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The purpose of this paper is to demonstrate how public health and systems science methods can be combined to examine the structure and behavior of Afghanistan’s routine childhood immunization system to identify the pathways through which health system readiness to deliver vaccination services may extend beyond immunization outcomes.

Using findings from an ecological study of Afghanistan’s immunization system and a literature review on immunization program delivery, the routine immunization system was mapped using causal loop diagrams. Next, a stock-and-flow diagram was developed and translated to a system dynamics (SD) model for a system-confirmatory exercise. Data are from annual health facility assessments and two cross-sectional household surveys. SD model results were compared with measured readiness and service outcomes to confirm system structure.

Readiness and demand-side components were associated with improved immunization coverage. The routine immunization system was mapped using four interlinking readiness subsystems. In the SD model, health worker capacity and demand-side factors significantly affected maternal health service coverage. System readiness components affected their future measures mostly negatively, which may indicate that the reinforcing feedback drives current system-structured behavior.

The models developed herein are useful to explore the potential impact of candidate interventions on service outcomes. This paper documents the process through which public health and systems investigators can collaboratively develop models that represent the feedback-driven behavior of health systems. Such models allow for more realistically addressing health policy and systems-level research questions.

Relational autonomy proposes that persons are socially embedded, with decisions being made within social relationships. Through this theoretical lens, this article explores how the healthcare professional–patient relationship can affect pregnant women’s decisions to accept pertussis and influenza vaccines.

Hackney was chosen as the study site as it has very low vaccine uptake rates. In-depth interviews were conducted with 40 pregnant and recently pregnant women, as well as 10 healthcare professionals. Interviews explored experiences of the UK's National Health Service (NHS) health care and views towards vaccination in pregnancy. An observation of a consultation between a pregnant patient and her General Practitioners (GPs) was also conducted in order to understand how the vaccination discussion takes place.

The findings of this study indicate that advice from friends and family can greatly influence a pregnant woman’s vaccination decisions. The patient’s social context, including influences on her decisions, must be understood by healthcare professionals, so that discussions about concerns can take place. If close relationships with patients are formed, healthcare professional advice is more likely to be trusted. With support from healthcare professionals, patients feel competent, empowered to make the right decision for them, and are more likely to vaccinate.

This research will help to inform contextualised policies aimed at increasing vaccination acceptance and reducing inequality in access to vaccination during pregnancy in Hackney.

To the author’s knowledge, this chapter is the first to apply the theory of relational autonomy to views towards maternal vaccination and decision making. It provides valuable insights into how healthcare professionals’ interactions with their pregnant patients can influence vaccination acceptance. The chapter contains advice on how both healthcare professionals and policy-makers can include mothers in vaccine decision-making processes in more personalised ways, by adopting a dialogue that appreciates and understands the social processes around vaccination concerns.

Prior to the onset of the COVID-19 pandemic, women did nearly three-quarters of the world’s unpaid work. As institutional supports, including in-person school and community-based care for children, the elderly, and the disabled vanished early in the pandemic, many women’s caregiving responsibilities increased. In some cases, opportunities for paid employment disappeared due to layoffs and furloughs, while in others, paid work was no longer possible without access to the missing institutional supports. Either way, access to needed supports – financial, practical, and social – was diminished. The lapse of needed supports also had severe impacts on subgroups of women, including pregnant and post-partum women. A range of considerations – vaccine safety, social interaction and infection risk, disease severity – have posed serious challenges for pregnant and post-partum women. Across the board, women’s need for continuous access to better social, financial, and practical supports at home, in the community, and in the workplace was made even more evident by the COVID-19 pandemic.

Vaccine hesitancy is a long-standing issue among both the general population and health communicators. This study aims to ascertain the inclination and the reasons for vaccine hesitancy by conducting content analysis and sentiment analysis of the perspectives expressed in comments on videos related to vaccine hesitancy uploaded from India on YouTube.

