Developing an evaluation framework for Hepatitis B immunization programs in developing countries: A case study with Cuba

Hepatitis B is a serious viral infection that causes thousands of deaths worldwide each year. Immunization against hepatitis B protects individuals from hepatitis B and its resulting sequelae. The World Health Organization (WHO) strongly supports the development of hepatitis B immunization programs. By protecting immunized people from infection, hepatitis B immunization programs reduce the number of chronic carriers in a population. WHO has devised a number of hepatitis B immunization program protocols. If enacted as stated, these program protocols will successfully reduce the number of hepatitis B chronic carriers in a population. Cuba has a strong public health system and stresses the importance of immunization. A process evaluation of Cuba’s hepatitis B immunization program was undertaken by comparing Cuba’s practices with WHO guidelines. A thorough literature search facilitated this process, as did communication with Cuban health professionals. The importance of pairing a qualitative evaluation with a quantitative evaluation to enable an impact assessment is also presented. A framework for developing a quantitative evaluation of a hepatitis B immunization program through the use of an infection marker survey is discussed. The process evaluation reflects Cuba’s strong hepatitis B immunization program administration. Cuba should consider conducting a quantitative evaluation employing fieldwork techniques described in this paper. The collection of quantitative seromarker data will provide evidence to further support the success of Cuba’s hepatitis B immunization program in decreasing the rate of chronic carriers in its population.