A Delphi study to assess the effect of changes in language between the first and second editions of the WHO's Joint External Evaluation.

INTRODUCTION: Countries use the WHO Joint External Evaluation (JEE) tool-part of the WHO International Health Regulations (2005) Monitoring and Evaluation Framework-for voluntary evaluation of global health security (GHS) capacities. After releasing the JEE first edition (E1) in 2016, WHO released the JEE second edition (E2) in 2018 with language changes to multiple indicators and associated capacity levels. To understand the effect of language changes on countries' ability to meet requirements in each edition, we conducted a Delphi study-a method where a panel of experts reach consensus on a topic through iterative, anonymous surveys-to solicit feedback from 40+ GHS experts with expertise in one or more of the 19 JEE technical areas. METHODS: We asked experts first to compare the language changes for each capacity level within each indicator and identify how these changes affected the indicator overall; then to assess the ability of a country to achieve the same capacity level using E2 as compared with E1 using a Likert-style score (1-5), where '1' was 'significantly easier' and '5' was 'significantly harder'; and last to provide a qualitative justification for score selections. We analysed the medians and IQR of responses to determine where experts reached consensus. RESULTS: Results demonstrate that 14 indicators and 49 capacity levels would be harder to achieve in E2. CONCLUSION: Findings underscore the importance of considering how language alterations impact how the JEE measures GHS capacity and the feasibility of using the JEE to monitor changes in capacity over time.

Critical success factors for high routine immunization performance: A case study of Senegal.

Background: The essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on how policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019. Methods: We identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health facility, and community-level, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data. Results: The following success factors emerged: 1) Strong political will and prioritization of resources for immunization programming supported urgent allocation of funding and supplies; 2) Collaboration between the Ministry of Health and Social Action and external partners fostered innovation, capacity building, and efficiency; 3) Improved surveillance, monitoring, and evaluation allowed for timely and evidence-based decision making; 4) Community ownership of vaccine service delivery supported tailored programming and response to local needs; and 5) Community health workers spearheaded vaccine promotion and demand generation for vaccines. Conclusion: The vaccination program in Senegal was supported by evidence-based decision making at the national-level, alignment of priorities between governmental entities and external partners, and strong community engagement initiatives that fostered local ownership of vaccine delivery and uptake. High routine immunization coverage was likely driven by prioritization of immunization programming, improved surveillance systems, a mature and reliable community health worker program, and tailored strategies for addressing geographical, social, and cultural barriers.

Advancing Legal Preparedness through the Global Health Security Agenda.

The Global Health Security Agenda (GHSA) is a multilateral, multisectoral partnership comprised of more than 70 countries, international organizations, foundations, and businesses to strengthen global health security.