The assessment of the sentiments of the vaccine-hesitant population is done using Valence Aware Dictionary and sEntiment Reasoner sentiment analysis module implemented with Python’s NLTK library to automatically determine the sentiments of the comments. Manual content analysis was performed on 60.09% viewer comments randomly selected from the total comments in 238 videos on vaccine hesitancy originated from India and labelled each comment with labels “Anti”, “Pro”, “Confused”, “Not Applicable” and “Unrelated” labels.

The study found “Mistrust-Government policies”, “Fear-health related consequences”, “Mistrust-Scientific research”, “Vaccine effectiveness and efficacy” and “Misinformation/myths” as the top five determinants for vaccine hesitancy, whereas “Religious beliefs”, “Fear-Economic consequences”, “Side Effects- short-term” and “Fear-mode of administration” found to be the lesser cited reasons for vaccine hesitancy. However, the study also investigates changes in the inclination of Indian commenters towards vaccine hesitancy and revolving issues over time.

Public health policymakers and health communicators may find the study useful in determining vaccine hesitancy factors in India.

The originality of this study lies in its approach. To date, no sentiment analysis has been conducted on the content released on YouTube by Indian content creators regarding pro- and anti-vaccination videos. This inquiry seeks to fill this research gap.

The purpose of this paper is to map research literature on all aspects of refugee health in Europe (2015–2019): by research domain, study design, targeted population, type of setting, host country, journal title. This will help to identify recent research trends in the field, provide policymakers with useful source of information and help researches to target important gaps in evidence.

WHO (with other international agencies) has developed strategic documents and produced technical guidance, which formulate priority issues of refugee health in Europe. These documents state the need for relevant information and research data to support effective decision-making at all levels of health care systems. Although recent bibliometric analysis of global migration health research (2000–2016) concluded that 25.4% of retrieved documents were about refugees and asylum seekers, still there remain critical gaps in the knowledge base on a wide range of determinants of health service delivery and access for refugees and asylum seekers in the WHO European Region. Mapping review design was chosen as it maps and categorizes existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature. Search strategy was developed and searches were executed in six databases: PubMed Medline; Scopus; ProQuest (Thesis and Dissertations); Cochrane Library; BASE; eLibrary (Russian journal articles).

Mapping review revealed that although research in some domains of refugee health was growing (mental health, infectious diseases, access to health care), there are still gaps in evidence in many important aspects: maternal and reproductive health, NCD, nutrition and economic evaluations. Most of 1,291 retrieved studies used observational or quasi-experimental design (75%), while very few were experimental studies (1.8%). Secondary research constituted a significant portion of retrieved publications: systematic reviews and meta-analysis – 8%, other reviews with systematic approach – 16%.

Detailed mapping of research by a combination of setting, population and research domains and comparison of results with those from previous decades and with planned trials and systematic reviews.

The purpose of this paper is to develop a theoretical framework for understanding the identity politics associated with parental hesitancy and refusal of vaccines for their children (“vaccine hesitancy or refusal” or “VHR”). Understanding these identity politics helps policymakers to craft appropriate communication interventions that do not make the problem worse.

Social identity theory is a way of understanding how group identities develop around the lifestyle practices that often include refusal to vaccinate, and how this group identity is accentuated by conflict with the pro-vaccinating societal mainstream. This paper critically appraises existing studies of VHR to explore this groupness across many different contexts.

Groupness is evident across many different contexts. There are also key group characteristics: preference for natural birth and breastfeeding, nature as a concept and use of complementary and alternative medicine.

The paper is speculative and theoretical, using existing sources. Future studies will need to demonstrate empirically with new data. However, this theoretical approach sets up a new research agenda.

These findings can help governments and policymakers minimise social conflict that risks further polarising vaccine conversations and wedging parents on the fence.

This paper argues that the decision to vaccinate or not is an inherently social one, not a matter of pure individual rationality. This is a novel approach to engaging with what is often characterised and studied as an individual decision.

The purpose of this paper is to understand disparities in child immunization and nutritional status among children by migration status in urban India.

