The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina, Jordan, and South Africa (2017–2018). Issue 45 (21st October 2020)

• Record Type: Journal Article
• Authors: Panero, Maria S.; Khuri-Bulos, Najwa; Biscayart, Cristián; Bonvehí, Pablo; Hayajneh, Wail; Madhi, Shabir A.
• Is Part Of: Vaccine. Volume 38:Issue 45(2020)
• Page Start: 7118
• Page End: 7128
• Publication Date: 2020-10-21
• Subjects: Accountability -- ACIP-American Committee on Immunization Practices USA -- Evidence-informed -- Decision-making -- Governance -- Health policy -- Immunization legislation -- NIP-National Immunization -- Program -- NITAG-National Immunization Technical Advisory Group -- Integrity -- Participation -- Policy capacity -- Policy process -- Transparency -- Vaccine introduction; ACIP American Committee on Immunization Practices USA -- AFR African Region -- CoI Conflict of Interest -- ICC Coordinating Committees -- JO Jordan -- KI Key Informant -- KII Key Informant Interview -- MIC Middle Income Country -- MoH Ministry of Health -- NIP National Immunization Program -- NITAG National Immunization Technical Advisory Group -- NRA National Regulatory Agency -- PAHO Pan American Health Organization -- SAGE Strategic Advisory Group of Experts on Immunization, WHO -- SA South Africa -- SIVAC Supporting Independent Immunization and Vaccine -- SOP Standard Operating Procedures -- TOR Terms of Reference -- WHO World Health Organization; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2020.08.069
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Good governance enables governments to formulate and implement effective policies. NITAGs recommendations are designed to foster evidence-informed policies. NITAGs contributions to governance may lead to policy success. Enhancement of key governance attributes may benefit NITAGs practices. Assessment of NITAGs may further promote good governance. Abstract: Introduction: Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. Methods: In 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). Results: Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. Conclusions: Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.