Article type
Abstract
Background. Decisions in immunization policy impact human and financial resources of national health systems. Therefore, these should be informed by independent, comprehensive, and best available evidence. National Immunization Technical Advisory Groups (NITAGs) are independent expert groups that advise policymakers on immunization questions. The World Health Organization (WHO) recommends that NITAGs should develop their recommendations using a systematic evidence-based approach (Evidence to Recommendation (EtR)-Process), but especially newly established NITAGs struggle to implement such an approach. Therefore, in 2020, the WHO Regional Office for Europe and Robert Koch Institute (RKI) initiated the SENSE* project to strengthen NITAGs of middle-income countries of the WHO European Region and their evidence-based recommendation-making.
Objectives. Evaluate NITAGs to identify a) the extent of the implementation of a systematic recommendation-making process, b) existing challenges that prevent implementation, and c) areas for targeted support.
Methods. Evaluations assessed the NITAGs' functionality, their integration into policy processes, and their recommendation-making processes. Available documents (eg, standard operating procedures (SOPs), developed recommendations) were reviewed, and ambiguities were discussed with the NITAGs.
Results. Between 2020 and 2023, the NITAGs of Albania, Armenia, Belarus, Federation of Bosnia and Herzegovina, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Serbia, and Uzbekistan were evaluated and allowed a comprehensive picture of current NITAG processes. All NITAGs demonstrated substantial progress in improving their functioning and collaboration with Ministries of Heath. With regards to the implementation of systematic recommendation-making processes, none of the evaluated NITAGs followed the recommended EtR-Process: Most NITAGs do not develop specific policy questions or predefine criteria for evidence collection. Main challenges are the unawareness of the importance of the process, the lack of annual workplans that allow sufficient time to apply a comprehensive evidence-based recommendation-making, and, most important, constraints within the NITAGs' Secretariat in terms of human and financial resources.
Conclusions. To address identified challenges, the WHO and RKI developed a guidance on an adapted EtR-Process that acknowledges human resource constraints. Hands-on trainings on the process using current NITAG topics were conducted, and a template for NITAG SOP was developed. Nevertheless, to allow a sustainable implementation of the process, a major focus of NITAG partners should be on advocacy to strengthen NITAG Secretariat resources.
Objectives. Evaluate NITAGs to identify a) the extent of the implementation of a systematic recommendation-making process, b) existing challenges that prevent implementation, and c) areas for targeted support.
Methods. Evaluations assessed the NITAGs' functionality, their integration into policy processes, and their recommendation-making processes. Available documents (eg, standard operating procedures (SOPs), developed recommendations) were reviewed, and ambiguities were discussed with the NITAGs.
Results. Between 2020 and 2023, the NITAGs of Albania, Armenia, Belarus, Federation of Bosnia and Herzegovina, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Serbia, and Uzbekistan were evaluated and allowed a comprehensive picture of current NITAG processes. All NITAGs demonstrated substantial progress in improving their functioning and collaboration with Ministries of Heath. With regards to the implementation of systematic recommendation-making processes, none of the evaluated NITAGs followed the recommended EtR-Process: Most NITAGs do not develop specific policy questions or predefine criteria for evidence collection. Main challenges are the unawareness of the importance of the process, the lack of annual workplans that allow sufficient time to apply a comprehensive evidence-based recommendation-making, and, most important, constraints within the NITAGs' Secretariat in terms of human and financial resources.
Conclusions. To address identified challenges, the WHO and RKI developed a guidance on an adapted EtR-Process that acknowledges human resource constraints. Hands-on trainings on the process using current NITAG topics were conducted, and a template for NITAG SOP was developed. Nevertheless, to allow a sustainable implementation of the process, a major focus of NITAG partners should be on advocacy to strengthen NITAG Secretariat resources.