Resilience in childhood vaccination

Analysing delivery system responses to shocks in Lebanon

Bibliographic Data

ID21879871
AuthorsSharif A Ismail (0000-0001-7246-7337, London School of Hygiene & Tropical Medicine, corresponding author), Andrada Tomoaia-Cotisel (0000-0003-4793-6298, RAND Corporation), Aya Noubani (Queen Margaret University), Fouad Mohamed Fouad (0000-0002-4124-4058, American University of Beirut), Sadie Bell (0000-0003-4381-0030, London School of Hygiene & Tropical Medicine), Josephine Borghi (0000-0002-0482-5451, London School of Hygiene & Tropical Medicine), Karl Blanchet (0000-0003-0498-8020, University of Geneva)
Year2023
Volume8
Issue11
Pagese012399
Publication date2023-11-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-012399
PMID37931939
OpenAlexW4388410386
LanguageEN
Citations received1
References cited27

INTRODUCTION: Despite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We focused on routine childhood vaccination delivery in Lebanon in the context of at least three shocks overlapping to varying degrees in space and time: large-scale refugee arrivals from neighbouring Syria; COVID-19; and an economic crisis. METHODS: Semistructured interviews were performed with 38 stakeholders working at different levels in the system. Interview transcripts were analysed using purposive text analysis to generate individual stakeholder causal loop diagrams (CLDs) mapping out relationships between system variables contributing to changes in coverage for routine antigens over time. These were then combined using a stepwise process to produce an aggregated CLD. The aggregated CLD was validated using a reserve set of interview transcripts. RESULTS: Various system responses to shocks were identified, including demand promotion measures such as scaling-up community engagement activities and policy changes to reduce the cost of vaccination to service users, and supply side responses including donor funding mobilisation, diversification of service delivery models and cold chain strengthening. Some systemic changes were introduced-particularly in response to refugee arrivals-including task-shifting to nurse-led vaccine administration. Potentially transformative change was seen in the integration of private sector clinics to support vaccination delivery and depended on both demand side and supply side changes. Some resilience-promoting measures introduced following earlier shocks paradoxically increased vulnerability to later ones. CONCLUSION: Flexibility in financing and human resource allocation appear key for system resilience regardless of the shock. System dynamics offers a promising method for ex ante modelling of ostensibly resilience-strengthening interventions under different shock scenarios, to identify-and safeguard against-unintended consequences

Business · Causal loop diagram · Economics · Environmental health · Geography · Political science · Psychological resilience · Public economics · Public relations · Refugee · Service delivery framework · Stakeholder · Supply chain · System dynamics · Vaccination · Computer Science · Disaster Response and Management · Global Maternal and Child Health · Medicine · Psychology · Social Psychology · Viral Infections and Outbreaks Research · Immunology · Marketing

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