title: Meningococcal vaccine introduction in Mali through mass campaigns and its impact on the health system.
abstract: OBJECTIVE
  To evaluate the impact of the meningococcal A (MenA) vaccine introduction in Mali through mass campaigns on the routine immunization program and the wider health system.
  
  
  METHODS
  We used a mixed-methods case-study design, combining semi-structured interviews with 31 key informants, a survey among 18 health facilities, and analysis of routine health facility data on number of routine vaccinations and antenatal consultations before, during, and after the MenA vaccine campaign in December 2010. Survey and interview data were collected at the national level and in 2 regions in July and August 2011, with additional interviews in January 2012.
  
  
  RESULTS
  Many health system functions were not affected-either positively or negatively-by the MenA vaccine introduction. The majority of effects were felt on the immunization program. Benefits included strengthened communication and social mobilization, surveillance, and provider skills. Drawbacks included the interruption of routine vaccination services in the majority of health facilities surveyed (67%). The average daily number of children receiving routine vaccinations was 79% to 87% lower during the 10-day campaign period than during other periods of the month. Antenatal care consultations were also reduced during the campaign period by 10% to 15%. Key informants argued that, with an average of 14 campaigns per year, mass campaigns would have a substantial cumulative negative effect on routine health services. Many also argued that the MenA campaign missed potential opportunities for health systems strengthening because integration with other health services was lacking.
  
  
  CONCLUSIONS
  The MenA vaccine introduction interrupted routine vaccination and other health services. When introducing a new vaccine through a campaign, coverage of routine health services should be monitored alongside campaign vaccine coverage to highlight where and how long services are disrupted and to mitigate risks to routine services.
authors.affiliation: London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mounier-Jack
authors.affiliation: London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Helen Elizabeth Denise
authors.initials: HE
authors.lastname: Burchett
authors.affiliation: London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Ulla Kou
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: Independent Consultant , Bamako, Mali.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Konate
authors.affiliation: Independent Consultant , Bamako, Mali.
authors.forename: Kassibo Sira
authors.initials: KS
authors.lastname: Diarra
mesh_terms: D016022:Case-Control Studies; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D007857:Leadership; D008302:Mali; D032541:Mass Vaccination; D008589:Meningococcal Infections / Q000517:prevention & control*; D022401:Meningococcal Vaccines; D011634:Public Health
chemical_list: D022401:Meningococcal Vaccines