Immunisation Service Delivery Framework
Effective immunisation depends on many parts of the health system working well. This Immunisation Service Delivery Framework is the outcome of national engagement with a wide range of stakeholders, including an Expert Advisory Group, with leadership from Dr Win Bennett, Hawkes Bay DHB and Dr Alison Roberts, Ministry of Health, and the Service Improvement Group. Catherine Poutasi has been the Project Manager. The Framework is presented with its rationale, key areas of focus, major recommendations and suggestions for DHBs, PHOs and the Ministry of Health for improving immunisation coverage.
Vaccine preventable diseases have a significant impact on the health of a population. One of the most cost effective interventions in health is immunisation. To limit the spread of vaccine-preventable disease we need to ensure that 90 – 95% of the population is immunised. Reducing the morbidity and mortality of vaccine-preventable diseases is prioritised in the New Zealand Health Strategy (2000) and the Primary Health Care Strategy (2001). It is also a key component in the National Immunisation Programme, and is a Health Target.
In considering how to improve immunisation rates in New Zealand the Expert Advisory Group (EAG) has endorsed several major change themes:
1. An “evolutionary” rather than a “revolutionary approach” to any proposed changes to the current immunisation system, because:
- immunisation rates are improving, albeit slowly
- the National Immunisation Register has the potential to further significantly increase immunisation rates
- evidence exists that, even in the present system, high rates are achievable (for example, Auckland, Canterbury, Otago and West Coast DHBs)
2. A balance between local autonomy and central direction.
There are some processes, decisions and activities which are best undertaken nationally to avoid duplication of resources and effort and to provide consistency where important. However, achieving good rates depends on local performance and therefore the need to allow for adaptation to local circumstances. Clarity of roles, effective communication and cooperation, and both local and national leadership are essential. Mechanisms by which DHBs, the Ministry of Health and community health providers (including PHOs) can share effective models of service delivery is also key to improving coverage.
3. The responsibility and accountability for immunisation should continue to lie primarily with PHOs and General Practice.
An evolutionary approach to improving immunisation coverage should include a strong focus on strengthening and coordinating efforts in primary health care. Growing and facilitating the role of PHOs is also important because PHO’s play a central role in the strategic development of primary care.
4. A review of performance in five years [2012-13]
One outcome of the review may be further consideration of the need to increase the range of funded immunisation providers e.g. Well Child, pharmacists if targets are not being achieved.
The Framework will now be developed into an Action Plan for the sector, led by MOH and DHBs.
