This scenario presents a common challenge in immunization pharmacy practice: translating research findings into tangible quality improvements and effective simulation-based training. The professional challenge lies in navigating the complexities of evidence-based practice, ensuring patient safety, and adhering to regulatory expectations for continuous professional development and service enhancement within the Sub-Saharan African context. Careful judgment is required to select an approach that is both scientifically sound and practically implementable, considering resource limitations and local public health priorities. The best approach involves systematically evaluating the research, developing a targeted simulation program based on identified gaps, and then implementing and monitoring the impact of this program on actual immunization service delivery. This aligns with the principles of quality improvement cycles (e.g., Plan-Do-Check-Act) and the regulatory expectation for pharmacies to engage in activities that enhance patient care and public health outcomes. Specifically, it addresses the translation of research into practice by creating a structured learning environment (simulation) designed to improve specific immunization competencies. This proactive and evidence-driven method ensures that training is relevant, effective, and directly contributes to better immunization rates and patient safety, fulfilling the spirit of licensure requirements for ongoing professional competence and service quality. An incorrect approach would be to implement a broad, unvalidated simulation training program without first critically assessing relevant research and identifying specific areas for improvement in the local immunization context. This fails to demonstrate a commitment to evidence-based practice and may result in inefficient use of resources, training that does not address actual needs, and a lack of demonstrable quality improvement. Another incorrect approach would be to rely solely on anecdotal evidence or past practices to design simulation training, neglecting the importance of current research and established quality improvement methodologies. This risks perpetuating suboptimal practices and failing to incorporate advancements in immunization techniques or patient safety protocols, thereby not meeting the expectations for continuous learning and service enhancement. A further incorrect approach would be to conduct simulations without a clear plan for evaluating their effectiveness or translating the learned skills into improved real-world practice. This misses the crucial step of research translation and quality improvement, rendering the simulation exercise a standalone event rather than a component of a larger strategy to enhance immunization pharmacy services. Professionals should employ a decision-making process that begins with identifying a need or opportunity for improvement in immunization services. This should be followed by a thorough review of relevant research and best practices. Based on this evidence, specific learning objectives and simulation scenarios should be developed. The simulation program should then be implemented, followed by rigorous evaluation of its impact on knowledge, skills, and ultimately, on actual patient care and immunization outcomes. This iterative process ensures that efforts are targeted, effective, and contribute to the overarching goal of improving public health through enhanced immunization pharmacy services.

The performance metrics show a concerning trend of underutilization of advanced immunization services in several rural districts across Sub-Saharan Africa. This directly impacts public health outcomes, particularly for vulnerable populations. The challenge lies in identifying and addressing the systemic barriers that prevent qualified pharmacists from pursuing the Advanced Sub-Saharan Africa Immunization Pharmacy Licensure Examination, which is designed to equip them with the specialized skills and knowledge to expand access to these critical services. Professionals must navigate complex logistical, economic, and educational hurdles while upholding the highest standards of patient care and regulatory compliance. The most effective approach involves a multi-faceted strategy that directly addresses the identified barriers to eligibility and participation. This includes proactive outreach to potential candidates, providing comprehensive information about the examination’s purpose, benefits, and eligibility criteria, and offering targeted support mechanisms. Such support could encompass financial assistance for examination fees, access to preparatory training materials, and flexible scheduling options for both training and the examination itself. This approach is correct because it aligns with the overarching goal of the licensure examination: to increase the number of highly competent immunization pharmacists in underserved areas. By actively facilitating access and demonstrating the tangible benefits of licensure, it directly tackles the root causes of underutilization and promotes equitable access to advanced immunization services, thereby fulfilling the public health mandate. An approach that focuses solely on increasing the number of examination seats without addressing the underlying reasons for low application rates is insufficient. While increasing capacity might seem like a solution, it fails to recognize that the problem is not a lack of available slots but rather a lack of eligible and prepared candidates. This overlooks the critical need to support potential applicants through the process, from understanding the requirements to meeting them. Another less effective approach would be to simply disseminate information about the examination through general public health channels without specific targeting or support. While awareness is a component, it does not adequately address the practical and financial obstacles that often prevent pharmacists in resource-limited settings from pursuing advanced licensure. This passive dissemination fails to actively engage potential candidates and provide them with the necessary resources to overcome barriers. A strategy that prioritizes the examination of existing, already licensed pharmacists for advanced roles without considering the specific eligibility pathways and preparatory needs for the Advanced Sub-Saharan Africa Immunization Pharmacy Licensure Examination is also flawed. The examination is designed to assess a specific set of advanced competencies, and simply reassigning existing personnel without ensuring they meet these criteria through the prescribed licensure process would undermine the integrity and purpose of the advanced qualification. Professionals should employ a decision-making process that begins with a thorough analysis of performance data to identify specific challenges. This should be followed by a needs assessment to understand the barriers faced by potential candidates. Based on this understanding, a strategic plan should be developed that incorporates targeted outreach, comprehensive information dissemination, and robust support systems. Continuous evaluation of the effectiveness of these interventions is crucial to ensure that the program is achieving its objectives of increasing the number of qualified immunization pharmacists and improving public health outcomes.

