Research note • Epidemiol. Serv. Saúde 31 (2) 202208 July 2022 • https://doi.org/10.1590/S2237-96222022000200016   copy

Diagnosis of vaccination rooms in Brazilian primary health care centers taking part in the PlanificaSUS project, 2019 PlanificaSUS, 2019

Evelyn Lima de Souza Ilana Eshriqui Eliana Tiemi Masuda Daiana Bonfim Rubia Pereira Barra Márcio Anderson Cardozo Paresque About the authors

Abstract

Objective:

To describe the diagnosis of vaccination rooms in primary healthcare centers in Brazil.

Methods:

This was a cross-sectional study with secondary data of convenience sampling comprised of 25 rooms. Results of a checklist adapted from the Vaccine Room Supervision Tool of the National Immunization Program in 2019 regarding the dimensions ‘general organization’, ‘general aspects’, ‘technical procedures’, ‘cold chain’, ‘information system’, ‘adverse events following vaccination’, ‘special immunobiological agents’, ‘epidemiological surveillance’ and ‘health education’, were used. Percentages of scores, both overall and by dimensions were described in median, interquartile range, minimum and maximum values.

Results:

The overall median was 77.1%, higher for ‘health education’ (100.0%) and ‘cold chain’ (86.7%), and lower for ‘special immunobiological agents’ (50.0%) and ‘general organization’ (58.3%).

Conclusion:

Using the checklist enabled the diagnosis in different macro-regions, inter- and intra-regional differences were found in the dimensions, and positive results and opportunities for improvement in the general plan.

Keywords:
Vaccination; Primary Health Care; Immunization Programs; Quality of Health Care

Study contributions

Main results

A greater strengthening in the dimensions ‘health education’ and ‘cold chain’ stands out, with scores of at least 87%; ‘special immunobiological agents’ and ‘general organization’ obtained median scores lower than 60%. It can be seen inter- and intra-regional heterogeneity.

Implications for services

The checklist used proved to be easily applicable for the diagnosis, identification of opportunities for improvement, and vaccination room monitoring in the five regions of Brazil.

Perspectives

We highlight the need to update the checklist and strengthen the actions in dimensions with unfavorable results, especially in some regions of the country, taking into consideration the local needs.

Introduction

The National Immunization Program (PNI) coordinates immunization activities in Brazil and has contributed to the history of high vaccination coverage, in addition to ensuring universal and free access to immunobiological agents.11. Domingues CMAS, Maranhão AGK, Teixeira AM, Fantinato FFS, Domingues RAS. The Brazilian National Immunization Program: 46 years of achievements and challenges. Cad Saude Publica. 2020;36(Suppl 2):e00222919. doi: 10.1590/0102-311X00222919
https://doi.org/10.1590/0102-311X0022291... However, currently there has been a decrease and heterogeneity in vaccination coverage in the country.22. Ministério da Saúde (BR). Programa Nacional de Imunizações. Programa Nacional de Imunizações: coberturas vacinais no Brasil (período 2010-2014) [Internet]. Brasília: Ministério da Saúde; 2015 [citado 2020 Maio 13]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2017/agosto/17/AACOBERTURAS-VACINAIS-NO-BRASIL---2010-2014.pdf
https://portalarquivos2.saude.gov.br/ima...

3. Arroyo LH, Ramos ACV, Yamamura M, Weiller TH, Crispim JA, Cartagena-Ramos D, et al. Areas with declining vaccination coverage for BCG, poliomyelitis, and MMR in Brazil (2006-2016): maps of regional heterogeneity. Cad Saude Publica. 2020;36(4):e00015619. doi: 10.1590/0102-311X00015619
https://doi.org/10.1590/0102-311X0001561...

