Potential Barriers to and Solutions to Hepatitis B Birth-Dose Vaccine Uptake in Sub-Saharan Africa Countries

Intervention LevelDeterminantPotential BarriersPotential Solutions
PolicyLack of political willingness: advocacyLack of awareness of importance of vaccineEngage relevant stakeholders, decision makers, and effective in-country advocacy groups
Lack of vaccine advocacyEstablish national-level policy mandates for the timely delivery of HepB-BD
Lack of political willingness: affordabilityLack of available resourcesProvide cost-effective examples in sub-Saharan Africa
Lack of awareness of quantitative impact of vaccineDraw on drug manufacturer or other donors for distribution cost support
Need for effective recommendationsLack of consensus recommendations for vaccine implementationDevelop site-specific recommendations that draw upon research and literature, international guidelines, and feedback from diverse stakeholders
Facility and LogisticsKnowledge and training of health workersLack of awareness of vaccine benefits, stigma, and gaps in knowledge among CHWsEducate 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 wastageMake available vial size combinations
Short window for administering vaccine24-hour administration windowKeep mothers in delivery ward at least 24 hours after delivery
Mother's hesitancy to vaccinate infantAdminister vaccine in delivery ward
Mitigate cost burden
Cost burdenUser fees for vaccinesSubsidize or reduce costs associated with regular immunization
Tracking systemsLack of adequate reporting infrastructureStandardize all Hep B-BD immunization-reporting tools
Faltering vaccine recording buy-in by facility staff
Vaccine storage and stockoutsLimited storage space and stock-out determinantsStore 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 wardsEstablish standing orders for the vaccine
Reaching remote rural villages with vaccinesCultivate partnerships with vaccine distributor
CommunityMaternal involvementAt-home birthsLeverage post-home birth visit to administer vaccine
Raise vaccine awareness within the community
Geographic distance inhibiting timely delivery of newborn to health facilityEducate mothers during antenatal care visits
Families to keep home-based records
Community health worker involvementPoor communication channels between CHWs and mothersPerform 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 communitiesVaccine refrigeration requirementsUse 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.