Scenario Analysis: This scenario is professionally challenging because it requires navigating the initial stages of establishing a new pharmacy practice in a region with specific, evolving regulatory requirements for licensure. The pressure to commence operations quickly can lead to shortcuts, but adherence to the established regulatory framework is paramount for patient safety and legal compliance. Careful judgment is required to balance the urgency of establishing services with the meticulous process of meeting all licensure prerequisites. Correct Approach Analysis: The best professional approach involves proactively engaging with the relevant Sub-Saharan African national pharmacy regulatory authority from the outset. This means submitting a complete and accurate application package, including all required documentation, and diligently following up on the status of the application. This approach is correct because it directly aligns with the fundamental principle of pharmacy licensure: obtaining official authorization from the governing body before commencing practice. Regulatory authorities are established to ensure that all pharmacies meet minimum standards for safety, efficacy, and public health. By engaging directly and submitting a thorough application, the applicant demonstrates respect for the regulatory process and a commitment to operating within the legal framework. This proactive engagement also allows for clarification of any ambiguities in the application process, preventing potential delays or rejections. Incorrect Approaches Analysis: One incorrect approach involves commencing operations based on a verbal assurance from a regulatory official that the application is “in process.” This is professionally unacceptable because verbal assurances do not constitute official licensure. Pharmacy practice is a regulated profession, and operating without a formal, written license is a direct violation of the law. This approach disregards the established legal and regulatory framework, potentially exposing patients to risks associated with an unlicensed facility and practitioners. It also places the individual or entity at significant legal risk, including fines, closure, and professional sanctions. Another incorrect approach is to assume that licensure in a neighboring country with similar healthcare standards automatically grants permission to practice. This is a critical regulatory failure. Each Sub-Saharan African nation has its own distinct pharmacy council or regulatory body with specific laws, regulations, and application procedures. Cross-border recognition of licenses is not automatic and requires formal agreements or specific recognition processes, which are unlikely to exist for initial licensure. Relying on such an assumption bypasses the essential due diligence required to understand and comply with the specific jurisdiction’s requirements, leading to illegal practice. Finally, an incorrect approach is to begin stocking the pharmacy and preparing for patient services while awaiting the physical inspection, without having received formal approval to operate. While preparing for an inspection is a necessary step, commencing any aspect of patient care or dispensing before receiving the official license and passing the inspection is premature and potentially illegal. This approach demonstrates a misunderstanding of the sequential nature of the licensure process, where operational readiness must be validated by the regulatory authority before any patient-facing activities can legally commence. It risks significant penalties and undermines the integrity of the regulatory oversight designed to protect public health. Professional Reasoning: Professionals should adopt a systematic, compliance-first approach. This involves thoroughly researching the specific requirements of the relevant Sub-Saharan African national pharmacy regulatory authority, gathering all necessary documentation, submitting a complete application, and patiently awaiting official approval before commencing any pharmacy operations. When faced with uncertainty, direct communication with the regulatory body is essential. Professionals must always prioritize adherence to the legal and ethical standards of the jurisdiction in which they intend to practice, recognizing that patient safety and public trust are contingent upon this compliance.

