Is there an association between local health department organizational and administrative factors and childhood immunization coverage rates?

BACKGROUND: Vaccines are valuable- cost-effective tools for preventing disease and improving community health. Despite the importance and ubiquity of vaccinations- childhood immunization coverage rates vary widely by geography- race- and ethnicity. These differences have been documented for nearly two decades- but their sources are poorly understood. Between 2005 and 2008- immunization staff of the National Association of County & City Health Officials (NACCHO) visited 17 local health department (LHD) immunization programs in 10 states to assess their immunization service delivery (ISD) practices and their impact on community childhood immunization coverage rates. PURPOSE: To qualitatively characterize LHD immunization programs and specific organizational factors underlying ISD performance challenges and successes related to community childhood immunization coverage rates. METHODS: Case studies were conducted in a convenience sample of 17 geographically and demographically diverse LHDs- predicated on each LHD