Assessment of National Immunization Technical Advisory Group (NITAG) functionality in selected Eastern Mediterranean countries

Abstract National Immunization Technical Advisory Groups (NITAGs) are independent advisory committees providing evidence-based recommendations for decision-making on new vaccine introduction and immunization policy. This report, addresses issues of the functionality of the NITAGs in the selected EMR countries, building the capacity of NITAG to improve the functionality of NITAG in the targeted counties as part of EMPHNET support to health systems strengthening in the region. This assessment was conducted in 13 EMR countries Afghanistan, Algeria, Iraq, Jordan, Libya, Morocco, Oman, Qatar, Tunisia, Saudi Arabia, Sudan, Syria, and Yemen. The target population was NITAG chairperson and NITAG technical secretary (NEPI). the assessment tool was digitalized using a KoBo toolbox. Following the data analysis, a five-day inter-country workshop was conducted to provide a facility to the countries under review to develop country improvement plans to accomplish the NITAG functionality in the region. According to the findings, all of the under-review countries have active NITAG with the written terms of reference. For 41% of the respondents, the role of NITAG was not clear and they mentioned that the NITAG directly makes the policy. Based on the findings 36% of the countries don’t have SOPs for their NITAGs. Regarding the membership, all the countries mentioned that their NITAG consists of multidisciplinary experts. However, 46% of the countries faced a shortage of experts. Likewise, 69% of the countries reported high turnover of the NITAG members which negatively affects the functionality of NITAG. Based on the findings the main challenges to the NITAG included staff turnover, shortage of technical capacity, and the load on human resources. Some highlighted political or personal biases. Financial challenges were also noted in all countries except high-income countries. Only 24.5% of the participants mentioned that they documented the NITAG recommendations separately from the meeting minutes. Likewise, 59% of the participants mentioned that the NITAG uses a standardized and systematic method of searching for, reviewing, and synthesizing relevant evidence based on a PICO-like framework for the policy question. The findings of the regional assessment clearly showed that major gaps need to be tackled to ensure the functionality of NITAG. Clear TOR, SOPs, the clear and well-defined role of secretariats, and ensuring the systematic provision of the recommendation for policymakers.