4. Césare N, Mota TF, Lopes FFL, Lima ACM, Luzardo R, Quintanilha LF, et al. Longitudinal profiling of the vaccination coverage in Brazil reveals a recent change in the patterns hallmarked by differential reduction across regions. Int J Infect Dis. 2020;98:257-80. doi: 10.1016/j.ijid.2020.06.092
https://doi.org/10.1016/j.ijid.2020.06.0... -55. Sato APS. What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil?. Rev Saude Publica. 2018;52:96. doi: 10.11606/S1518-8787.2018052001199
https://doi.org/10.11606/S1518-8787.2018... Given the reemergence of vaccine-preventable diseases,77. Silveira MF, Buffarini R, Bertoldi AD, Santos IS, Barros AJD, Matijaseviche A, et al. The emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982-2015. Vaccine. 2020;38(3):482-8. doi: 10.1016/j.vaccine.2019.10.070
https://doi.org/10.1016/j.vaccine.2019.1...

8. Barello S, Nania T, Dellafiore F, Graffigna G, Caruso R. 'Vaccine hesitancy' among university students in Italy during the COVID-19 pandemic. Eur J Epidemiol. 2020;35(8):781-3. doi: 10.1007/s10654-020-00670-z
https://doi.org/10.1007/s10654-020-00670...

9. Jaca A, Mathebula L, Iweze A, Pienaar E, Wiysonge CS. A systematic review of strategies for reducing missed opportunities for vaccination. Vaccine. 2018;36(21):2921-7. doi: 10.1016/j.vaccine.2018.04.028
https://doi.org/10.1016/j.vaccine.2018.0... -1010. Crocker-Buque T, Mounier-Jack S. Vaccination in England: A review of why business as usual is not enough to maintain coverage. BMC Public Health. 2018;18(1):1351. doi: 10.1186/s12889-018-6228-5
https://doi.org/10.1186/s12889-018-6228-... the need to strengthen the evaluation and organization actions of the PNI and health services stands out.66. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Manual de normas e procedimentos para vacinação [Internet]. Brasília: Ministério da Saúde; 2014 [citado 2021 Mar 30]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_procedimentos_vacinacao.pdf
https://bvsms.saude.gov.br/bvs/publicaco...

Regarding the so-called Health Care Planning, a methodology that aims at the organization and integration of services in health care networks,1111. Evangelista MJO, Guimarães AMDN, Dourado EMR, Vale FLB, Lins MZS, Matos MAB de, et al. Planning and building health care networks in brazil's federal district. Cien Saude Colet. 2019;24(6):2115-24. doi: 10.1590/1413-81232018246.08882019
https://doi.org/10.1590/1413-81232018246... ,1212. Mendes EV, Matos MAB, Evangelista MJO, Barra RP. A Construção Social da Atenção Primária à Saúde [Internet]. 2. ed. Brasília: CONASS; 2019 [citado 2021 Ago 30]. 192 p. Disponível em: https://www.conass.org.br/biblioteca/a-construcao-social-da-atencao-primaria-a-saude-2a-edicao
https://www.conass.org.br/biblioteca/a-c... the strengthening of these actions includes storage organization, logistics, dose administration and local coverage monitoring, contributing to the adequacy of vaccination rooms to meet the standards recommended by the PNI.66. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Manual de normas e procedimentos para vacinação [Internet]. Brasília: Ministério da Saúde; 2014 [citado 2021 Mar 30]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_procedimentos_vacinacao.pdf
https://bvsms.saude.gov.br/bvs/publicaco...

Few studies address the diagnosis of vaccination rooms at the local level and there are no studies addressing this subject at the national level.1313. Galvão MFPS, Almeida PC, Lopes MSV, Coutinho JFV, Martins MC, Barbosa LP. Avaliação das salas de vacinação de unidades de Atenção Primária à Saúde. Rev Rene. 2019;20:e39648. doi: 10.15253/2175-6783.20192039648
https://doi.org/10.15253/2175-6783.20192...

14. Araújo ACM, Guimarães MJB, Frias PG, Correira JB. Evaluation of vaccination rooms of the state of Pernambuco in 2011. Epidemiol Serv Saude. 2013;22(2):255-64. doi: 10.5123/s1679-49742013000200007
https://doi.org/10.5123/s1679-4974201300...

