systematic review of global evidence examined outcomes and processes in controlled studies attempting integration of other services with infant immunisation. Secondly, in rural Papua New Guinea (PNG),  integration questions were nested in a prospective observational cohort study following 699 mother-infant pairs from first antenatal visit until 12 months after childbirth. Repeated assessments examined co-morbidity and preventive care needs, experiences of integrated services, and a unique open exploration of women’s preferences for future
integration. Thirdly, a cross-sectional health services assessment, in the same setting, examined integration practices and preferences of health managers and front-line staff.
Integration of Immunisation and Other Services 

Findings
Review of global evidence documented new work integrating family planning, HIV, malaria and nutrition. Most linked services benefited, with mixed outcomes for immunisation. A new typology of integrated services emerged, with richer detail on what determines success. In PNG, need for integrated care is high but provision is low. PNG women’s preferences surpassed current evidence, policy and practice; seeking addition of maternal illness care, comprehensive child illness care, better education on important disease threats, and sexual and reproductive health care. They had many insights for improved implementation of integrated services. Women privilege holistic quality care over savings in time and money, although the latter are valued. Acceptability is not universal, with sensitive topics needing careful management.

The existing immunisation program in PNG offers some integration opportunities, but meeting women’s preferences will require additional investments in planning and  staffing. Synergies when strengthening immunisation for integration may also expand routine coverage and capacity to support emergency responses. Priorities include addressing maternal health during immunisation clinics, integration of nutrition, family planning and immunisation in the first and second years of life, and reducing missed
opportunities for vaccination during illness care.

Conclusion
Integration of other services with immunisation in infancy should be pursued; first because it can offer holistic care for the multiple health needs in families, and then for potential efficiencies. Implementation details, especially addressing users’ preferences, are critical to success. Better understanding of families’ needs and preferences is essential to health planning, as more responsive services offer pathways to system resilience and universal coverage.
KW  - Immunisation
KW  - Immunization
KW  - Vaccination
KW  - Global health
KW  - Integration
KW  - Integrated services
KW  - Low-income countries
KW  - Middle-income countries
KW  - Papua New Guinea
KW  - Child health
KW  - Under-five child care
KW  - Postnatal health care
KW  - Maternal health care
KW  - Preventive medicine
T1  - Integrated approaches to immunisation and other health services for maternal, newborn and child health in resource-constrained settings
L1  - /bitstream/handle/11343/258895/5fb179bd-34ff-e711-9480-0050568d7800_Morgan606936PhDThesisAndAppendices31Jan2021.pdf?sequence=1&isAllowed=n
ER  -