In September 2008, the Ministry of Health (the Ministry) launched the Human Papillomavirus (HPV) Immunisation Programme (the Programme) across New Zealand.
The Programme aims to reduce cervical cancer rates in New Zealand by protecting young women against HPV infection, which if left untreated can develop into cervical cancer.
The Ministry commissioned Litmus Ltd to evaluate the implementation of the Programme to assess how well it achieved the Ministry’s short-term goals, objectives and implementation priorities.
Litmus was asked to assess whether an equitable vaccination programme was implemented for Māori and Pacific girls with the long-term view of reducing inequalities in cervical cancer. The evaluation focused on Māori, Pacific and Other* young women across two groups:
- girls born in 1997
- young women born between 1990 and 1991 who could access the free vaccine up to 31 December 2011.
The evaluation concluded:
- the Programme was implemented with equitable outcomes for Māori and Pacific girls born in 1997
- the Programme successfully targeted and tailored implementation to achieve target uptake and equity of those women who experience the greatest burden of cervical cancer
- other girls born in 1997, who represent two-thirds of the birth cohort, have not achieved target vaccine uptake
- other parents of non-vaccinated girls born in 1997 are not opposed to the HPV vaccine but have decided to delay uptake until their daughters are in their late teens
- other parents of non-vaccinated girls also perceived the HPV vaccine as not for their daughters because the parents perceived a lack of sexual maturity.
- equity results for 1990 and 1991 cohort are mixed with target uptake and equity of uptake achieved for Pacific women, but not for Māori women.
Vaccine uptake appeared to be higher when there was evidence of integration and information sharing across a series of components including DHB Planning and Funding, HPV team, Immunisation Coordinator, school-based delivery, primary care delivery and whānau engagement. Lower vaccine uptake occurred when there was limited integration between these components.
Challenges and recommendations
The evaluation identified key challenges for the Programme going forward including increasing uptake of the vaccine by Other girls born in 1997, while continuing equity of uptake by Māori and Pacific girls. The Ministry is addressing this challenge through its development of a communications strategy targeting students in year 12 and 13, as well as first year tertiary students reminding them to check their HPV vaccine status.
As part of the evaluation, Litmus recommended key areas to improve the implementation of the Programme including:
- develop evidenced-based strategies to address the misinformation about the HPV vaccine
- increase integration of school-based and primary care delivery as both modes of delivery are essential to ensuring high vaccine uptake
- identify possible health equity mechanisms that could be used in primary care delivery, including the role of and levers available to primary health organisations.
The evaluation also reviewed the design phase of the Programme and identified key lessons for the Ministry which included managing relationships with external stakeholders and advisors better and recognising the role of conflict in seeking system change. The evaluation recommended the Ministry enhance the management of disagreement and ensure consistent decision-making.
The Ministry has actively managed these recommendations, which has resulted in strengthened relationships as a result of the following activities:
- quarterly district health board forums
- quarterly School Based Immunisation Programme teleconferences
- regular meetings with immunisation steering groups
- identifying community immunisation champions and asking this group to advocate for immunisation.