Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders

Joseph G. Rosen, Dominique Guillaume, Linda B. Mlunde, Belinda J. Njiro, Castory Munishi, Davis Mlay, Amelia Gerste, Taylor Holroyd, Mary Rose Giattas, Christopher Morgan, Furaha Kyesi, Florian Tinuga, Joseline Ishengoma, Bruno F. Sunguya, Rupali J. Limaye

Research output: Contribution to journalArticlepeer-review

Abstract

To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June-July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e. government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme's feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.

Original languageEnglish (US)
Pages (from-to)486-495
Number of pages10
JournalHealth policy and planning
Volume38
Issue number4
DOIs
StatePublished - May 1 2023

Keywords

  • Human papillomavirus vaccination
  • adolescents
  • health service integration
  • implementation science
  • qualitative research
  • sub-Saharan Africa

ASJC Scopus subject areas

  • General Medicine

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