Table 2 List of determinants to vaccine coverage
Theme | Determinant | Description | Relationship | Evidence | Label in Fig. 2 |
|---|---|---|---|---|---|
Facility Readiness | Facility Readiness (Routine) | Health facility is ready to vaccinate children | Directly impacts Utilization | [44] | 1 |
Service HR/Mgmt | Adequate health facility staff to meet demand | Directly impacts Facility Readiness | 2 | ||
Training | Adequate health facility staff training | Moderates Service HR/Mgmt | 3 | ||
Performance Assessment | Procedures for facility staff performance assessment | Moderates Service HR/Mgmt | 4 | ||
Disbursement/Fund Mgmt | Adequate resources and management for health facility staff | Directly impacts Service HR/Mgmt, Training, Performance Assessment | 5 | ||
Waste Disposal | Procedures and equipment for vaccine waste | Directly impacts Facility Readiness | 6 | ||
Facility Vaccine Supply | Health facility has vaccines to administer | Directly impacts Facility Readiness | 7 | ||
Facility Storage Capacity | Health facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Facility Vaccine Supply | 8 | ||
Stock/Flow Awareness | Staff members know the status of vaccine inventory | Moderates Facility Vaccine Supply | 9 | ||
Consumption Forecasting | Appropriate anticipation of future demand | Directly impacts Stock/Flow Awareness | 10 | ||
Transaction Visibility | Adequate resources dedicated to supply chain transparency | Directly impacts Stock/Flow Awareness | 11 | ||
Transaction Reporting | Adequate resources dedicated to communication of transactions | Directly impacts Stock/Flow Awareness | 12 | ||
Supply LMIS | Logistics management information system for tracking supply | Moderates Transaction Reporting, Transaction Visibility | 13 | ||
Inventory HR/Mgmt | Adequate resources dedicated to inventory management | Directly impacts Stock/Flow Awareness | 14 | ||
Training | Adequate inventory management training | Moderates Inventory HR/Mgmt | 15 | ||
Performance Assessment | Procedures for inventory management performance assessment | Moderates Inventory HR/Mgmt | 16 | ||
Disbursement/Fund Mgmt | Adequate resources and management for inventory management | Directly impacts Inventory HR/Mgmt, Training, Performance Assessment | 17 | ||
Intermediary Vaccine Supply | Intermediate storage facility has vaccines to distribute | Directly impacts Facility Vaccine Supply | 18 | ||
Intermediary Storage Capacity | Intermediate storage facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Intermediary Vaccine Supply | 19 | ||
Facility Distribution Method | Established means of transporting stock from intermediate storage to health facility | Directly impacts Facility Vaccine Supply | 20 | ||
Distribution Equipment | Vehicles and other equipment to distribute supply from intermediate storage to health facility | Moderates Facility Distribution Method | 21 | ||
Distribution HR/Mgmt | Adequate resources dedicated to distribution management | Moderates Facility Vaccine Supply, Intermediary Vaccine Supply | 22 | ||
Training | Adequate distribution management training | Moderates Distribution HR/Mgmt | 23 | ||
Performance Assessment | Procedures for distribution system performance assessment | Moderates Distribution HR/Mgmt | 24 | ||
Disbursement/Fund Mgmt | Adequate resources and management for distribution systems | Directly impacts Distribution HR/Mgmt, Training, Performance Assessment | 25 | ||
Country Vaccine Supply | Central storage facility has vaccines to distribute | Directly impacts Intermediary Vaccine Supply | 26 | ||
Country Storage Capacity | Central storage facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Country Vaccine Supply | 27 | ||
Intermediary Distribution Method | Established means of transporting stock from central to intermediate storage | Directly impacts Intermediary Vaccine Supply | 28 | ||
Distribution Equipment | Vehicles and other equipment to distribute supply from central to intermediate storage | Moderates Intermediary Distribution Method | 29 | ||
Leadership and Consistency | Oversight and decision-making in vaccine systems | Directly impacts Disbursement/Fund Mgmt, Outreach Protocol, Demand Generation Activities, Community Partnership, Service Cost, Supply LMIS | 30 | ||
Political Commitment | High-level support for vaccination systems | Directly impacts Leadership and Consistency, Funding | 31 | ||
Development Partner Participation | High-level engagement from development partners in vaccination systems | Directly Impacts Political Commitment, Funding, Country Vaccine Supply | 32 | ||
Funding | Adequate high-level funding for vaccination systems | Directly impacts Disbursement/Fund Mgmt, Facility Infrastructure, Service Cost | 33 | ||
Facility Readiness (Outreach) | Health facility is ready to vaccinate children through outreach activities | Directly impacts Utilization | 34 | ||
Outreach Transportation | Adequate vehicles to conduct outreach activities | Directly impacts Facility Readiness (Outreach) | 35 | ||
