title: Ideal and reality: do countries adopt and follow recommended procedures in comprehensive multiyear planning guidelines for national immunization programmes?
abstract: BACKGROUND
  Meticulous steps and procedures are proposed in planning guidelines for the development of comprehensive multiyear plans for national immunization programmes. However, we know very little about whether the real-life experience of those who adopt these guidelines involves following these procedures as expected. Are these steps and procedures followed in practice? We examined the adoption and usage of the guidelines in planning national immunization programmes and assessed whether the recommendations in these guidelines are applied as consistently as intended.
  
  
  METHODS
  We gathered information from the national comprehensive multiyear plans developed by 77 low-income countries. For each of the 11 components, we examined how each country applied the four recommended steps of situation analysis, problem prioritization, selection of interventions, and selection of indicators. We then conducted an analysis to determine the patterns of alignment of the comprehensive multiyear plans with those four recommended planning steps.
  
  
  RESULTS
  Within the first 3 years following publication of the guidelines, 66 (86%) countries used the tool to develop their comprehensive multiyear plans. The funding conditions attached to the use of these guidelines appeared to influence their rapid adoption and usage. Overall, only 33 (43%) countries fully applied all four recommended planning steps of the guidelines.
  
  
  CONCLUSIONS
  Adoption and usage of the guidelines for the development of comprehensive multiyear plans for national immunization programmes were rapid. However, our findings show substantial variation between the proposed planning ideals set out in the guidelines and actual use in practice. A better understanding of factors that influence how recommendations in public health guidelines are applied in practice could contribute to improvements in guidelines design. It could also help adjust strategies used to introduce them into public health programmes, with the ultimate goal of a greater health impact.
authors.affiliation: Faculty of Medicine and Biology, Institute of Preventive and Social Medicine, University of Lausanne, 10 Route de la Corniche, 1010, Lausanne, Switzerland. Peter.Mala@unil.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Mala
authors.affiliation: Department of Essential Medicines and Health Products, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland. zuberp@who.int.
authors.forename: Patrick
authors.initials: P
authors.lastname: Zuber
authors.affiliation: Department of Immunization, Vaccines and Biological, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland. politic@who.int.
authors.forename: Claudio
authors.initials: C
authors.lastname: Politi
authors.affiliation: Faculty of Medicine and Biology, Institute of Preventive and Social Medicine, University of Lausanne, 10 Route de la Corniche, 1010, Lausanne, Switzerland. Fred.Paccaud@chuv.ch.
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
mesh_terms: D003906:Developing Countries; D006287:Health Planning Guidelines; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D018673:Nutrition Policy