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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ as there may be differences of approach between regions of different countries so also there may be differences between autonomous regions within the same country. It is clear from the analysis of the responses of the regions that although there are dif- ferences, a majority may have given a similar response to a particular question thus constituting what might be regarded as a “norm”. The important question from the Ben RHM II perspective is: Can this “norm” be regarded as representing good practice that might be emulated by other regions and, if so, how does it equate/relate to one of the evidence-based interventions and policies selected for the reference frameworks? Another question that occurs from the results of the analysis is: Did the open question method used in the interviews always obtain the right information? Applying these two questions to the results of the analysis of the responses, a number of observations can be made. The use by 10 of the 16 regions that responded, of mass media, radio and television, for public information and education about measles vaccination, constitutes a “norm” of sorts. However the incidence of measles in 3 of the 6 regions that do not conform to this “norm” is zero and the uptake of measles vaccination is high in 2 of them. They may be satisfied with the results of other methods and might not see any need to use mass media at present, as it can be relatively expensive. However, regions were not asked why they do not use or why they use, mass media. Also, circumstances may determine its use. For example, it may be necessary for some regions to use mass media to counteract other information carried by the mass media itself, such as claims about risks from the use of MMR vaccine. The establishment of an invitation/reminder/recall system for measles immunisation is an evidence-based intervention included in the reference framework for measles. The analysis of responses shows that this good practice norm has been implemented by 12 of the 18 regions that responded and it is reasonable to assume that other regions should follow suit. However, it is clearly demonstrated by 1 of the 6 regions that has not implemented a formal written invitation system, that a personal approach by the visiting nurse or family doctor is an effective alternative for that region since uptake of measles vaccination is exceedingly high, 99.8%, and the incidence of measles is zero. This demonstrates that it is for the policy makers and managements of the regions to choose which interventions are the most appropriate for adoption by their region. Vaccination registers are held at different levels in 15 of the 18 regions that responded. The establishment of a vaccination register, and surveillance of uptake rates, is another evi- - 252 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ dence-based good practice norm in the reference framework. The analysis examined the level at which such registers are held by the regions and showed that whilst the majority (5) are held at local level only, a lesser number (4) hold them at regional level only, and a lesser number again (2) hold them at national level only. However they are held at all three levels in 2 regions and at two of the three levels in the remaining 2 regions. This shows the difficulty of adopting a good practice norm and demonstrates the need for more explicit definition of the relevant policy or intervention. As a general comment it can be said that the performance in- dicators in terms of vaccine uptake and incidence of measles, are comparatively less favour- able in the regions that hold the register at the local level only and that the holding of informa- tion at different levels may contribute to more effective management of measles immunisation programmes. The target age groups chosen by the regions for the first and second measles vaccination show a wide range of variation but, for the first dose, 17 regions (of 18) start within 3 months of the WHO recommended age of 12 months. Although there is a wide varia- tion also for the second dose, all regions are within the WHO recommendation that it be given between 9 months and the 15 th year of life. The age at which vaccination is given is not in- cluded as an evidence-based intervention in the reference framework. It should be noted that all of the regions that responded to the in-depth interview ex- clusively use MMR vaccine and that there is an obligation in all regions to register adverse reactions from the vaccine. The latter requirement is included as an evidence-based interven- tion in the reference framework. The financing of measles vaccination also produced a wide variety of approaches by the 18 regions that responded. As one would expect, given the different health systems, in most cases funding comes exclusively from the national government budget in 6 regions and from health insurance or the national health insurance fund in 5 regions. Financing in the other regions comes from different combinations of national government, regional or health insurance budgets and, in the case of 2 regions, exclusively from the regional budget. It should be noted that the latter 2 regions are islands, Sicily (IT) and Madeira (PT). Differences in financing arrangements between regions or between regions within the same country may be related to socio-political or socio-economic circumstances and are not all that significant from a Ben RHM II perspective as financing arrangements are not included in the reference framework. What would be interesting in the context of financing is whether the budget for mea- sles immunisation has to compete with other services as part of a general budget for main- stream services or whether any part of it is a dedicated ring-fenced budget for measles immu- - 253 -

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