Behavior Profile: Timely Birth Dose| Health Goal: Improve maternal and child survival | ||
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Providers administer timely birth dose vaccines
n countries where applicable, percentage of newborns vaccinated within 7 days of birth with BCG, zero-dose OPV, and HepB-BD
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Behavior Analysis |
Strategy | ||
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BEHAVIOR AND STEPSWhat steps are needed to practice this behavior?Providers administer timely birth dose vaccines
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FACTORSWhat factors may prevent or support practice of this behavior?StructuralAccessibility: Providers do not provide timely birth dose vaccination because of stockouts Accessibility: Providers do not provide timely birth dose vaccination because vaccination services are separate from labor, delivery, and neonatal services (and are not available 24/7) Service Experience: Providers do not provide timely birth dose vaccination due to the absence of appropriate policies and standard operating procedures, including integration into essential newborn care and other institutional mechanisms Service Experience: Providers do not provide timely birth dose vaccination because reporting forms do not allow for recording of timeliness or of birth dose vaccination SocialNorms: Providers do not provide timely birth dose vaccination because of norms around multi-dose vial use even when policies change Norms: Providers do not provide timely birth dose vaccination because of the low priority accorded to vaccination of neonates before discharge InternalAttitudes and Beliefs: Providers do not provide timely birth dose vaccination because they do not agree about the benefits of early vaccination Knowledge: Providers do not provide timely birth dose vaccination because they do not know that illness, low birth weight, and other conditions are not contraindications for birth dose vaccines |
SUPPORTING ACTORS AND ACTIONSWho must support the practice of this behavior, and what actions must they take?InstitutionalManagers: Provide, confirm understanding and ability of, and supportively supervise implementation of clear guidance on birth dose vaccination, including benefits, dosage, method, timing, contraindications, and documentation Managers: Expand and improve outreach services to identify and vaccinate newborns Managers: Prioritize, plan, budget for, staff, and supervise facility- and community-based timely birth dose vaccination Managers: Make birth dose vaccination prior to discharge and at community level a child health priority Logistics Personnel: Actively monitor vaccine stocks, related commodities, and cold chain viability within and beyond health facilities Policy Makers and Managers: Institute and widely disseminate birth dose vaccination policies and standard operating procedures that facilitate timely vaccination of all newborns, whether or not born in health facilities Health System Decision-Makers: Update immunization and maternity/delivery forms to include birth dose vaccinations and timeliness School Administrators: Teach routine immunization, including birth dose vaccination, in pre-service training for all health care providers |
POSSIBLE PROGRAM STRATEGIESWhat strategies will best focus our efforts based on this analysis?Strategy requires Communication Support Enabling EnvironmentFinancing: Secure and implement adequate financing for pre-filled injectable birth-dose vaccines, heat-stable vaccines, and outreach services (including community-based vaccination where needed) Institutional Capacity Building: Increase capacity for vaccine storage, handling, administration, reporting, and recording, and simplify the supply chain by using heat-sensitive labels to allow storage of vaccine outside the cold chain and pre-filled injectable vaccines for home births Policies and Governance: Develop, update, and disseminate (with on-the-job training) policies and SOPs to maximize timely birth dose vaccination, including integrated services, community outreach, and community-based vaccination Systems, Products and ServicesProducts and Technology: Invest in single-dose, heat stable BCG and HepB birth dose vaccines and delivery technologies Products and Technology: Exploit digital technologies to improve patient and vaccine supply record keeping, enable sharing of birth and other data between health facilities and community health workers, and prompt providers to administer timely birth doses as part of their labor, delivery, and newborn care routine Quality Improvement: Organize maternity and immunization services to facilitate 24-hour, 7 days per week, and holiday access to all birth dose vaccines and to personnel trained to administer them, including improving coordination between the services and ensuring vaccination shortly after birth (instead of just before discharge). Quality Improvement: In conjunction with integration of birth-dose vaccination into newborn care services and expansion of community-based vaccination, provide pre-service and in-service education and training on timely birth dose vaccination to maternity and newborn health providers, routine and supplemental immunization service providers, traditional birth attendants, and community health workers Demand and UseCommunication: Engage providers in reflection and discussion of the benefits of and updated protocols for timely birth dose vaccination, including cost-benefit analysis of opening a multi-dose vial for a single newborn Communication: Lead by example in providing timely birth dose vaccination to all facility-born infants regardless of their number or the day or time of their birth Communication: Inform providers about their birth dose immunization rates, caregiver feedback, the benefits of birth dose immunization, newborns due for vaccination, and factors affecting immunization rates |