Mobile Storage Capacity | Health facility has sufficient capacity to store vaccines during outreach activities | Directly impacts Facility Readiness (Outreach) | [31] | 36 | |
Outreach Protocol | Procedures and plans for outreach activities | Directly impacts Mobile Storage Capacity, Outreach Transportation | 37 | ||
Decision to Vaccinate | Community Partnership | Active and positive relationship between health facility and community | Directly impacts Quality of Care, Community Awareness, Attitude | 38 | |
Demand Generation Activities | Health facility encourages vaccine utilization in the community | Directly impacts Perceived Safety, Need, Effectiveness, Community Awareness, Attitude, Vaccine Awareness, Attitude | 39 | ||
Quality of Care | Quality of care at health facility for vaccination | Directly impacts Wait Time, Perceived Quality of Care | 40 | ||
Facility Infrastructure | Quality of health facility building and equipment | Directly impacts Wait Time, Perceived Quality of Care | 41 | ||
Service Cost | Cost of vaccine services charged to the mother or caretaker by the health facility | Moderates Ability to Finance Service | 42 | ||
Wait Time | Wait time at health facility for vaccination | Directly impacts Perceived Quality of Care | 43 | ||
Patient Volume | Number of patients who typically visit health facility | Directly impacts Wait Time | [9] | 44 | |
Decision to Vaccinate | Mother or caretaker intends to vaccinate the child | Directly impacts Utilization | 45 | ||
Vaccine Awareness, Attitude | Mother or caretaker is aware of vaccine and perceives it to be beneficial | Directly impacts Decision to Vaccinate, Perceived Eligibility | [8, 28,29,30, 32, 41, 46, 48, 49, 51, 53, 54, 56, 59, 61, 65, 69, 72,73,74, 77,78,79,80,81,82,83] | 46 | |
Perceived Quality of Care | Mother or caretaker perceptions about the quality of care in the health facility | Directly impacts Vaccine Awareness, Attitude | 47 | ||
Education | Mother or caretaker education | Directly impacts Vaccine Awareness, Attitude | [8–10, 32, 37, 39, 44, 48, 51, 57, 59, 61, 66, 75, 76, 78, 81,82,83,84,85,86,87,88,89] | 48 | |
Prior Use | Child has been vaccinated previously | Directly impacts Vaccine Awareness, Attitude, Child Has Card | 49 | ||
Child Has Card | Child has vaccine card for recording doses | Directly impacts Vaccine Awareness, Attitude | 50 | ||
Perceived Safety, Need, Effectiveness | Mother or caretaker perceives that there is risk of disease and the vaccine is safe and effective | Directly impacts Vaccine Awareness, Attitude | [9, 29, 30, 38, 41, 45, 46, 51, 68, 72, 73, 75, 76,77,78,79, 90, 91] | 51 | |
Community Awareness, Attitude | Influential community members are aware of the vaccine and perceive it to be beneficial | Directly impacts Vaccine Awareness, Attitude, Perceived Safety, Need, Effectiveness, Patient Volume | 52 | ||
Perceived Eligibility | Mother or caretaker perceives that child is eligible for vaccination | Directly impacts Decision to Vaccinate | 53 | ||
Child Eligibility | Child Eligibility | Child meets criteria to be eligible for vaccination | Directly impacts Utilization | 54 | |
Child Health | Child is healthy enough to be vaccinated | Directly impacts Child Eligibility, Perceived Eligibility | 55 | ||
Child Age | Child is of the appropriate age to be vaccinated | Directly impacts Child Eligibility, Perceived Eligibility | 56 | ||
Child Sex | Sex of child | Directly impacts Perceived Eligibility | 57 | ||
Mother Able | Mother Able | Mother or caretaker has access to the means and time to vaccinate the child | Directly impacts Utilization | 58 | |
Ability to Finance Service | Mother or caretaker can afford any cost of vaccine services | Directly impacts Mother Able, Decision to Vaccinate | 59 | ||
Ability to Finance Transport | Mother or caretaker can afford any cost of transportation | Directly impacts Mother Able, Decision to Vaccinate | 60 | ||
Ability to Spare Time | Mother or caretaker can take time out of other responsibilities to vaccinate the child | Directly impacts Mother Able, Decision to Vaccinate | 61 | ||
Insurance | Whether the mother or caretaker has health insurance | Moderates Ability to Finance Service | 62 | ||
SES | Socio-economic status of mother or caretaker | Directly impacts Ability to Finance Service | 63 | ||
Transport Time/Cost | Duration and cost of transportation to health facility incurred by mother or caretaker | Moderates Ability to Finance Transport, Ability to Spare Time | 64 | ||
Parity | Number of siblings of the child | Directly impacts Ability to Spare Time | [8–10, 29, 30, 39, 51, 57, 59, 61, 71, 75, 76, 79, 81, 83, 85, 88, 93] | 65 | |
Distance | Distance from household to health facility | Directly impacts Transport Time/Cost | [10, 27, 30, 32, 39, 45, 48, 54, 56, 57, 61, 65, 79, 88, 93] | 66 | |
Marital Status | Mother or caretaker marital status | Directly impacts Ability to Spare Time | 67 | ||
Maternal Health | Mother or caretaker health | Directly impacts Mother Able, Decision to Vaccinate | 68 |