title: Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia.
abstract: BACKGROUND
  A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention.
  
  
  METHODS
  A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff.
  
  
  RESULTS
  The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response.
  
  
  CONCLUSIONS
  To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level.
authors.affiliation: Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. hotchkis@tulane.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Hotchkiss
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
authors.forename: Mamuka
authors.initials: M
authors.lastname: Djibuti
authors.forename: Eva A
authors.initials: EA
authors.lastname: Silvestre
authors.forename: Natia
authors.initials: N
authors.lastname: Rukhadze
mesh_terms: D017144:Focus Groups; D005500:Follow-Up Studies; D005846:Georgia (Republic) / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D015994:Incidence; D009111:Local Government; D011057:Politics; D011159:Population Surveillance / Q000379:methods*; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D011635:Public Health Administration / Q000639:trends*; D040442:Public Health Informatics; D011795:Surveys and Questionnaires; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines