Overview of the African Routine Immunization System Essentials Project (ARISE) including the rationale for using a case-based approach and details on case selection, data collection and fieldwork approach, challenges, and use of data. (Anne LaFond, JSI)

1. What Drives Routine Immunization
System Performance in Africa?
A mixed methods comparative case study approach
The Africa Routine Immunization System Essentials
Project (ARISE)
​Anne LaFond, JSI
​Panel on Case-based Evaluation Approaches, Washington DC,
​November 2014

2. 2
Context
​History of investment in
national immunization
programs in Africa.
​Why does coverage improve
in some settings and not in
others?
The Complexity:
Many variables
associated with high
levels of immunization
coverage but little
understanding of the
dynamics of coverage
improvement.

3. 3
Methods
• Mixed methods, multiple case studies
• Case selection: Countries with DPT3
coverage improvement
• Nested case:Three districts per country
with recent DPT3 coverage improvement
and one district with steady or
unchanged coverage
Robert K. Yin 1984, p 23

4. 4
Design
&
Data
Collection
​Focus on district level and the dynamics of change
​Mixed methods: Coverage trend analysis and verification; RI
Situation Analysis (service readiness); Open-ended, semi structured
key informant interviews district, facility, community levels; FGD;
field observation.
​Iterative field level analysis by district
​Grounded theory building
​Interdisciplinary team: Routine immunization expert, researchers,
country program
​Cross district case consistency
​Close collaboration with technical and country experts
​Country level validation (stakeholder workshop)

5. Theory building

6. Addressing challenges
• Quality and availability of coverage data to
select cases
• Consistent approach across country cases
• Intensive fieldwork stage with iterative
analysis and theory building

7. Four Direct Drivers of RI Performance Improvement
Cadre of
Community
Centered
Health
Workers
Immunization
Services
Tailored to
Community
Needs
Health System
and
Community
Partnership
Regular Review
of Program and
Health Worker
Performance
Improved
Service
Delivery
Increased
Acceptance
and Use
Improved
Immunization
Coverage

9. ​information
​For more information,
please contact:
​Anne_LaFond@jsi.com
thank you
Funded by
the Bill and Melinda Gates Foundation
Implemented by
Anne LaFond, Natasha Kanagat, Jenny Sequeira, Robert Steinglass,
Rebecca Fields (JSI). Judith Justice (Ehtiopia), Cheikh Niang,
(Cameroon) and Ann Larson (Ghana)
In collaboration with
Sangeeta Mookherji, George Washington University SPH