15. Siqueira LG, Martins AMEBL, Versiani CMC, Almeida LAV, Oliveira CS, Nascimento JE, et al. Avaliação da organização e funcionamento das salas de vacina na Atenção Primária à Saúde em Montes Claros, Minas Gerais, 2015. Epidemiol Serv Saude. 2017;26(3):557-68. doi: 10.5123/S1679-49742017000300013
https://doi.org/10.5123/S1679-4974201700...

16. Vasconcelos KCE, Rocha SA, Ayres JA. Evaluation of vaccination rooms in the primary health care network of the Municipality of Marília, State of São Paulo, Brazil, 2008-2009. Epidemiol Serv Saude. 2012;21(1):167-76. doi: 10.5123/s1679-49742012000100017
https://doi.org/10.5123/s1679-4974201200... -1717. Cunha JO, Oliveira IMB, Santos AD, Cunha MWN, Santos FJ, Santos JMJ. Avaliação da padronização dos procedimentos nas salas públicas de vacinas do município de Itabaiana, Sergipe, Brasil. Rev Bras Pesq Saúde. 2018;20(1):70-8. doi: 10.21722/rbps.v20i1.20610
https://doi.org/10.21722/rbps.v20i1.2061... Therefore, the objective of this Research Note was to describe the diagnosis of vaccination rooms in Primary Healthcare Centers (PHC) that executed the Health Care Planning in 2019.

Methods

Study design

This was a cross-sectional study based on secondary data from a convenience sampling of vaccination rooms distributed over the five Brazilian macro-regions.

Setting

The universe of this study was comprised of 26 PHCs, each of them was located in a regional health department in 20 Federative Units. These PHCs were selected as a model for the execution of the Planning process in the first stage of the PlanificaSUS project, whose official name is ‘Organization of Specialized Outpatient Care in Network with Primary Health Care’,1818. Instituto Israelita de Responsabilidade Social Albert Einstein. e-Planifica [Internet]. São Paulo: Instituto Israelita de Responsabilidade Social Albert Einstein; 2021 [citado 2021 Ago 30]. Disponível em: https://planificasus.com.br/index.php
https://planificasus.com.br/index.php ... carried out between 2018 and 2020.

Participants

Among the 26 PHCs selected, 25 had a vaccination room, therefore they were eligible to take part in this study.

Variables

Variables of interest:

  1. Overall vaccination room score (%): (sum of checklist items that were implemented/number of checklist items) x 100

  2. Vaccination room score by dimension (%): (sum of dimension items that were implemented/number of dimension items) x 100

  3. Location of PHCs according to the five Brazilian macro-regions.

Data source and measurement

Vaccine Room Supervision Tool, developed by the PNI1919. Ministério da Saúde (BR). Programa Nacional de Imunização. Programa de avaliação do instrumento de supervisão sala de vacinação - PAISSV [Internet]. Brasília: Ministério da Saúde; 2004 [citado 2021 Abr 19]. Disponível em: http://pni.datasus.gov.br/apresentacao.asp
http://pni.datasus.gov.br/apresentacao.a... and adapted as a checklist by means of Microsoft Excel Spreadsheet, was used during PlanificaSUS activities aiming at performing the diagnosis and organizing vaccination rooms. The nursing professional who was responsible for the vaccination room filled out the checklist, pointing out whether or not the items were implemented (yes; no). PlanificaSUS tutor of the respective PHC was responsible for inserting the completed checklist file, in Excel, into the project platform (e-Planifica), where it was stored for consultation. This study used the files available in e-Planifica.

The checklist is comprised of 131 items, subdivided into nine dimensions (Box 1). The diagnosis was made by analyzing continuous measurements of the scores, both overall score and by dimension, as detailed in statistical methods.

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Box 1
Dimensions and items of the diagnostic checklist of vaccination rooms

Bias control

In order to reduce biases, the checklist was presented in a standard way by the project mentoring team, and the completion of all services occurred in the same operationalization phase of the Planning process.

