Understanding Internal Accountability in Nigeria's Routine Immunization System: Perspectives From Government Officials at the National, State, and Local Levels.
Understanding Internal Accountability in Nigeria's Routine Immunization System: Perspectives From Government Officials at the National, State, and Local Levels.
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DOI：
10.15171/ijhpm.2016.150
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发表时间：
2017-07-01
影响因子：
3.5
通讯作者：
Wonodi C
中科院分区：
文献类型：
--
作者：
Erchick DJ;George AS;Umeh C;Wonodi C
背景资料：尼日利亚的常规免疫覆盖率仍然很低，研究发现，缺乏问责制是免疫系统取得高绩效的障碍。问责制是尼日利亚最近发起的加强各种卫生系统努力的核心，包括与免疫接种有关的努力。我们的目的是了解卫生官员对阻碍各级政府提供免疫服务的问责挑战的看法。 研究方法：采用半结构式问卷对尼日利亚中北部尼日尔州的国家、州、地方和卫生机构各级的免疫接种和初级保健（PHC）官员进行了访谈。选定的个人代表免疫系统中的一系列作用和责任。调查问卷探讨了与内部问责制有关的概念，采用了一个框架，根据问责制如何推动卫生系统的变革，将问责制分为三个轴心。 结果如下：答复者强调了免疫系统多个组成部分的问责挑战，包括疫苗供应、筹资、后勤、人力资源和数据管理。一个主要的重点是机构内部和各级政府之间缺乏明确的作用和责任。供资方面的拖延，特别是在较低级别的政府，扰乱了服务的提供。监督的频率低于必要的频率，管理人员的决策空间有限，使问题无法得到解决。官员不能履行职责，影响了他们的积极性。官员们提出了许多改善问责制的建议，包括明确角色和责任，确保及时发放资金，以及正式制定监督、解决问题和数据报告的程序。 结论：问责制薄弱是尼日利亚常规免疫系统和高免疫覆盖率的一个重大障碍。作为确保卫生系统业绩的利益攸关方之一，例行免疫接种官员揭示了需要优先考虑的关键领域，如果新的干预措施，以改善例行免疫接种的问责制，将产生影响。
Background: Routine immunization coverage in Nigeria has remained low, and studies have identified a lack of accountability as a barrier to high performance in the immunization system. Accountability lies at the heart of various health systems strengthening efforts recently launched in Nigeria, including those related to immunization. Our aim was to understand the views of health officials on the accountability challenges hindering immunization service delivery at various levels of government. Methods: A semi-structured questionnaire was used to interview immunization and primary healthcare (PHC) officials from national, state, local, and health facility levels in Niger State in north central Nigeria. Individuals were selected to represent a range of roles and responsibilities in the immunization system. The questionnaire explored concepts related to internal accountability using a framework that organizes accountability into three axes based upon how they drive change in the health system. Results: Respondents highlighted accountability challenges across multiple components of the immunization system, including vaccine availability, financing, logistics, human resources, and data management. A major focus was the lack of clear roles and responsibilities both within institutions and between levels of government. Delays in funding, especially at lower levels of government, disrupted service delivery. Supervision occurred less frequently than necessary, and the limited decision space of managers prevented problems from being resolved. Motivation was affected by the inability of officials to fulfill their responsibilities. Officials posited numerous suggestions to improve accountability, including clarifying roles and responsibilities, ensuring timely release of funding, and formalizing processes for supervision, problem solving, and data reporting. Conclusion: Weak accountability presents a significant barrier to performance of the routine immunization system and high immunization coverage in Nigeria. As one stakeholder in ensuring the performance of health systems, routine immunization officials reveal critical areas that need to be prioritized if emerging interventions to improve accountability in routine immunization are to have an effect.
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影响因子：
3.2
作者：
George, Asha S.;Erchick, Daniel J.;Wonodi, Chizoba
通讯作者：
Wonodi, Chizoba
DOI：
10.1016/j.ijgo.2014.07.004
发表时间：
2014-10-01
影响因子：
3.8
作者：
Garba, Aminu Magashi;Bandali, Sarah
通讯作者：
Bandali, Sarah
影响因子：
3.2
作者：
Murthy, RK;Klugman, B
通讯作者：
Klugman, B
影响因子：
3.2
作者：
Brinkerhoff, Derick W.;Bossert, Thomas J.
通讯作者：
Bossert, Thomas J.
影响因子：
10.8
作者：
Garuba, Habibat A.;Kohler, Jillian C.;Huisman, Anna M.
通讯作者：
Huisman, Anna M.