Measuring what matters: Context-specific indicators for assessing immunisation performance in Pacific Island Countries and Areas.

Increasing countries' access to data can improve immunisation coverage through evidence-based decision-making. However, data collection and reporting is resource-intensive, so needs to be pragmatic, especially in low-and-middle-income countries. We aimed to identify which indicators are most important for measuring, and improving, national immunisation performance in Pacific Island Countries (PICs). We conducted an expert elicitation study, asking 13 experts involved in delivering immunisation programs, decision-makers, health information specialists, and global development partners across PICs to rate 41 indicators based on their knowledge of the feasibility and relevance of each indicator. We also asked experts their preferences for indicators to be retained or removed from a list of indicators for PICs. Experts participated in two rating rounds, with a discussion on the reasons for ratings before the second round. We calculated mean scores for feasibility and relevance, and ranked indicators based on experts' preferences and mean scores. We used framework analysis to identify reasons for selecting indicators. Experts agreed that certain indicators were essential to measure (e.g. data use in program planning and measles vaccination coverage), but preferences varied for most indicators. Preferences to include indicators in a set of indicators for PICs moderately correlated with scores for relevance (r = 0.68) and feasibility (r = 0.56). In discussions, experts highlighted usefulness for decision-making and ease of data collection, reporting and interpretation as the main reasons driving indicator selection. Country-specific factors such as health system factors, roles and influence of various immunisation actors, and macro-level factors (namely population size, distribution and mobility) affected relevance and feasibility, leading us to conclude that a single set of indicators for all PICs is inappropriate. Rather than having a strict set of indicators that all countries must measure and report against, performance indicators should be flexible, country-specific, and selected in consultation with immunisation actors who collect and use the data.

Measuring National Immunization System Performance: A Systematic Assessment of Available Resources.

BACKGROUND: Vaccination coverage is widely used to assess immunization performance but, on its own, provides insufficient information to drive improvements. Assessing the performance of underlying components of immunization systems is less clear, with several monitoring and evaluation (M&E) resources available for use in different operational settings and for different purposes. We studied these resources to understand how immunization system performance is measured. METHODS: We reviewed peer-reviewed and gray literature published since 2000 to identify M&E resources that include national-level indicators measuring the performance of immunization systems or their components (governance, financing, regulation, information systems, vaccine logistics, workforce, service delivery, and demand generation). We summarize indicators by the system components or outcomes measured and describe findings narratively. RESULTS: We identified 20 resources to monitor immunization program objectives and guide national strategic decision-making, encompassing 631 distinct indicators. Indicators for immunization program outcomes comprised the majority (124/631 [19.7%]), largely vaccination coverage (110/124 [88.7%]). Almost all resources (19/20 [95%]) included indicators for vaccine logistics (83/631 [13.2%]), and those for regulation (19/631 [3.0%]) and demand generation (28/631 [4.4%]) were least common. There was heterogeneity in how information systems (92/563 [14.6%]) and workforce (47/631 [7.4%]) were assessed across resources. Indicators for vaccination coverage in adults, data use in decision-making, equity and diversity, effectiveness of safety surveillance, and availability of a public health workforce were notably lacking. CONCLUSIONS: Between the resources identified in this review, we identified considerable variability and gaps in indicators assessing the performance of some immunization system components. Given the multitude of indicators, policymakers may be better served by tailoring evaluation resources to their specific context to gain useful insight into health system performance and improve data use in decision-making for immunization programs.

Small area mapping of domestic radon, smoking prevalence and lung cancer incidence--A case study in Northamptonshire, UK.

Smoking and radon both cause lung cancer, and together the risk is significantly higher. UK public health campaigns continue to reduce smoking prevalence, and other initiatives identify houses with raised radon (radon-222) levels and encourage remedial action. Smoking prevalence and radon levels in the UK have been mapped at Primary Care Trust level. This paper extends that work, using a commercial socio-demographic database to estimate smoking prevalence at the postcode sector level, and to predict the population characteristics at postcode sector level for 87 postcode sectors in Northamptonshire. Likely smoking prevalence in each postcode sector is then modelled from estimates of the smoking prevalence in the different socio-economic groups used by the database. Mapping estimated smoking prevalence, radon potential and average lung cancer incidence for each postcode sector suggested that there was little correlation between smoking prevalence and radon levels, as radon potential was generally lower in urban areas in Northamptonshire, where the estimates of smoking prevalence were highest. However, the analysis demonstrated some sectors where both radon potential and smoking prevalence were moderately raised. This study showed the potential of this methodology to map estimated smoking prevalence and radon levels to inform locally targeted public health campaigns to reduce lung cancer incidence.