Potential Barriers to and Solutions to Hepatitis B Birth-Dose Vaccine Uptake in Sub-Saharan Africa Countries
| Intervention Level | Determinant | Potential Barriers | Potential Solutions |
|---|---|---|---|
| Policy | Lack of political willingness: advocacy | Lack of awareness of importance of vaccine | Engage relevant stakeholders, decision makers, and effective in-country advocacy groups |
| Lack of vaccine advocacy | Establish national-level policy mandates for the timely delivery of HepB-BD | ||
| Lack of political willingness: affordability | Lack of available resources | Provide cost-effective examples in sub-Saharan Africa | |
| Lack of awareness of quantitative impact of vaccine | Draw on drug manufacturer or other donors for distribution cost support | ||
| Need for effective recommendations | Lack of consensus recommendations for vaccine implementation | Develop site-specific recommendations that draw upon research and literature, international guidelines, and feedback from diverse stakeholders | |
| Facility and Logistics | Knowledge and training of health workers | Lack of awareness of vaccine benefits, stigma, and gaps in knowledge among CHWs | Educate facility staff on the HepB-BD vaccine and administration protocol |
| Cultivate champions | |||
| Comprehensive training | |||
| Completion of checklist form by staff before discharge of newborn | |||
| Couple immunization with BCG and oral polio vaccine | |||
| Variable vial size and concern for wastage | Make available vial size combinations | ||
| Short window for administering vaccine | 24-hour administration window | Keep mothers in delivery ward at least 24 hours after delivery | |
| Mother's hesitancy to vaccinate infant | Administer vaccine in delivery ward | ||
| Mitigate cost burden | |||
| Cost burden | User fees for vaccines | Subsidize or reduce costs associated with regular immunization | |
| Tracking systems | Lack of adequate reporting infrastructure | Standardize all Hep B-BD immunization-reporting tools | |
| Faltering vaccine recording buy-in by facility staff | |||
| Vaccine storage and stockouts | Limited storage space and stock-out determinants | Store the vaccine in existing cold chains and/or in labor wards | |
| Allow private providers to obtain the vaccine free-of-charge | |||
| Poor communication between the immunization and maternity wards | Establish standing orders for the vaccine | ||
| Reaching remote rural villages with vaccines | Cultivate partnerships with vaccine distributor | ||
| Community | Maternal involvement | At-home births | Leverage post-home birth visit to administer vaccine |
| Raise vaccine awareness within the community | |||
| Geographic distance inhibiting timely delivery of newborn to health facility | Educate mothers during antenatal care visits | ||
| Families to keep home-based records | |||
| Community health worker involvement | Poor communication channels between CHWs and mothers | Perform home visits in rural communities to educate mothers, track pregnancies, and refer mother-infant pair to nearby facilities | |
| Provide at-home immunization for infants | |||
| Strengthen ties between CHWs and facilities | |||
| Engage community leaders and members | |||
| Provide incentives for CHWs | |||
| Evidence-based innovations to reach communities | Vaccine refrigeration requirements | Use of out-of-cold-chain or controlled temperature chains | |
| Mobile-based devices to track pregnancies in rural areas |
Abbreviations: BCG, Bacillus Calmette-Guerin; CHW, community health worker; HepB-BD, hepatitis B birth dose.