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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ Table 12: Measles 2005 Health Performance Indicators Selected by the Steering Group 1st Uptake Dose (percentage) 2nd Uptake Dose (percentage) Because of the values reported by the mentioned regions, only Szabolcs-Szatmár-Bereg (HU) and Moravia-Silesia (CZ) were considered for the second approach of the analysis to identify good practice. BG - Varna-Oblast 9.2.2 Second approach: analysis of additional information In order to identify good practice models, the organigraphs, in-depth interviews and reference frameworks from Szabolcs-Szatmár-Bereg (HU) and Moravia-Silesia (CZ) were examined to recognise similarities among these regions. a. Organigraphs Basing on the analysis of the organigraphs and system descriptions from the section 5.1.16, it was verified that in Szabolcs-Szatmár-Bereg (HU) and in Moravia-Silesia (CZ), the organi- graphs and system descriptions show one chain through which there is downward transmis- sion from national Ministry level to regional and local levels, of a measles immunisation pol- icy or programme, including vaccination schedules decided by the Ministry nationally, and another chain through which there is upward transmission of surveillance data to national level (see section 5.1.16 for the definition of chain). CZ - Moravia-Silesia HU-S Szabolcs-Szatmár PT - Madeira 93,00 97,45 99,80 77,90 90,00 94,14 99,80 95,90 Incidence (per 100.000) 0,00 0,00 0,00 0,00 Mortality (per 100.000) 0,00 0,00 0,00 0,00 Hospitalisation (percentage of cases) 0,00 0,00 0,00 0,00 b. In-depth interviews Examining the information from the in-depth interviews, similarities among Szabolcs- Szatmár-Bereg (HU) and Moravia-Silesia (CZ) were confirmed with regard to the measles policies and interventions conducted in the regions. For example, both regions keep registers about vaccinated persons and adverse reactions. Moreover, children in these two regions re- ceive their first measles immunisation dose at the same point in time and both regions use - 316 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ MMR vaccine. Funds for measles vaccination are in both regions provided by the national budget. Another feature shared by both regions is the fact that both have a specific immunisa- tion law and that measles elimination is part of the current political agenda. c. Reference frameworks What is now interesting is a look at the reference frameworks of the regions of Moravia- Silesia (CZ) and Szabolcs-Szatmár-Bereg (HU). It was verified that these regions conducted similar measures/interventions in the health management of measles (the interventions carried out in each region are marked in yellow in the illus. 27 and 28). When looking at the measures/interventions carried out within the individual/immediate setting, it turns out that the following measures are carried out in both regions: coverage with 1st dose, individual reminder, documentation of immunisation for parents (passes, certificates etc.), documentation of immunisation for Primary Care Physician (IT, patient files etc.), obligation to immunise, home-visiting interventions, easy/cheap access to vaccination/reduction of out of pocket costs for vaccination, education of agents in shared facilities about the benefits/risks of vaccination, coverage with 2nd dose, individual reminder, documentation of immunisation (passes, certificates etc.) and identification of contacts. At population level, the following interventions/measures are carried out in the two regions: invitation/reminder/recall system, strategies to immunise marginal groups/sub-groups (e.g. gypsies, unregistered migrants, refugees), special strategies for lower socio-economic groups, educational measures about benefits/risks of vaccination, local authorities offer information/counselling, invitation/reminder system and strategies to immunise sub-groups. When looking at the social system, at the legislative and professions, it becomes obvious that both regions implement the following interventions/measures: legislation/law on infectious diseases, strategy for measles elimination, national/regional immunisation plan with defined targets, implementation of WHO-immunisation guidelines, sentinels, drug law, licensing of vaccine, producer is obligated to cold-chain logistics (product liability), strategy for quality assurance in place and regular review, development of strategy, rapid communication of cases and coordination of health services, obligation to report cases, surveillance of uptake rates, vaccination register, register of severe adverse reactions, Health reporting, implementation of surveillance guidelines of WHO and vigorous case investigation and laboratory confirmation. - 317 -

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Part II
IB417 - IIS RU