Enablers and barriers of maternal and neonatal immunization programs in Latin America

Alba Maria Ropero Alvarez, Alba Vilajeliu, Mirta Magariños, Barbara Jauregui, Lely Guzmán, Alvaro Whittembury, Emilia Cain, Odalys Garcia, Raul Montesanos, Cuauhtemoc Ruiz Matus

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The Region of the Americas has a long history of implementing maternal and neonatal immunization (MNI) programs. Our study aimed to understand the state of MNI policies, strategies and implementation practices in Latin America (LA). Methods: Study conducted in 5 middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru. The methods included a desk review, interviews with national stakeholders and health care providers, focus groups with pregnant women and observations in health facilities. Enablers and barriers were identified and categorized as individual, societal or related to the health system. Results: All 5 participating countries had similar MNI policies and high access to antenatal care. Key enablers were the high acceptability of vaccination during pregnancy, high-level of political will and a national legal framework ensuring free access to vaccines. At the health system level, implementation was facilitated by the existence of immunization advisory committees, a pooled vaccine procurement mechanism, complementary vaccine delivery strategies, conditional cash transfer to users and performance incentives to health facilities. The main programmatic barriers were the lack of adequate MNI information; limited coordination between antenatal and immunization services; inadequate supply, resources and infrastructure; high staff turnover; insufficient training for health care providers; and weak monitoring and reporting systems. Conclusion: Middle-income countries in LA have successfully implemented MNI programs and several enablers were identified. To overcome remaining barriers, there is a need to focus on improving the “immunization journey” for pregnant women through providing more clear and timely information to users and providers; removing barriers to access; ensuring adequate supply, human resources and infrastructure; making the health service experience positive; and establishing integrated information systems that allow for monitoring the progress toward achieving MNI goals. Strengthening the MNI programs can also improve equitable access to health services and prepare for the introduction of future vaccines for pregnant women.

Original languageEnglish
JournalVaccine
DOIs
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
The authors would like to thank the Ministries of Health of Argentina, Brazil, Honduras, Mexico and Peru; NITAG members; representatives of Scientific Societies; health care providers and pregnant women interviewed in the five countries. This study received funding from the Bill and Melina Gates Foundation (BMGF).

Publisher Copyright:
© 2020

Keywords

  • Latin America
  • Maternal immunization
  • Middle-income country
  • Neonate
  • Pregnancy
  • Vaccine

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