Review of the TIP tool and approach

“The guide to tailoring immunization programmes (TIP)”, developed in 2013, offered countries a process through which to diagnose barriers to and motivators of vaccination in under-vaccinated groups and to 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 facilitate important progress towards 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 a review in June to December 2016 – informed by country assessments, a review of national and regional documents, and an online regional survey.

Results

The review committee concluded that there is strong demand among immunization programmes in the European Region for research to understand enablers of and barriers to vaccination in under-vaccinated 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 part of health authorities, service providers and researchers;
• building trust and helping to break down barriers of misunderstanding in the under-vaccinated 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 is to go beyond identification of under-vaccinated groups and diagnosis of barriers to and enablers of 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;
• follow-up meetings, advocacy and (potentially) incentives like seed funding for intervention and evaluation activities.