Kids Count grants for immunization registry systems illustrates the kind of collaboration needed.3 Committee member Robert Ross, who served on the All Kids Count advisory committee, was impressed by the ability of the foundation to insist on representation from all elements of the public and private health care delivery systems, including physicians, nurses, hospitals, and community organizations, in proposal development and interviews during site visits.

No single plan will lead to comprehensive immunization coverage in every state. Common themes may exist, but each state must find a solution that takes into account the specific immunization needs of its children and how its providers and organizational resources can be used to meet those needs. The committee is persuaded that solutions will require state collaboration with local health departments, private providers, state and local chapters of providers' professional organizations, community groups, and others. States should be exploring how to strengthen primary care to meet not only children's immunization needs but also their other important health care requirements.

FEDERAL LEADERSHIP

States can benefit from the strong federal support for improving immunization levels among preschool children. Political influence on behalf of immunization initiatives as well as funding and technical assistance can come from federal sources.

With its responsibility for overseeing the President's Childhood Immunization Initiative (see box), the NVPO has a critical leadership role to play. It is coordinating federal immunization efforts, working with the national leadership of provider organizations, and stimulating awareness of immunization issues among the public health and private provider communities and the public at large.

CDC's role includes implementing operational aspects of the President 's Childhood Immunization Initiative, administering major grant programs, providing technical assistance to public health departments in the delivery and monitoring of services, and conducting disease surveillance. CDC also coordinated the development and publication of the Standards for Pediatric Immunization Practices (CDC, 1993b). The standards are an influential tool for

3  

In 1992, the Robert Wood Johnson Foundation (1992) established a new grant program called All Kids Count. The program seeks to improve immunization rates among preschool children by supporting the development and implementation of computerized systems that record and monitor children's immunization status. Recipients of 1-year planning grants, awarded in 1992, were eligible to apply for a limited number of larger implementation grants that would provide support for a maximum of 4 years.



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