The efficiency study reveals a common challenge faced by candidates preparing for the Advanced Sub-Saharan Africa Immunization Pharmacy Licensure Examination: the optimal allocation of study resources and time. This scenario is professionally challenging because inadequate preparation can lead to licensure failure, impacting public health by delaying the availability of qualified immunization pharmacists. It requires careful judgment to balance comprehensive learning with efficient use of limited candidate time and resources. The best approach involves a structured, phased preparation strategy that prioritizes foundational knowledge and practical application, aligned with the examination’s stated objectives and the regulatory requirements for immunization pharmacy practice within Sub-Saharan African nations. This includes dedicating specific blocks of time to understanding core immunization principles, vaccine storage and handling protocols, administration techniques, adverse event management, and relevant national immunization schedules and policies. Candidates should also engage with official examination syllabi, past papers (if available and permitted), and recommended reading materials from recognized professional bodies or regulatory authorities. This methodical approach ensures all critical areas are covered systematically, building confidence and competence. An incorrect approach would be to solely rely on informal study groups without consulting official syllabi or regulatory guidelines. This fails to guarantee comprehensive coverage of mandated topics and may lead to misinformation or an incomplete understanding of legal and ethical obligations, potentially violating professional conduct standards. Another incorrect approach is to focus exclusively on memorizing facts without understanding the underlying principles or their practical application in a pharmacy setting. This superficial learning does not equip candidates to handle the complex scenarios often presented in licensure exams, which test critical thinking and problem-solving skills, and may not meet the competency standards set by regulatory bodies. A further incorrect approach is to postpone intensive preparation until the last few weeks before the examination. This rushed strategy often results in superficial learning, increased stress, and a higher likelihood of overlooking crucial details, which is detrimental to both the candidate’s success and the public’s safety. Professionals should adopt a proactive and structured decision-making process when preparing for licensure. This involves thoroughly reviewing the examination’s official syllabus and any provided study guides, identifying key knowledge domains and practical skills required. They should then create a realistic study timeline, breaking down the material into manageable segments and allocating sufficient time for each. Prioritizing resources that are officially sanctioned or widely recognized by regulatory bodies is crucial. Regular self-assessment through practice questions or mock exams helps identify areas needing further attention. This systematic and evidence-based approach ensures preparedness meets the rigorous standards expected for public health professionals.

Scenario Analysis: This scenario presents a common implementation challenge in Sub-Saharan African healthcare settings: integrating new digital health technologies while ensuring patient safety and adhering to evolving regulatory frameworks. The professional challenge lies in balancing the potential benefits of improved data management and medication tracking with the risks of data breaches, incorrect information entry, and non-compliance with national pharmaceutical regulations. Pharmacists must exercise careful judgment to ensure that the implementation process prioritizes patient well-being and meets legal obligations. Correct Approach Analysis: The best professional practice involves a phased implementation approach that includes comprehensive training for all pharmacy staff on the new informatics system, focusing on data accuracy, patient privacy, and the specific regulatory requirements for medication dispensing and record-keeping within the relevant Sub-Saharan African jurisdiction. This approach ensures that staff are equipped with the necessary skills and knowledge to use the system safely and compliantly. Regulatory justification stems from the fundamental duty of care owed to patients, which mandates accurate medication management and the protection of sensitive health information. Furthermore, national pharmaceutical acts and regulations in most Sub-Saharan African countries mandate precise record-keeping and adherence to dispensing protocols, which a well-trained staff can uphold using the new system. Ethical considerations also support this approach, as it demonstrates a commitment to patient safety and professional responsibility. Incorrect Approaches Analysis: Implementing the informatics system without adequate staff training risks significant medication errors due to user unfamiliarity with the software, incorrect data entry, or misinterpretation of system outputs. This directly violates the professional obligation to dispense medications safely and accurately, potentially leading to patient harm. It also fails to meet regulatory expectations for accurate record-keeping, exposing the pharmacy to sanctions. Deploying the system with only a subset of the pharmacy team, particularly those deemed “tech-savvy,” creates a knowledge gap and potential for inconsistent application of protocols. This can lead to errors when non-trained staff handle dispensing or record-keeping, compromising patient safety and regulatory compliance. It also fosters an inequitable work environment and can lead to reliance on informal knowledge transfer, which is prone to inaccuracies. Launching the system with a focus solely on data capture speed, without robust validation checks for medication details, patient identifiers, or dosage information, introduces a high risk of dispensing errors and incorrect patient records. This prioritizes efficiency over safety and compliance, directly contravening regulatory mandates for accurate medication dispensing and patient identification, and potentially leading to severe patient harm and legal repercussions. Professional Reasoning: Professionals should adopt a systematic approach to technology implementation. This involves a thorough needs assessment, selection of appropriate technology, comprehensive staff training tailored to the specific system and regulatory environment, pilot testing, and ongoing monitoring and evaluation. Decision-making should be guided by patient safety as the paramount concern, followed by strict adherence to all applicable national pharmaceutical laws, regulations, and ethical guidelines. A proactive approach to identifying and mitigating risks associated with new technologies is essential for maintaining professional integrity and ensuring high-quality patient care.