Study size

The study was comprised of 25 eligible rooms that had completed the checklist and inserted it into the e-Planifica.

Statistical methods

A descriptive analysis of the scores, both overall and by dimension, of the vaccination rooms was performed, presenting median, interquartile range and minimum and maximum values. The items of the dimensions with the lowest median score were described. A scatter plot was used to verify the distributions of the rooms over the Brazilian macro-regions, according to the scores, both overall and by dimension.

Microsoft Excel and R, a statistical software package (v.4.1.0) were used.

Ethical aspects

The study project was approved by the Research Ethics Committee of the Hospital Israelita Albert Einstein: Opinion CEP/Einstein No. 3,674,106, approved on October 22, 2019; Certificate of Submission for Ethical Appraisal (CAAE) No. 12395919.0.0000.0071.

Results

A total of 25 rooms were studied, distributed over 19 states: 5 in the North region, 9 in the Northeast region, 3 in the Midwest region, 3 in the Southeast region and 5 in the South region.

The description of the scores, both overall and by dimension, of the checklist is shown in Table 1. The median overall score was 77.1%; ‘health education’ and ‘cold chain’ were the dimensions with the highest medians, while ‘special immunobiological agents’ and ‘general organization’ obtained the lowest medians.

Thumbnail
Table 1
Description of the median, interquartile range and minimum and maximum values of scores, both overall score and by dimensions, of selected Brazilian vaccination rooms (n = 25), 2019

A detailed analysis of the items revealed that, in the dimension related to ‘general organization’, in 20 vaccination rooms, the implementation or updating of standard operating procedure was not identified, and in 17, it was found that the team responsible for the vaccination room was unaware of such procedures. In addition, the lack of periodic training for professionals working in vaccination rooms was reported by those who were responsible for 15 rooms.

Regarding the dimension ‘special immunobiological agents’, in most vaccination rooms, the professionals were aware of the existing reference centers (n = 22) and the flow to request these immunobiological agents and/or referral to these services (n = 13). However, in 15 rooms, the professionals were unaware of the list of immunobiological agents available; and in 16, they were unaware of their indications.

Figure 1 shows the distribution of scores, both overall and by dimensions, according to the location of the rooms in Brazilian macro-regions. It could be seen inter- and intra-regional heterogeneity, especially regarding the dimensions ‘information system’, ‘adverse events following vaccination’ and ‘special immunobiological agents’. Among the rooms with scores below 50% in the dimensions evaluated, a higher frequency of those located in the North and Northeast regions was found.

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Figure 1
Distribution of scores, both overall and by dimension, of selected Brazilian vaccination rooms (n = 25), according to the macro-region where they are located, 2019

Discussion

This study allowed us to observe a positive scenario in the general diagnosis of PHC vaccination rooms in several regions of the country, with emphasis on health education actions, communication of the importance of vaccination, and structural and logistical aspects of the cold chain. It is worth highlighting the need to prioritize the strengthening of actions related to the knowledge of professionals about special immunobiological agents and the general organization of rooms. Furthermore, inter-regional and intra-regional variability in the diagnosis of vaccination rooms was observed, with less favorable results for the North and Northeast regions.

The limitations of this study include the fact that the sample studied is not representative of Brazil and its regions, given that the allocation of the number of centers per region was not proportional (selection bias). Another limitation is related to the variable number of items per dimension of the checklist, which may weaken the comparability of percentage scores of the dimensions.

It is worth mentioning the need to update the tool, in line with the ‘Manual of Rules and Procedures for Vaccination’ of the Ministry of Health,1212. Mendes EV, Matos MAB, Evangelista MJO, Barra RP. A Construção Social da Atenção Primária à Saúde [Internet]. 2. ed. Brasília: CONASS; 2019 [citado 2021 Ago 30]. 192 p. Disponível em: https://www.conass.org.br/biblioteca/a-construcao-social-da-atencao-primaria-a-saude-2a-edicao
https://www.conass.org.br/biblioteca/a-c... and to standardize the evaluation criteria.

