Enhancing State and Tribal Health, Indian Health Services (IHS) and Urban Indian Clinics' Immunization Partnerships: The Oregon Tribal Immunization Initiative (OTII) 2008-2009

Background:  American Indian and Alaska Natives (AI/ANs) are special populations at-risk for vaccine-preventable diseases needing immunizations. Urban Indian clinics and Tribal Health and Indian Health Service (IHS) clinics, operating under the authority of Tribal governments, provide immunization services for many AI/ANs in Oregon and work with the State via government-to-government relationships.

Objectives:  Oregon Immunization Program (OIP) launched the OTII in 2008 to strengthen relationships, better understand clinics’ vaccine delivery systems, increase awareness of and access to state-funded vaccines, identify needs and barriers at clinics, and explore opportunities to work together and improve OIP services.

Methods:  The project team worked with stakeholders to coordinate efforts, clarify project objectives, and obtain advice; developed qualitative assessment tools; and reviewed clinics’ publicly-funded vaccine ordering, immunization information system (IIS) use and other program participation. Then, the team gained support from Tribal representatives at a State-Tribal health meeting, completed extensive semi-structured visits at each of 10 clinics and began follow-up efforts.

Results: Strengths identified include Tribal clinics’ uniqueness, notable OIP successes, clinics’ commitment to promoting immunization and excitement about clinics’ own immunization initiatives, and desire to improve partnerships with OIP.  Challenges included both shared and clinic-specific immunization barriers, limited resources to handle patients or encourage staff participation in OIP trainings, lack of consistent immunization screening, limited use of state-funded vaccines, significant barriers with electronic tracking systems use (grappling with multiple systems and missing records and delayed institution of bidirectional IHS RPMS-ALERT system data exchanges), and limited knowledge or use of AFIX quality improvement services.

Conclusions: With specific recommendations for enhancing partnerships and providing more consistent services, OIP is currently following up providing AFIX visits and trainings, assistance with ordering VFC and 317 vaccines, and support for novel H1N1 influenza response and immunization activities.