Scenario Analysis: This scenario presents a professional challenge because it requires a pharmacist to navigate the complexities of licensure renewal, specifically concerning the implications of failing to meet examination requirements within the stipulated timeframe. The challenge lies in understanding the precise consequences of such a failure according to the Advanced Sub-Saharan Africa Immunization Pharmacy Licensure Examination’s established policies, balancing the desire to continue practice with the regulatory framework governing licensure. Misinterpreting these policies can lead to unauthorized practice, professional sanctions, and potential harm to public health. Correct Approach Analysis: The best professional approach involves proactively seeking clarification directly from the examination board regarding the specific retake policies and the implications of exceeding the allowed attempts or timeframe for passing. This approach is correct because it adheres strictly to the established regulatory framework for licensure. The examination board’s policies are the definitive source of information on blueprint weighting, scoring, and retake procedures. By directly engaging with the board, the pharmacist ensures they are acting in accordance with the law, preventing any potential violations of licensure requirements. This demonstrates a commitment to ethical practice and professional accountability by seeking accurate guidance before making decisions about continued practice or retraining. Incorrect Approaches Analysis: One incorrect approach is to assume that failing to pass within a certain period automatically disqualifies one from future licensure without further inquiry. This assumption bypasses the official channels for understanding policy nuances and potential exceptions or alternative pathways that might exist within the examination board’s regulations. It risks premature cessation of practice or unnecessary retraining based on incomplete information. Another incorrect approach is to attempt to practice under the assumption that a grace period or informal extension might be granted. This is a serious ethical and regulatory failure. Practicing without a valid, current license, or in violation of its terms, constitutes unauthorized practice, which can lead to severe disciplinary actions, including fines, suspension, or permanent revocation of licensure. It also directly compromises public safety by allowing an individual to provide pharmaceutical services without meeting the established competency standards. A further incorrect approach is to rely on anecdotal information or advice from colleagues who may not have current or accurate knowledge of the specific examination board’s retake policies. While peer advice can be helpful, it is not a substitute for official regulatory guidance. Misinformation from peers can lead to the same regulatory and ethical violations as making assumptions or practicing without authorization. Professional Reasoning: Professionals facing such situations should always prioritize direct communication with the relevant regulatory body. The decision-making process should involve: 1) Identifying the specific policy or regulation in question. 2) Recognizing the need for definitive interpretation. 3) Proactively contacting the issuing authority (in this case, the examination board) for clarification. 4) Documenting all communications and guidance received. 5) Acting solely based on the official information provided, ensuring all actions align with regulatory requirements and ethical obligations to public health.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between ensuring patient access to essential medicines and adhering to strict dispensing regulations designed to safeguard public health. The pharmacist must navigate potential supply chain disruptions while upholding their legal and ethical obligations to dispense only authorized medications. Careful judgment is required to balance these competing demands without compromising patient safety or regulatory compliance. Correct Approach Analysis: The best professional practice involves proactively communicating with the prescribing physician about the unavailability of the specified brand and exploring authorized therapeutic alternatives. This approach prioritizes patient care by seeking to maintain treatment continuity while strictly adhering to regulatory requirements. By engaging the prescriber, the pharmacist ensures that any substitution is medically appropriate and documented, aligning with the principles of responsible medication management and patient safety, which are paramount in pharmacy practice. This also respects the prescriber’s clinical judgment and the patient’s treatment plan. Incorrect Approaches Analysis: One incorrect approach involves dispensing a different, unapproved brand of the same active ingredient without consulting the prescriber. This is a significant regulatory failure as it bypasses the established process for medication authorization and substitution. It undermines the pharmacist’s role as a gatekeeper for safe and effective drug use and could lead to unexpected therapeutic outcomes or adverse drug reactions, violating the duty of care owed to the patient. Another incorrect approach is to inform the patient that the medication is unavailable and advise them to seek a prescription from another doctor. This fails to adequately address the patient’s immediate healthcare needs and places an undue burden on them. While acknowledging the unavailability, it neglects the pharmacist’s professional responsibility to facilitate access to necessary treatment through appropriate channels, such as physician consultation. A third incorrect approach is to dispense a generic equivalent without confirming its availability and suitability with the prescriber, especially if the original prescription specified a particular brand for a clinical reason (e.g., patient allergy to excipients in generics, specific formulation needs). This can lead to therapeutic inequivalence or patient non-adherence if the generic is not bioequivalent or if the patient experiences side effects, representing a failure to ensure the appropriateness of the dispensed medication. Professional Reasoning: Professionals should adopt a systematic decision-making process when faced with medication unavailability. This involves: 1. Identifying the core issue (unavailability of prescribed medication). 2. Recalling relevant professional standards and regulations regarding dispensing and substitution. 3. Prioritizing patient safety and continuity of care. 4. Initiating communication with the prescriber to discuss alternatives. 5. Documenting all actions and communications. This structured approach ensures that decisions are evidence-based, ethically sound, and legally compliant.