Based on the diagnosis of vaccination rooms, health education actions have stood out, favorable in most of them, a result similar to those of studies conducted in Minas Gerais1515. Siqueira LG, Martins AMEBL, Versiani CMC, Almeida LAV, Oliveira CS, Nascimento JE, et al. Avaliação da organização e funcionamento das salas de vacina na Atenção Primária à Saúde em Montes Claros, Minas Gerais, 2015. Epidemiol Serv Saude. 2017;26(3):557-68. doi: 10.5123/S1679-49742017000300013
https://doi.org/10.5123/S1679-4974201700... and São Paulo.1616. Vasconcelos KCE, Rocha SA, Ayres JA. Evaluation of vaccination rooms in the primary health care network of the Municipality of Marília, State of São Paulo, Brazil, 2008-2009. Epidemiol Serv Saude. 2012;21(1):167-76. doi: 10.5123/s1679-49742012000100017
https://doi.org/10.5123/s1679-4974201200... On the other hand, a study carried out in Pernambuco,1414. Araújo ACM, Guimarães MJB, Frias PG, Correira JB. Evaluation of vaccination rooms of the state of Pernambuco in 2011. Epidemiol Serv Saude. 2013;22(2):255-64. doi: 10.5123/s1679-49742013000200007
https://doi.org/10.5123/s1679-4974201300... when jointly evaluating the dimensions of health education and epidemiological surveillance, found unfavorable results. Thus, it is worth highlighting the need for the sustainability of educational actions, given that communication with the population make clear the importance of vaccines as individual and collective protective measures, in addition to demystifying rumors, contributing to the link between population and service, greater adherence to vaccination and maintenance of satisfactory vaccination coverage.99. Jaca A, Mathebula L, Iweze A, Pienaar E, Wiysonge CS. A systematic review of strategies for reducing missed opportunities for vaccination. Vaccine. 2018;36(21):2921-7. doi: 10.1016/j.vaccine.2018.04.028
https://doi.org/10.1016/j.vaccine.2018.0... ,1010. Crocker-Buque T, Mounier-Jack S. Vaccination in England: A review of why business as usual is not enough to maintain coverage. BMC Public Health. 2018;18(1):1351. doi: 10.1186/s12889-018-6228-5
https://doi.org/10.1186/s12889-018-6228-...

Another dimension of great prominence that has been observed in this study and in the literature1414. Araújo ACM, Guimarães MJB, Frias PG, Correira JB. Evaluation of vaccination rooms of the state of Pernambuco in 2011. Epidemiol Serv Saude. 2013;22(2):255-64. doi: 10.5123/s1679-49742013000200007
https://doi.org/10.5123/s1679-4974201300...

15. Siqueira LG, Martins AMEBL, Versiani CMC, Almeida LAV, Oliveira CS, Nascimento JE, et al. Avaliação da organização e funcionamento das salas de vacina na Atenção Primária à Saúde em Montes Claros, Minas Gerais, 2015. Epidemiol Serv Saude. 2017;26(3):557-68. doi: 10.5123/S1679-49742017000300013
https://doi.org/10.5123/S1679-4974201700...

16. Vasconcelos KCE, Rocha SA, Ayres JA. Evaluation of vaccination rooms in the primary health care network of the Municipality of Marília, State of São Paulo, Brazil, 2008-2009. Epidemiol Serv Saude. 2012;21(1):167-76. doi: 10.5123/s1679-49742012000100017
https://doi.org/10.5123/s1679-4974201200... -1717. Cunha JO, Oliveira IMB, Santos AD, Cunha MWN, Santos FJ, Santos JMJ. Avaliação da padronização dos procedimentos nas salas públicas de vacinas do município de Itabaiana, Sergipe, Brasil. Rev Bras Pesq Saúde. 2018;20(1):70-8. doi: 10.21722/rbps.v20i1.20610
https://doi.org/10.21722/rbps.v20i1.2061... was the cold chain, with a satisfactory result and low variability among the services, possibly because they are items that have the power to directly affect the quality and safety of these supplies, despite possible losses due to irregularities in the conditioning and/or logistics of resources.1212. Mendes EV, Matos MAB, Evangelista MJO, Barra RP. A Construção Social da Atenção Primária à Saúde [Internet]. 2. ed. Brasília: CONASS; 2019 [citado 2021 Ago 30]. 192 p. Disponível em: https://www.conass.org.br/biblioteca/a-construcao-social-da-atencao-primaria-a-saude-2a-edicao
https://www.conass.org.br/biblioteca/a-c...

