Evaluation of the TIP tool and approach in the European Region
In 2013 the WHO Regional Office for Europe developed the Guide to tailoring immunization programmes (TIP), offering countries a process through which to diagnose barriers and motivators to vaccination in susceptible groups and design tailored interventions.
The potential bottom-line health impact of the TIP approach has been widely recognized in recent years. Successful integration of tailored approaches in immunization services, built upon evidence of and insight into the behavioural determinants of specific individuals and groups, has the potential to make important in-roads into regional and global disease elimination and eradication targets.
To take stock of TIP implementation and health impact, an external committee of 6 leading global experts conducted an evaluation in June to December 2016, informed by country assessments, a review of national and regional documents and an online regional survey.
The evaluation committee concluded that there is strong demand among immunization programmes in the European Region for research to understand enablers and barriers to vaccination in susceptible population groups.
The interdisciplinary approach and the community engagement and qualitative research were among the most important strengths of TIP, enhancing the ability of programmes to listen and gain an understanding of community and individual perspectives. As such, a TIP project can be a means to 2 ends:
- building in-depth understanding on the side of health authorities, service providers and researchers;
- building trust and helping to break barriers of misunderstanding in the susceptible community.
The emphasis on considering changes to service delivery rather than focusing solely on communication was another highlighted strength of the approach.
A critical aspect of TIP implementation is the fact that changing service delivery is a long, slow and often complicated process. Emphasizing that the purpose of TIP should go beyond identification of susceptible groups and diagnosis of barriers and enablers to vaccination, the evaluation committee recommended that WHO place emphasis on helping countries translate diagnostics into interventions and start the necessary process of overall change. The implementation of interventions should be supported by an emphasis on:
- enhanced local ownership;
- integrated diagnostic and intervention design; and
- follow-up meetings, advocacy and potentially incentives like seed funding for intervention and evaluation activities.