This scenario presents a significant professional challenge due to the inherent risks associated with sterile product compounding and the critical need for robust quality control systems to ensure patient safety. The pharmacist must balance the demand for essential compounded medications with the stringent requirements for sterility assurance and regulatory compliance within the Sub-Saharan African context. Careful judgment is required to implement practices that are both effective and sustainable in potentially resource-limited settings. The best approach involves establishing a comprehensive quality control system that prioritizes aseptic technique training, environmental monitoring, and adherence to established compounding standards. This includes regular competency assessments for personnel involved in sterile compounding, routine environmental monitoring of the cleanroom (e.g., viable and non-viable particle counts), and strict adherence to USP or equivalent regional guidelines for sterile compounding. This approach is correct because it directly addresses the core principles of sterility assurance and risk mitigation mandated by pharmaceutical regulations and ethical practice. It ensures that the compounded sterile products are prepared under conditions that minimize microbial contamination, thereby protecting patients from potentially life-threatening infections. Regulatory frameworks in Sub-Saharan Africa, while varying, generally emphasize the pharmacist’s responsibility for ensuring the quality and safety of dispensed medications, including compounded sterile preparations. An incorrect approach would be to rely solely on visual inspection of the final product without implementing rigorous aseptic techniques during preparation. This fails to address the invisible microbial contamination that can occur during compounding, leading to a high risk of patient harm. Ethically and regulatorily, this is unacceptable as it bypasses fundamental principles of sterile product preparation and quality assurance. Another incorrect approach would be to delegate sterile compounding tasks to untrained pharmacy assistants without adequate supervision or ongoing competency validation. This violates the principle of professional responsibility and regulatory requirements for qualified personnel to perform such critical tasks. Sub-Saharan African pharmacy practice acts typically stipulate that pharmacists are ultimately responsible for the accuracy and safety of all dispensed medications, including compounded preparations. A further incorrect approach would be to use expired or unvalidated compounding equipment and supplies. This compromises the integrity of the compounding process and the sterility of the final product. Regulatory bodies expect pharmacies to maintain equipment in good working order and use only materials that meet quality standards, as failure to do so can lead to product defects and patient harm. Professionals should employ a decision-making framework that begins with identifying the specific regulatory requirements and professional standards applicable to sterile compounding in their jurisdiction. This should be followed by a thorough risk assessment of the compounding process, considering potential sources of contamination and error. Implementing evidence-based best practices, investing in appropriate training and equipment, and establishing a robust quality assurance program with regular monitoring and evaluation are crucial steps. Finally, continuous professional development and staying abreast of evolving guidelines are essential for maintaining high standards of practice.