It could be seen opportunities for improvement related to the dimension general organization, in the aspects of human resources, process standardization and training. The identification of shortage of human resources can lead to accumulation of tasks and weaknesses in communication and active search for users.2020. Barros MGM, Santos MCS, Bertolini RPT, Pontes Netto VB, Andrade MS. Perda de oportunidade de vacinação: aspectos relacionados à atuação da atenção primária em Recife, Pernambuco, 2012. Epidemiol Serv Saude. 2015;24(4):701-10. doi: 10.5123/S1679-49742015000400012
https://doi.org/10.5123/S1679-4974201500... Taking into consideration the constant updates of the immunization schedule and the variability in the professionals’ understanding of the service process, facts that have already been reported in other studies,1313. Galvão MFPS, Almeida PC, Lopes MSV, Coutinho JFV, Martins MC, Barbosa LP. Avaliação das salas de vacinação de unidades de Atenção Primária à Saúde. Rev Rene. 2019;20:e39648. doi: 10.15253/2175-6783.20192039648
https://doi.org/10.15253/2175-6783.20192... ,2020. Barros MGM, Santos MCS, Bertolini RPT, Pontes Netto VB, Andrade MS. Perda de oportunidade de vacinação: aspectos relacionados à atuação da atenção primária em Recife, Pernambuco, 2012. Epidemiol Serv Saude. 2015;24(4):701-10. doi: 10.5123/S1679-49742015000400012
https://doi.org/10.5123/S1679-4974201500... it is worth highlighting the need for permanent education2121. Martins JRT, Alexandre BGP, Oliveira VC, Viegas SMF. Permanent education in the vaccination room: what is the reality?. Rev Bras Enferm. 2017;71(Suppl 1):668-76. doi: 10.1590/0034-7167-2017-0560
https://doi.org/10.1590/0034-7167-2017-0... and standardization of procedures, aiming at an immediate response to the occurrence of vaccine-preventable diseases, such as the COVID-19 pandemic.

Another opportunity for improvement that should be prioritized, among the dimensions of the checklist, is related to the dimension special immunobiological agents, corroborating other studies.1515. Siqueira LG, Martins AMEBL, Versiani CMC, Almeida LAV, Oliveira CS, Nascimento JE, et al. Avaliação da organização e funcionamento das salas de vacina na Atenção Primária à Saúde em Montes Claros, Minas Gerais, 2015. Epidemiol Serv Saude. 2017;26(3):557-68. doi: 10.5123/S1679-49742017000300013
https://doi.org/10.5123/S1679-4974201700... ,1717. Cunha JO, Oliveira IMB, Santos AD, Cunha MWN, Santos FJ, Santos JMJ. Avaliação da padronização dos procedimentos nas salas públicas de vacinas do município de Itabaiana, Sergipe, Brasil. Rev Bras Pesq Saúde. 2018;20(1):70-8. doi: 10.21722/rbps.v20i1.20610
https://doi.org/10.21722/rbps.v20i1.2061... The fragility of health professionals’ understanding of special immunobiological agents may impair access to this type of input and, consequently, the quality of life of specific populations that need it.2222. Nóbrega LAL, Novaes HMD, Sartori AMC. Avaliação da implantação dos Centros de Referência para Imunobiológicos Especiais. Rev Saude Publica. 2016;50:58. doi: 10.1590/S1518-8787.2016050006183
https://doi.org/10.1590/S1518-8787.20160... ,2323. Wolkers PCB, Yakuwa MS, Pancieri L, Mendes-Rodrigues C, Furtado MCC, Mello DF. Crianças com diabetes mellitus tipo 1: acesso aos imunobiológicos especiais e à puericultura. Rev Esc Enferm USP. 2017;51:e03249. doi: 10.1590/S1980-220X2016049103249
https://doi.org/10.1590/S1980-220X201604... However, a study conducted in a municipality of São Paulo achieved satisfactory results for the dimension special immunobiological agents.1616. Vasconcelos KCE, Rocha SA, Ayres JA. Evaluation of vaccination rooms in the primary health care network of the Municipality of Marília, State of São Paulo, Brazil, 2008-2009. Epidemiol Serv Saude. 2012;21(1):167-76. doi: 10.5123/s1679-49742012000100017
https://doi.org/10.5123/s1679-4974201200...