The study utilized third round of National Family Health Survey (NFHS, 2005-2006) data, which is the Indian version of Demographic and Health Survey. Descriptive statistics and binary logistic regression models were used to study the levels and factors associated with child nutrition and immunization by migration status.

Results suggest that malnutrition and no immunization are very high among children of rural-urban migrants and full immunization is lower than urban non-migrants and urban-urban migrants. More than half of the children from marginalized households suffer from the problem of undernutrition among rural-urban migrants. Multivariate results show economic status, age of the mother, education, caste and media exposure are negatively associated with malnutrition and positively associated with immunization. Children from south, north-east and east are found to have lesser chance of being malnourished than north region of India.

The challenges experienced by rural-urban migrants are reflected over their children and needs a greater attention among policy makers in India.

The finding of this study that children of the rural-urban migrants are in a disadvantageous position in terms of nutrition and immunization. This reflects the precarious condition of rural-urban migrants who initially settles in poor neighbourhoods, which are characterized by lack of adequate sanitation and clean water, poor housing and overcrowding, and difficulty in access to modern health services brought out by many researchers.

Objectives – Purchasing has been promoted as a key policy instrument to improve health system performance. Despite its widespread adoption, there is little empirical evidence on how it works, the challenges surrounding its implementation, its impact, and the preconditions for it to function effectively, particularly in low- and middle-income settings. The objective of this chapter is to analyze critically the extent to which purchasing could be, and has been used strategically in China and to identify modifications that are needed for purchasing to be effective in assuring that the government's new funding for health care will result in efficient and effective health services.

Methods – We present a conceptual framework for purchasing, which identifies three critical principal–agent relationships in purchasing. We draw on evidence from secondary data, results of other research studies, interviews, and the impact evaluation of a social experiment in rural China that explicitly used purchasing to improve quality and efficiency. This information is used to examine purchasing relationships in urban social health insurance (SHI), the rural medical insurance scheme, and purchasing of public health services.

Findings – To date, use of strategic purchasing is limited in China. Both the urban and the rural health insurance schemes act as passive third-party payers, failing to take advantage of the opportunities to strengthen incentives to improve quality and efficiency. This may be because as government agencies, the extent to which the Ministries of Health and Labor and Social Security can act independently from provider interests, or act in the best interest of the population, is unclear. Other important challenges include ensuring adequate representation of the population's views and preferences and making better use of the leverage provided by purchasing to create appropriate provider incentives, through better integration of financing and improved coordination among purchasers.

Implications for policy – In designing purchasing arrangements, attention needs to be paid to all three principal–agent relationships. Successful purchasing appears to require mechanisms to mobilize and represent community preferences and more strategic contracting with providers. More research is needed to strengthen the evidence on which purchasing arrangements work, which do not work, and under what conditions different purchasing configurations can work most effectively.

Over the past 20 years, the primary focus of education policy and programming in low- and middle-income country contexts has shifted from access to quality. There has also been a laudable increase in the amount of available research about education quality in low- and middle-income countries, and a growing emphasis placed on incorporating research- and evidence-based activities and approaches into donor-funded education programs, particularly for early grade reading. Reviews of early grade reading (EGR) programs and their level of impact, however, particularly when programs are implemented at large scale, may leave some practitioners, policy makers, and donors dismayed. Effect sizes and impacts of the programs are often positive, but the absolute gains in reading performance are not as dramatic as we would like, despite the implementation of evidence-based approaches.

In education policy and implementation literature, the decoupling of policy and implementation, and the messiness involved in putting research into practice in education, are well documented. In this chapter, the authors propose the idea of “satisficing,” as it has been defined in policy and implementation literature, as a useful lens for considering the apparent decoupling of actual impacts and anticipated outcomes for programs that have adopted research- and evidence-based approaches. Using examples from EGR programs in African and Asian contexts, the authors argue that “satisficing” occurs at multiple levels, including the classroom, school, district, and even the program implementation (i.e., contractor or grantee) levels. The authors also argue that this lens has important implications for education program design and research.