Legal and administrative basis for NITAGs and their Terms of Reference
All countries reported that the legal basis for NITAG's establishment was a ministerial decree. However, we received the relevant legal document or ministerial decree from eight countries. All NITAGs have written terms of reference (TORs). however, only six countries shared their TORs. They were Algeria, Morocco, Qatar, Sudan, Tunisia and Yemen. As per the content of the terms of references, it was noted that objectives, mandate, and membership composition were part of the TOR in all countries. However, only five countries highlighted that their TORs refer to establishing technical working groups. The countries were Oman, Qatar, KSA, Sudan, and Tunisia. For further information refer to Table 2.
Table 2
Functionality of the NITAG in the countries under review according to the six WHO criteria.
|
Legislative or administrative basis for the advisory group
|
Formal written terms of reference
|
At least five different areas of expertise are represented among core members.
|
At least one meeting per year
|
Circulation of the agenda at least one week before meetings
|
Mandatory disclosure of any conflict of interest
|
The country met the six WHO criteria as reported on JRF for WHO/UNICEF
|
Afghanistan
|
YES
|
YES
|
YES
|
YES
|
NO
|
YES
|
YES
|
Algeria
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
Iraq
|
YES
|
YES
|
YES
|
YES
|
YES
|
NO
|
NO
|
Jordan
|
YES
|
YES
|
YES
|
YES
|
NO
|
NO
|
YES
|
Libya
|
YES
|
YES
|
NO
|
YES
|
NO
|
YES
|
NO
|
Morocco
|
YES
|
YES
|
YES
|
YES
|
NO
|
YES
|
YES
|
Oman
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
Qatar
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
Saudi Arabia
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
NO
|
Sudan
|
YES
|
YES
|
YES
|
YES
|
NO
|
YES
|
YES
|
Syria
|
YES
|
YES
|
NO
|
YES
|
NO
|
YES
|
YES
|
Tunisia
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
YES
|
Yemen
|
YES
|
YES
|
YES
|
YES
|
NO
|
YES
|
NO
|
Role of NITAG
All articulated that the NIATG has a technical advisory role. However, seven respondents said that the NITAG directly makes policy, which should not be the case. The respondents noted that their respective NITAGs have a role in the selection and introduction of vaccines (11 respondents), vaccine policy (4), and vaccine safety (1). All the NITAG respondents criticized the role of the secretariat.
Standard Operating Procedures (SOPs)
It has been noticed that only seven countries have SOPs, and the remaining six countries don’t have SOPs for their respective NITAGs.
Membership
Respondents from all countries mentioned that their NITAG consists of multidisciplinary experts and the selection of these experts was based on a transparent process. At the same time, nine countries complained about the high turnover of the NITAG core members. Six countries reported a shortage of required experts (refer to Table 2). All the countries were complaining about the workload on the NITAG members. The number of NITAG members varies from country to country it ranges from 8 to 40 members, according to the respondents. Morocco, for example, reported forty members on the NITAG.
Conflict of Interest:
Only six countries follow a written policy on Conflict of Interest. Those include Afghanistan, Algeria, Iraq, Jordan, KSA, and Sudan. Interestingly, none attached the Declaration of Interest (DOI) form as requested for the assessment. Six out of 17 respondents said the policy for preventing and managing conflict of interest is clear. Eight participants only said the (DOI) forms were available for members to complete. While 11 participants claimed that all core members declared their interest at the time of appointment, only six said they expressed their interest before every meeting.
Independence of Core members
All countries claimed that the chairperson was independent of the National Immunization Programme and served there. At the same time, three respondents mentioned that the core members were not independent and were part of the Ministry of Health decision-makers.
Annual Work Plan of NITAGs
Respondents from eight countries claimed their annual work plan was based on National EPI goals. Ten NITAGs reported that most core members approve the annual work plan. Different mechanisms were reported to identify NITAG agenda themes and priorities, but all respected the collaborative nature.
Access to data:
All participants have access to the required data, and no significant difficulties in accessing data or obtaining input from stakeholders were reported.
NITAG secretariat
As per respondents’ answers, all NITAGs except one receive adequate support from the secretariat. Figure 1 shows. As expressed by participants, challenges to the NITAG secretariat included staff turnover, lack of technical capacity, and the load on human resources. Some highlighted political or personal biases. Financial challenges were also noted.
Funding
Six countries reported that NITAG activities were sustainable through securing adequate funding. They are Oman, Qatar, KSA, Tunisia, Sudan, and Syria. However, only two countries (Syria and Sudan) said that a budget line for NITAG activities appears in the EPI budget or the overall MOH budget. Syria reported that NITAG develops and shares an annual budget that covers its activities. The remaining seven countries had problems with the funding, and they were dependent on NEPI or WHO which created a conflict of interest.
Integration of NITAG into the policy process
Respondents from all countries reported that the MOH routinely consults the NITAG for immunization policy questions, and respondents from 10 countries claimed that there is a defined process for the MOH to request NITAG recommendations officially. Among them, 10 countries expressed an effective collaborative communication between MOH and NITAG as a result MOH is considering NITAG recommendations. However, none of them provide an example of the recommendation process to be implemented. The questionnaire further probed the NITAG quality of work process and outputs. The result reveals that all the targeted countries share the minutes of the meeting with the NITAG members within a defined period after a meeting for the finalization of the meeting minutes. Furthermore, 75.6% of the participants mentioned that they did not document the NITAG recommendations separately from the meeting minutes. Likewise, 41% of the participants mentioned that the NITAG is not using a standardized and systematic method of searching for, reviewing, and synthesizing relevant evidence based on a PICO-like framework for the policy question. For further information refer to Table 3.
Table 3
Views of participants towards NITAG quality of work process and outputs
Question
|
Yes (No)
|
No (No)
|
No response
|
Does the NITAG have a defined and adopted generic set of criteria as a basis for decision-making?
|
11
|
4
|
2
|
Are the above decision-making procedures always followed?
|
11
|
5
|
2
|
Does the NIATG follow a well-defined evidence-based methodology to gather and evaluate evidence?
|
11
|
4
|
2
|
Does the NITAG use a standardized and systematic method of searching for, reviewing, and synthesizing relevant evidence based on a PICO-like framework for the policy question?
|
8
|
7
|
2
|
Does the NITAG use existing systematic reviews and quality assessments of the evidence from SAGE, WHO, or other high-functioning NITAGs?
|
12
|
4
|
1
|
Do the recommendations of the NITAG follow a consistent format, with a summary of the evidence supporting the recommendation?
|
13
|
2
|
2
|
Do the recommendations of the NITAG refer to peer-reviewed published material and/or the background document?
|
11
|
5
|
1
|
Are the recommendations of the NITAG supported by local evidence or contextual information?
|
15
|
1
|
1
|
Are the recommendations of the NITAG documented separately from the meeting minutes?
|
4
|
12
|
1
|
Are the recommendations of the NITAG clear and straightforward?
|
16
|
0
|
1
|
Are background documents prepared for the NITAG for each policy question?
|
14
|
2
|
1
|
Are the minutes shared with all NITAGs members within a defined period after a meeting for finalizing?
|
16
|
0
|
1
|