The inter- and intra-regional inequalities observed in the diagnosis of vaccination rooms, with a less favorable result for most of the dimensions in the rooms in the North and Northeast regions, compared to those in the other regions, reflect the historical inequalities of investment in material and human resources in the Brazilian territory, and trends of a lower vaccination coverage in both regions aforementioned.22. Ministério da Saúde (BR). Programa Nacional de Imunizações. Programa Nacional de Imunizações: coberturas vacinais no Brasil (período 2010-2014) [Internet]. Brasília: Ministério da Saúde; 2015 [citado 2020 Maio 13]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2017/agosto/17/AACOBERTURAS-VACINAIS-NO-BRASIL---2010-2014.pdf
https://portalarquivos2.saude.gov.br/ima...

3. Arroyo LH, Ramos ACV, Yamamura M, Weiller TH, Crispim JA, Cartagena-Ramos D, et al. Areas with declining vaccination coverage for BCG, poliomyelitis, and MMR in Brazil (2006-2016): maps of regional heterogeneity. Cad Saude Publica. 2020;36(4):e00015619. doi: 10.1590/0102-311X00015619
https://doi.org/10.1590/0102-311X0001561... -44. Césare N, Mota TF, Lopes FFL, Lima ACM, Luzardo R, Quintanilha LF, et al. Longitudinal profiling of the vaccination coverage in Brazil reveals a recent change in the patterns hallmarked by differential reduction across regions. Int J Infect Dis. 2020;98:257-80. doi: 10.1016/j.ijid.2020.06.092
https://doi.org/10.1016/j.ijid.2020.06.0...

This study expands the diagnosis of vaccination rooms in several macro-regions of Brazil, from a contemporary perspective, given that the literature on the subject is scarce and it is not recent. It is noteworthy that vaccination is part of the basic microprocesses of Primary Health Care,2424. Mendes EV. A construção social da Atenção Primária à Saúde. Brasília: Conselho Nacional de Secretários de Saúde; 2015. 193 p. which should be implemented and monitored regularly in order to ensure conditions for the provision of quality services. Thus, the adopted checklist proved to be easily applicable in different contexts, and can serve as an example for the institutionalization of monitoring culture, evaluation and continuous improvement of immunization services.

Taking these results, it can be concluded that the diagnosis performed enabled the identification of opportunities for improvement in vaccination rooms, and that continuous monitoring and evaluation may support a more assertive action plan in different types of governance

References

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    Domingues CMAS, Maranhão AGK, Teixeira AM, Fantinato FFS, Domingues RAS. The Brazilian National Immunization Program: 46 years of achievements and challenges. Cad Saude Publica. 2020;36(Suppl 2):e00222919. doi: 10.1590/0102-311X00222919
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Publication Dates

  • Publication in this collection
    08 July 2022
  • Date of issue
    2022

History

  • Received
    20 Feb 2022
  • Accepted
    24 May 2022
Creative Common - by-nc 4.0
Este é um artigo publicado em acesso aberto sob uma licença Creative Commons
Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: ress.svs@gmail.com
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