Date of Conferral

2020

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Chester Jones

Abstract

The purpose of this ecological quantitative study was to examine the predictors of health systems building blocks and their interactions in improving access and uptake of immunizations in nine sub-Saharan African countries. Immunization rates in this region remain lower than global targets leading to preventable diseases and mortality. Using the systems approach, the study examined the relationships among five independent variables: quality of service delivery, governance, vaccine supply, health financing, socioeconomic factors and the dependent variable, access to immunizations. Datasets from the WHO and UNICEF were used. Analysis included a series of descriptive statistics, logistic and linear regression, and correlations. The logistic regression analysis showed a predictive relationship between the quality of service delivery, governance and access to immunizations. There was a significant association between immunization and the presence of a national reporting system for adverse events following immunizations (OR = 21.630, 95% CI 2.37, 201.040, p < 0.001). A larger Overseas Development Assistance, calculated as a percentage of gross national income, was associated with a higher rate of vaccination (p<0.05). Similarly, a higher per capita income and higher percentage of government funding for vaccination was associated with better vaccination rates (p<0.001 and p<0.001 respectively). There was also a significant relationship between the number of doctors in an area and BCG coverage (r= 0.928, p< 0.001) and the number of doctors in an area and DPT1 coverage (r = 0.892, p< 0.001). The positive social change implications of this study include how access to immunizations can be improved using the systems approach focusing on these health systems building blocks.

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