Proficient immunization personnel are an essential component of effective immunization systems in low- and middle-income countries (LMICs) [1]. And, improved quality of supervision through use of tools such as checklists, job aids, guidelines, and mobile technology has potential to enhance health care and improve health worker performance [2]. Supportive supervision is “a process that promotes quality at all levels of the health system by strengthening relationships within the system, focusing on the identification and resolution of problems, and helping to optimize the allocation of resources – promoting high standards, teamwork, and better two-way communication” [3]. Health care workers who were provided with direct, targeted supportive supervision have demonstrated improved performance, technical knowledge, and workplace coping skills [4]. Building immunization capacity and strengthening supportive supervision are some of the main goals of the 2011–2020 Global Vaccine Action Plan (GVAP) developed by the World Health Organization (WHO) [1].

The political and financial commitment to addressing the global shortage of health workers is stronger than ever before. Therefore, the global effort to strengthen human resources for health (HRH) must be co-ordinated and aligned to strategically utilize the current momentum and create sustainable impact. This paper assesses HRH strategies to (1) create greater understanding on the collective global action towards improving HRH, and (2) identify opportunities for greater co-ordination to improve sustainable health workforce development. We searched published and grey literature to identify the HRH strategies of select large-scale global health organizations. The most common approaches were increasing the supply of health workers, facilitating training and education and improving health worker management capacities. Overall, our analysis shows there is a need to (1) improve co-ordination among development partners, (2) ensure strong engagement and leadership of national governments and (3) generate scientific evidence on the best approaches for sustainable workforce development.

INTRODUCTION: Effective allocation of resources and investments heavily rely on good quality data. As global investments in vaccines increases, particularly by organisations such as Gavi, The Vaccine Alliance, Switzerland, the demand for data which is accurate and representative is urgent. Understanding what causes poor immunisation data and how to address these problems are therefore key in maximizing investments, improving coverage and reducing risks of outbreaks. OBJECTIVE: Identify the root causes of poor immunisation data quality and proven solutions for guiding future data quality interventions. METHODS AND RESULTS: Qualitative systematic review of both scientific and grey literature using key words on immunisation and health information systems. Once screened, articles were classified either as identifying root causes of poor data quality or as an intervention to improve data quality. A total of 8,646 articles were initially identified which were screened and reduced to 26. Results were heterogeneous in methodology, settings and conclusions with a variation of outcomes. Key themes were underperformance in health facilities and limited Human Resource (HR) capacity at the peripheral level leading to data of poor quality. Repeated reference to a "culture" of poor data collection, reporting and use in low-income countries was found implying that it is the attitudes and subsequent behaviour of staff that prevents good quality data. Documented interventions mainly involved implementing Information Communication Technology (ICT) at the district level. However, without changes in HR capacity the skills and practices of staff remain a key impediment to reaching its full impact. DISCUSSION: There was a clear incompatibility between identified root causes, mainly being behavioural and organizational factors, and interventions introducing predominantly technical factors. More emphasis should be placed on interventions that build on current practices and skills in a gradual process in order to be more readily adopted by health workers. Major gaps in the literature exist mainly in the lack of assessment at central and intermediate levels and association between inaccurate target setting from outdated census data and poor data quality as well as limited documentation of interventions that target behaviour change and policy change. This prevents the ability to make informed decisions on best methodology for improving data quality.

Accurate estimates of vaccination coverage are crucial for assessing routine immunization program performance. Community based household surveys are frequently used to assess coverage within a country. In household surveys to assess routine immunization coverage, a child's vaccination history is classified on the basis of observation of the immunization card, parental recall of receipt of vaccination, or both; each of these methods has been shown to commonly be inaccurate. The use of serologic data as a biomarker of vaccination history is a potential additional approach to improve accuracy in classifying vaccination history. However, potential challenges, including the accuracy of serologic methods in classifying vaccination history, varying vaccine types and dosing schedules, and logistical and financial implications must be considered. We provide historic and scientific context for the potential use of serologic data to assess vaccination history and discuss in detail key areas of importance for consideration in the context of using serologic data for classifying vaccination history in household surveys. Further studies are needed to directly evaluate the performance of serologic data compared with use of immunization cards or parental recall for classification of vaccination history in household surveys, as well assess the impact of age at the time of sample collection on serologic titers, the predictive value of serology to identify a fully vaccinated child for multi-dose vaccines, and the cost impact and logistical issues on outcomes associated with different types of biological samples for serologic testing.

BACKGROUND: International guidance recommends the scale up of routinely recommended, offered, and delivered health care provider-initiated HIV testing and counseling (PITC) to increase the proportion of persons who know their HIV status. We compared HIV test uptake under PITC to provider-referral to voluntary counseling and testing (VCT referral) in two primary health centers in South Africa. METHODS: Prior to introducing PITC, clinical providers were instructed to refer systematically selected study participants to VCT. After PITC and HIV rapid test training, providers were asked to recommend, offer and provide HIV testing to study participants during the clinical consultation. Participants were interviewed before and after their consultation to assess their HIV testing experiences. RESULTS: HIV test uptake increased under PITC (OR 2.85, 95% CI 1.71, 4.76), and more patients felt providers answered their questions on HIV (104/141 [74%] versus 73/118 [62%] for VCT referral; p 0.04). After three months, only 4/106 (3.8%) HIV-positive patients had registered for onsite HIV treatment. Providers found PITC useful, but tested very few patients (range 0-15). CONCLUSION: PITC increased the uptake of HIV testing compared with referral to onsite VCT, and patients reported a positive response to PITC. However, providing universal PITC will require strong leadership to train and motivate providers, and interventions to link HIV-positive persons to HIV treatment centers.