Performance of Immunization Programs – lessons for malaria control

Malaria control and immunization programs do work together in the form of national or local immunization campaigns where insecticide treated nets are also distributed.  There is an assumption that there will be a synergistic effect on coverage of combining these efforts, but an important question is whether the existing base platforms of immunization programs in countries can really deliver better vaccine coverage, let alone better ITN ownership and use.

Colleagues at the World Bank have conducted a qualitative inquiry into immunization program management to identify factors that might lead to success and thus, form the basis for more structured research.  The Expanded Program for Immunization has at least a 30-year history to draw on, and thereby, offers a good foundation for study.  The researchers chose the period 1997-2002 and looked at four sets of African countries: those with higher than average coverage that has increased over the 6-year period, those with high but decreasing coverage, those with low but increasing coverage and ones with both low and decreasing coverage.

immunization-function-sm.jpgIn-depth study was conducted in six countries that covered the four categories of countries.  The study focused on five core management functions: 1) demand, 2) financing, 3) governance/institutional framework and the supply function which was divided into 4) management and 5) service delivery strategy.  A summary score of indicators achieved under each function yielded a 4-point score which is seen in the attached chart.

The authors noted that, “What distinguished the two high performers from all other countries in our exercise was a robust implementation of their immunization programmes. Only (those two countries) combined reasonably good governance and a solid institutional framework with reasonably good management, service delivery, financing and demand.”

The researchers suggested that, “One way that multilateral and bilateral partners in immunization may help is by offering countries  performance-based incentives without earmarking their assistance for specific functions.”

They also found that, “Reasonably good performance on at least some functions (the high but decreased coverage examples) appeared to be more beneficial to coverage than deficient performance across all (the two low coverage countries); doing a few things well, however, did not appear to be sufficient to ensure a high level of sustained success.”

Since wide scale implementation of malaria control is still coming on board in most countries, there are few examples of widespread intervention where a similar study could be conducted right now. Even so a preliminary assessment of factors that affect such management functions in crucial so that both scale-up and sustainability can be promoted until such time that eradication is truly feasible.

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