THE DRIVERS OF ROUTINE IMMUNIZATION SYSTEM PERFORMANCE IN AFRICA

Thursday, 4th of August 2011

Findings from the Synopsis of the ARISE Lanscape Analysis

Findings

Analysis of Routine Immunization Performance in Africa

ARISE reviewed existing data on coverage and other measure of RI performance from 2000 to 2009 from all countries in the World Health Organization Africa region (WHO/AFRO) and grouped countries into coverage categories (Table 1).

Researchers also built on an analysis conducted by Cutts and Biellik (2011) to review and analyze RI performance trends in sub-Saharan Africa. Figure 1 summarizes DTP3 coverage trends in the WHO/AFRO region from 1980 to 2009.

Observations on Performance: Table 1 groups countries by DTP3 coverage experience (high, medium, low, and strongly increasing) and compares a range of performance and other indicators by country category.

§ Approximately half the children born in Africa live in countries in the medium range of DTP3 coverage, which is estimated at 75 percent in 2009.

§ Much of the improvement in DTP3 coverage in the past decade appears to have been realized between 2000 and 2005; between 2005 and 2009, increases were minor in medium- and high-performing countries, and there was no change in low-performing countries. This finding suggests that those countries have reached a plateau.

§ Almost one out of five (18 percent) African children born in 2009 were completely unvaccinated; In addition, 27 percent of children had started the immunization series but dropped out and did not complete it. In no country has the number of unvaccinated children exceeded the number of undervaccinated children. The problem of dropout is particularly elevated in countries in the low range of coverage, where the mean dropout rate across countries is 32 percent and where almost twice as many children are undervaccinated as are unvaccinated.

§ At subnational levels, general progress has been made in countries in all coverage categories with respect to the proportion of districts achieving at least 80 percent DTP3 coverage. This situation is most notable in countries categorized as strongly increasing coverage and as having low coverage. However, because such data come from routine administrative reports that cannot be validated through surveys, the figures must be interpreted with caution.

§ There does not appear to be a clear link between immunization performance and countries’ total health expenditures. Whereas, overseas development assistance (ODA) appear to increase successively as categories of DTP3 coverage increases.

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FROM JSI/ARISE

The potential of immunization to improve public health continues to grow as new vaccines against major diseases are developed. The recent infusions of support for global immunization, both through the recent replenishment of GAVI Alliance funding and the Decade of Vaccines, will increase the worldwide availability of new and underutilized vaccines. But any vaccine is only as effective as the system that delivers it. Thus, it is vital to understand what drives strong immunization program performance, particularly in low-resource settings facing substantial obstacles to routine immunization.

The Africa Routine Immunization System Essentials (ARISE) project, managed by John Snow, Inc. with funding from the Bill & Melinda Gates Foundation, documents successful interventions that drive strong routine immunization system performance in Africa and analyzes their potential for diffusion throughout the region. ARISE translates these tested solutions into focused options for supporting routine immunization at the global, regional, national, and sub-national levels.

As a first step, ARISE conducted a landscape analysis (LA) to identify potential drivers of strong routine immunization performance in Africa. A report of the LA, entitled “Landscape Analysis Synopsis: An Initial Investigation of the Drivers of Routine Immunization System Performance in Africa” is available at:

http://www.jsi.com/JSIInternet/Resources/Publications/childsurvival.cfm#immunization .

Comprised of a literature review, interviews with key informants, and secondary data analysis, the LA uses a multi-level framework (encompassing the immunization system, health system, and broad country context) to identify drivers of strong routine immunization performance in Africa. The systematic search for literature on this topic revealed that the great majority of documents on routine immunization in Africa focus on deficiencies and obstacles rather than contributors to successful performance.

Currently, ARISE is carrying out in-depth studies in Ethiopia, Cameroon, and Ghana to identify and explore drivers in three different settings. The studies aim to improve understanding of the link between drivers and performance and to their relative importance in the context of immunization programs. Findings from these studies will be used to develop and refine options for supporting routine immunization to help ensure that all children are protected from vaccine-preventable diseases.

We hope you find the landscape analysis report interesting and welcome your thoughts about it. Please send them to us at arise@jsi.com

Sincerely,

Robert Steinglass

Project Director

The ARISE Project