Microplanning Workshops for High-quality Vaccination in Brazil: An Experience Report, 2023

"The workshops promoted detailed mapping of the local context and the target population, in addition to providing opportunities for raising awareness and exchanging experiences among participants involved in vaccination programs."

In recent years, a decrease in vaccination coverage for several immunobiological agents has been observed in Brazil and other countries. Microplanning is used as a strategy to ensure high-quality vaccination activities, such as routine immunisation, campaigns, intensification, sweeps, and house-to-house vaccination, by enabling changes in the work process. This paper reports the experience of workshops designed to facilitate action plans in microplanning vaccination in Brazilian states and municipalities in 2023.

As outlined here, the stages of microplanning are dynamic, allowing for dialectical processes to discuss the challenges and easiness in immunisation efforts that can contribute to improving vaccination coverage. States and municipalities are expected to develop microplanning action plans based on their local realities and the priority population to identify the most appropriate and effective intra-and extramural vaccination activities.

Given the need to reverse the decline in vaccination coverage as of January 1 2023, changes were implemented within Brazil's Ministry of Health regulatory structure, including the reformulation and expansion of the Programa Nacional de Imunizações (PNI). Microplanning for high-quality vaccination activities was chosen as the strategy to increase vaccination coverage, introduced by Pan American Health Organization (PAHO) as an approach for promoting differentiated vaccination actions.

The 13 workshops aimed at establishing effective vaccination strategies were held between July 15 (Macapá, capital city of Amapá state) and September 14 2023 (Belo Horizonte, capital city of the state of Minas Gerais), with a total of 1,232 participants, including surveillance technicians, primary care practitioners, and those from other health sectors. The diversity of participants highlighted distinct challenges and the importance of cooperation in addressing low vaccination coverage across the country.

The workshops had an approximate total duration of 24 hours, spread over three days. Workshops were conducted in different states of Brazil and offered to all 27 federative units. Initially, the participants of each workshop were divided into groups, organised by affinity, according to health regions, levels of operation, healthcare facilities, and other aspects. The role of facilitators during the process was fulfilled by the technical team from the Ministry of Health.

The first session involved presenting the epidemiological situation and vaccination coverage in Brazil. Subsequently, topics covered included: communication and social mobilisation for vaccination actions; guidelines for microplanning and vaccination actions; high-quality components and criteria; the preparation and formation of the planning and execution committee; training, qualification, and updates for vaccination actions; microplanning and execution stages; analysis of the health situation; considerations for reaching vulnerable populations; vaccination records and perspectives of the Ministry of Health's information systems; vaccination concepts and indicators; method for calculating the unvaccinated cohort; assessment of the vaccination activity preparedness; safe vaccination planning and organising the monitoring of events supposedly attributable to vaccination or immunisation; monitoring and supervision of microplanning; and rapid vaccination assessment and monitoring and evaluation indicators.

The workshops served as a platform for raising awareness and exchanging experiences among stakeholders involved in vaccination. As reported here, completing and discussing data collection tools during the workshops made it possible to bridge the gap between theory and practice, in addition to promoting qualified input of participants and reporting on the needs faced in health services. The impact of its implementation has been observed in increased vaccination coverage and the increase in the number of municipalities meeting vaccination targets, comparing 2022 (pre-microplanning) and 2023 (post-microplanning). Overall evaluations were positive, with an average of 95.2% satisfaction, with facilitators receiving the highest score and training and content receiving the lowest score.

In conclusion: "The workshops were important in facilitating experience-sharing among the various players involved, fostering integration across different management levels, aligned with local needs....In the long term, the sustainable incorporation of the strategy by Brazilian states and municipalities is expected to eliminate and control vaccine-preventable diseases."