ArticleImplementation science : IS2015
The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda.
Article in Implementation science : IS, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review.BMC health services research · 2024Pooled it
- Interventions for improving coverage of childhood immunisation in low- and middle-income countries.The Cochrane database of systematic reviews · 2023Pooled it
- Interventions for improving coverage of childhood immunisation in low- and middle-income countries.The Cochrane database of systematic reviews · 2016Pooled it
- Exploring supplemental immunization strategies to reach zero-dose children in low- and middle-income countries: a scoping review.Therapeutic advances in vaccines and immunotherapy · 2026Article
- [Determinants of vaccine acceptance in Makokou, Gabon].The Pan African medical journal · 2024Article
- Service delivery interventions to improve maternal and newborn health in low- and middle-income countries: scoping review of quality improvement, implementation research and health system strengthening approaches.BMC health services research · 2023Article
- Applying quality improvement tools to the Reaching Every District strategy: a mixed-methods examination of a systems strengthening approach to building the capacity of immunization managers and service providers in Ethiopia.The Pan African medical journal · 2023Article
- A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms.Health systems (Basingstoke, England) · 2023Article
- Advancing sustainable development goals through immunization: a literature review.Globalization and health · 2021Review
- A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda.Gates open research · 2019Article
- Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda.Psychological medicine · 2018Article
- Quality improvement practices to institutionalize supply chain best practices for iCCM: Evidence from Rwanda and Malawi.Research in social & administrative pharmacy : RSAP · 2017Article
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Authors and funding
6 authors.
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Abstract
backgroundAlthough global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet-Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda.
methodsThe ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011-February 2012) and five follow-up months.
resultsWorkshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader--community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements.
conclusionsThe Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO's Reaching Every District (RED) immunization strategy.
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