Close Fidelity Gaps: Rabies Vaccination Implementation

The September 2021 mass rabies vaccination campaign in southern Cercado (Cochabamba, Bolivia) failed to meet the 80% protocol adherence threshold at any of 17 evaluated centers, with widespread cold chain, staffing, and communication failures.

A mixed-methods fidelity diagnostic using a 27-item Carroll checklist and CFIR-guided interviews identified operational and governance bottlenecks that are directly addressable with targeted logistics, coordination, and communication fixes.

• None of 17 centers reached ≥80% overall adherence, content scores ranged 32%–79%, and 12/17 centers met coverage targets.
• Cold chain gaps were common: 13/17 centers (76.5%) lacked refrigerators, and 8/17 (47.1%) reported damaged coolers.
• Binary checklist verification (YES/NO) plus 154 interviews (46 ETD staff, 108 pet owners) highlighted inner-setting and governance barriers rather than vaccine efficacy issues.

Fast take: Gómez-Vidal et al. (published 10 July 2026) used a 27-item Carroll checklist and CFIR-guided interviews (46 ETD staff, 108 pet owners) to assess fidelity of the September 2021 campaign in southern Cercado and found no center exceeded 80% adherence, widespread cold chain and team composition failures, and weak communication and interinstitutional coordination.

• Study context: September 2021 campaign; retrospective data collection in late 2022; published 10 July 2026.
• Units: 17 first-level health centers in southern Cercado, Cochabamba.
• Methods: 27-point quantitative checklist (Carroll) plus CFIR-guided qualitative interviews (COREQ reported).
• Full paper: PLOS Neglected Tropical Diseases.

Implementation fidelity gaps were widespread in the campaign, driven by failures in cold chain, brigades, and promotion.

The study operationalized fidelity through four Carroll constructs: content (19 items), coverage (2), frequency (4), and duration (1), plus a cross-cutting documentation check.

Using a strict YES/NO documentary verification approach, researchers found systemic failures in basic logistics (cold chain, carriers), human resources (incomplete brigades), and communication (advance promotion under one month in most centers).

• Binary scoring (YES/NO) prioritized verifiable documentation; partial compliance was counted as NO, which is conservative but reproducible.
• Qualitative CFIR coding mapped barriers and facilitators to organizational context, values, expected efficacy, and communication/coordination.
• Triangulation (documents plus 154 interviews) showed the bottlenecks were operational (inner setting) and governance-related, not a lack of vaccine efficacy.

This run-book reproduces the Bolivia study’s diagnostic in two weeks and produces an operational plan.

• Day 1: Ingest materials, upload 27-item checklists (CSV), vaccination logs, WhatsApp exports, and interview recordings. Enable PII redaction and add local terms to the custom dictionary (for example, OTB, SEDES).
• Days 2–3: Auto-transcribe and translate transcripts, verify a 10% sample, and run an initial topic extraction and frequency table.
• Days 4–6: Auto-code using a CFIR-aligned codebook template (apply Carroll checklist mapping). Review and refine codes with two coders to reach consensus.
• Day 7: Generate a co-occurrence network and a top-10 barrier list (frequency plus impact tags).
• Days 8–10: Produce stakeholder-specific briefs: (a) health centers (logistics fixes), (b) municipal managers (budget and coordination), (c) community leaders (communication plan).
• Days 11–14: Run a cross-segment comparison (for example, southern versus northern zones), finalize a prioritized 90-day action plan, and export visuals and a one-page executive memo for funders.

The Bolivia study (published 10 July 2026) shows that vaccines are effective but delivery systems often fail, and mixed-methods fidelity diagnostics produce actionable fixes.

• If you run vaccination campaigns or evaluate public health interventions, pilot the two-week Evidano workflow on one past campaign to prioritize the top three operational fixes and produce decision-ready briefs.
• Ready to convert transcripts, checklists, and messages into prioritized actions? Try Evidano for free and bring documentary evidence to your next planning table (original study: PLOS Neglected Tropical Diseases).