This scenario presents a professional challenge due to the critical need to balance immediate patient needs with the complexities of drug procurement and regulatory compliance in a resource-constrained environment. The pharmacist must navigate potential stockouts of essential medications for chronic and rare diseases while adhering to Sub-Saharan African immunization pharmacy licensure regulations and ethical guidelines. Careful judgment is required to ensure patient safety and continuity of care without compromising professional standards. The best professional approach involves proactively engaging with the Ministry of Health and relevant pharmaceutical suppliers to secure a consistent supply chain for essential medications. This includes advocating for expedited procurement processes for critical drugs, exploring alternative, approved suppliers if necessary, and maintaining open communication with healthcare providers about potential shortages and available alternatives. This approach is correct because it prioritizes patient well-being by ensuring access to necessary treatments while operating within the established regulatory framework. It demonstrates due diligence in supply chain management, a key responsibility for licensed pharmacists, and aligns with ethical obligations to provide competent care. Proactive communication also fosters trust and collaboration within the healthcare system. An incorrect approach would be to unilaterally substitute medications without proper authorization or consultation. This is professionally unacceptable because it bypasses established protocols for drug approval and substitution, potentially leading to adverse drug reactions, therapeutic failures, and contraventions of licensure requirements. It undermines the pharmacist’s role as a guardian of medication safety and efficacy. Another incorrect approach would be to inform patients of potential shortages without offering concrete solutions or engaging in proactive problem-solving. While transparency is important, this passive approach fails to meet the pharmacist’s professional responsibility to actively seek and implement solutions to ensure medication access. It can lead to patient anxiety and potentially non-adherence to treatment. Finally, an incorrect approach would be to cease dispensing essential medications due to anticipated shortages without exploring all available avenues for procurement or alternative management strategies. This is ethically and professionally unsound as it abandons patients in need and fails to uphold the pharmacist’s duty of care. Professionals should employ a decision-making framework that begins with identifying the core problem (medication shortage), assessing its impact on patient care, and then systematically exploring all available solutions within the regulatory and ethical boundaries. This involves collaboration with stakeholders, proactive communication, and a commitment to patient safety as the paramount consideration.

Scenario Analysis: This scenario presents a significant public health challenge in a resource-limited setting within Sub-Saharan Africa. The core difficulty lies in balancing the urgent need to increase immunization coverage for a preventable disease with the practical constraints of limited infrastructure, potential vaccine hesitancy, and the imperative to adhere to established public health pharmacy and immunization delivery protocols. Ensuring equitable access while maintaining vaccine integrity and patient safety requires careful planning and execution, making professional judgment paramount. Correct Approach Analysis: The most effective approach involves a multi-pronged strategy that prioritizes community engagement and leverages existing healthcare infrastructure. This includes conducting a thorough needs assessment to identify underserved populations and specific barriers to vaccination, such as geographical access, cultural beliefs, or misinformation. Subsequently, developing targeted outreach programs, potentially utilizing mobile vaccination units or community health worker networks, can significantly improve access. Crucially, this approach emphasizes robust training for healthcare professionals involved in immunization delivery, ensuring they are equipped to address vaccine hesitancy with evidence-based information and to maintain cold chain integrity. Collaboration with local leaders and community stakeholders is vital for building trust and fostering acceptance of immunization programs. This aligns with public health principles of equity, accessibility, and evidence-based practice, as well as the ethical responsibility to protect vulnerable populations. Incorrect Approaches Analysis: One incorrect approach would be to solely focus on increasing the number of vaccination sites without addressing the underlying reasons for low uptake. This fails to tackle barriers like vaccine hesitancy or logistical challenges in reaching remote populations, leading to inefficient resource allocation and potentially continued low coverage. Another flawed approach would be to bypass established protocols for vaccine storage and handling in an attempt to speed up delivery. This poses a severe risk to vaccine efficacy and patient safety, potentially leading to adverse events and undermining public trust in immunization programs. A further unacceptable approach would be to implement a top-down mandate without engaging the community or understanding local contexts. This can breed resistance and mistrust, making it harder to achieve long-term immunization goals and neglecting the principles of community-based public health. Professional Reasoning: Professionals facing such a challenge should adopt a systematic decision-making process. This begins with a comprehensive understanding of the local context, including epidemiological data, existing healthcare infrastructure, and socio-cultural factors influencing health behaviors. Next, they should identify specific, actionable objectives for improving immunization coverage. The development of strategies should be guided by principles of public health, ethics, and regulatory compliance, prioritizing evidence-based interventions that are both effective and equitable. Continuous monitoring and evaluation are essential to adapt strategies as needed and ensure program sustainability. Collaboration with all relevant stakeholders, from national health authorities to local community members, is fundamental to success.