BOX 1–4 Immunization infrastructure: The Michigan Example
Michigan received $6.4 million for “infrastructure” in 1999, about $20 per child under age 3. These funds support efforts associated with direct service delivery, infectious disease prevention, surveillance and assessment, efforts to improve coverage rates, and programs to strengthen system performance. Additional federal support pays for the state health department’s immunization program staff. That staff includes two public health advisers (employees of CDC)—one on the Michigan state central staff and one assigned to the city of Detroit.
More than half the infrastructure grant funds support service delivery. The state allocates funds to 43 local health departments based on the number of young children who live in the area. Local health departments are free to pursue the strategy they choose to ensure timely immunization. The most common use of the funds is to pay staff to administer vaccines.
The infrastructure grant supports a central immunization program staff and two four-person field staffs—one that works with local health departments and another that works with the VFC providers who work in the private sector. Both field staffs work with providers on the logistics of obtaining vaccines and proper vaccine storage and handling. The field staff working with local health departments assists when outbreaks occur. It also reviews assessments of coverage levels among children immunized by local health departments. This group is responsible as well for working with schools to ensure compliance with school entry immunization requirements. The field staff that deals with other VFC providers tries to retain and recruit new providers.
The core of the central staff comprises the program manager, a series of individuals with specialized functions, and support staff. A surveillance coordinator focuses on epidemiology and surveillance through activities such as visiting localities experiencing outbreaks and gathering reports of vaccine-preventable diseases. An outreach and education manager and staff work broadly through a newsletter with a circulation of 8,000 and annual immunization workshops conducted around the state that attract 800 people a year. This group targets efforts to improve service delivery, such as a peer-to-peer physician education network and distribution of an immunization provider toolkit.
The assessment coordinator oversees two contracts designed to provide immunization assessments—one for clinics and physician offices in the Detroit area and the other in 22 community and migrant health centers. This individual also conducts assessments outside Detroit. Assessments use the CDC-developed Assessment, Feedback, Incentives, and exchange of information (AFIX) methodology. This activity has produced an average of 10 percent higher coverage levels at the time of the second follow-up assessment. The state staff also includes an immunization registry coordinator, although the costs of operating the registry are paid with state funds. One person focuses on reducing perinatal hepatitis B transmission, following up on possible cases of transmission by mothers to their newborn children.
Federal funding for infrastructure supports other outreach efforts as well. These include contracts to answer calls to a toll free number for immunization information, and to conduct outreach to day care providers in an urban area with a history of outbreaks in day care centers.