Strengthening evidence-based planning of integrated health service delivery through local measures of health intervention delivery times.
BACKGROUND
Immunization services in developing countries are increasingly used as platforms for delivery of other health interventions. A challenge for scaling up interventions on existing platforms is insufficient resources allocated to the integrated platform with the risk of overburdening a health worker. Determining the length of time to deliver priority interventions can be useful information in planning integrated services and mitigating this risk. We designed and tested a methodology for collecting the time needed to deliver selected interventions.


METHODS
At 18 health facilities in Mali, Ethiopia, and Cameroon, we observed delivery of 11 maternal and child health interventions to determine delivery times. We interviewed health workers to estimate self-reported delivery times.


RESULTS
Based on observations, vitamin A supplementation (median, 2:00 minutes per child) and vaccinations (median, 2:22 minutes) took the least amount of time to deliver, whereas human immunodeficiency virus counseling and testing and sick infant treatment interventions were among the longest to deliver. Health worker-reported times to deliver interventions were consistently higher than observed times.


CONCLUSIONS
Using locally-obtained data can be useful to step for planners to determine how best to use existing platforms for delivering new interventions, particularly since these interventions may require substantially more time to deliver compared to immunizations.
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30322, USA. awallace@cdc.gov
Aaron
A
Wallace
Tove
T
Ryman
Richard
R
Mihigo
Modjirom
M
Ndoutabe
Baba
B
Tounkara
Gavin
G
Grant
Blanche
B
Anya
Emmanuel C
EC
Kiawi
Sekou
S
Kone
Habtamu
H
Tesfaye
Nathan
N
Trayner
Elizabeth T
ET
Luman
D002163:Cameroon; D002648:Child; D002662:Child Health Services; D019033:Delivery of Health Care, Integrated; D005002:Ethiopia; D055317:Evidence-Based Practice; D006801:Humans; D008302:Mali; D008427:Maternal Health Services; D013997:Time Factors; D014611:Vaccination