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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Childhood Vaccination with MMR, Flu, and HPV.

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Strategy. Enhanced Access to Vaccination Services

Approach. Support enhanced access to vaccination services to increase vaccination rates among children through cost reduction and expanded clinic hours.

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Overview. Enhancing access to vaccination services through cost reduction and expanded clinic hours involves removing financial challenges and offering vaccinations at convenient times to increase immunization rates among children.[1] This approach tackles two key hurdles that can prevent caregivers from getting their children vaccinated: affordability and scheduling conflicts.[1] Public health efforts to support enhanced access often involve a multi-pronged strategy.[1] One component might be supporting and implementing policies that eliminate co-pays and deductibles for childhood vaccinations within public and private insurance plans.[1] Additionally, health departments can organize mobile vaccination clinics or extend clinic hours in evenings and weekends to cater to working parents and busy schedules.[1] Peer-reviewed research has shown that such public health approaches are successful in increasing vaccination rates.[1] Studies have found that eliminating cost-sharing resulted in a significant rise in childhood immunizations, with some showing a 10-Percent point increase.[2] Similarly, research suggests that extended clinic hours can improve access and completion of childhood vaccination schedules.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

This strategy is also supported as "Vaccination Programs: Reducing Client Out-of-Pocket Costs" in The Community Guide.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Clinic appointment and wait time data
  • Patient reported challenges to service data
  • Patient satisfaction surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of clinics and provider sites offering free or low-cost vaccination services to eligible children. (Measures availability of affordable services)
  • Number of vaccination locations that expand their hours of operation to include evenings, weekends, and other convenient times for families. (Shows service usability)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of vaccination sites that offer walk-in and same-day appointments to minimize scheduling challenges for families. (Assesses client-centered service design)
  • Percent of clinic staff trained to provide respectful vaccination services to families. (Measures workforce capacity)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of community organizations, schools, and businesses that partner with clinics to host off-site vaccination events and outreach. (Expands service access points)
  • Number of vaccine financing policies and community benefit investments supported by Title V that sustain affordable and usable services. (Promotes financial sustainability)
  • Number of communities that achieve and maintain high immunization rates and low incidence of vaccine-preventable diseases in children. (Measures population health impact)
  • Number of healthcare providers that report improved efficiency, reduced missed opportunities, and increased capacity to serve families through access enhancements. (Indicates system benefits)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of free and low-cost vaccination services tailored to children in census tracts with the lowest coverage rates. (Assesses focus on health outcomes)
  • Percent of community health workers and navigators deployed to assist families facing healthcare access challenges in accessing affordable and convenient vaccination services. (Ensures support for those experiencing significant challenges)
  • Percent of communities that achieve and maintain high immunization rates and low incidence of vaccine-preventable diseases in children. (Measures population health impact)
  • Percent of healthcare providers that report improved efficiency, reduced missed opportunities, and increased capacity to serve families through access enhancements. (Indicates system benefits)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] National Academies of Sciences, Engineering, and Medicine. (2021). The critical public health value of vaccines: tackling issues of access and hesitancy: proceedings of a workshop. Guide to Community Preventive Services. Vaccination. https://www.thecommunityguide.org/topics/vaccination.html. Page last updated: October 4, 2022.

[2] Lin, C. J., Nowalk, M. P., Toback, S. L., & Ambrose, C. S. (2013). Factors associated with in-office influenza vaccination by US pediatric providers. BMC pediatrics, 13, 1-5.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.