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Tuesday, 11th of August 2015 Print





The International Initiative for Impact Evaluation (3ie)

Excerpt below; full text is at http://www.3ieimpact.org/media/filer_public/2015/07/29/3ie_immunisation_scoping_report_3.pdf

Executive summary


Substantial progress has been made in improving immunisation coverage for at least the routine vaccines across the world. The proportion of the world children who receive recommended vaccines, in other words, global vaccination coverage, has remained steady for the past few years. It is estimated that immunisation currently averts at least two to three million deaths every year. However, it is also clear that in some parts of the world, immunisation coverage rates are stagnating or,even worse, declining.

An estimated 21.8 million infants worldwide in 2013 were not covered with routine immunisation services, of whom nearly half live in three countries: India, Nigeria and Pakistan.

The global community and national governments continue to look for novel ways to improve access to and utilisation of immunisation services to reduce vaccine-preventable deaths.

There is an increasing realisation that communities need to be more than just passive recipients of immunisation services; they need to play a more prominent role and their involvement in planning and delivery of services can improve demand and potentially affect the quality of services.

In order to most effectively reach the last mile, health services and their community partners must make special efforts through strong community links to improve access and increase uptake.

Funded by the Bill & Melinda Gates Foundation and led by 3ie, this scoping paper has three main objectives:

1.map the landscape of evidence that shows what works and what doesnt in engaging communities to reverse stagnation and decline in immunisation;

2.draw on evidence from a range of sources and summarise what is already known about community engagement approaches to immunisation; and

3.identify innovative community engagement approaches to increase immunisation coverage.



The scoping paper focuses primarily on interventions and policies that lie at the intersection of immunisation and community engagement approaches. Four instruments were used to cover the scope of the study:

(a) a rapid evidence gap map which identifies and displays existing studies according to what intervention is evaluated and what outcomes are measured;

(b) a survey of key stakeholders, including implementers and researchers in the field of immunisation;

(c) semi-structured interviews with key experts in immunization to get their views on opportunities in and challenges to increasing immunisationcoverage through community engagement approaches; and

(d) evidence profiles that discuss community engagement initiatives in other development sectors.


iii Key Findings:

  • ·Insufficient high-quality evidence: high-quality evidence that can causally relate changes in immunisation coverage to specific programmes and interventions that use community engagement approaches are clearly scarce.
  • ·Community engagement approaches within the field of immunisation are underused: it may be possible to successfully engage communities in different types of interventions to tackle potential weak links in the causal chain. But results from our stakeholder survey suggest that communication is currently the most common form of community engagementin immunisation projects.
  • ·Interventions that are co-managed with communities are likely to be more successful: other sectors have successfully engaged communities to design, implement and monitor development processes.

Co-management, where communities are actively involved in project design, implementation, monitoring and evaluation, is integral to the success of an intervention. 

  • ·There is no one-size-fits-all; contextual factors should inform the design of community engagement approaches: immunisation, and especially routine immunisation, is part of the national health system in almost all countries. Customising immunization and taking into account important cultural and contextual influences can address the problem of reaching the last mile.

This is where communities can be most engaged. Programmes and interventions need to be designed at the community level and should be more participatory in nature. 

  • · Implementation and delivery capacity is likely to be a bottleneck: many responses from expert interviews underscored the need to ensure continuous and consistent engagement for (micro-) planning, awareness creation, and monitoring and surveillance.

An overwhelming majority of experts talked about the problems facing beneficiaries at the point where services are delivered.

Two main areas where this is likely are: problems with interpersonal communication between the service provider and beneficiaries, and problems related to scheduling, cancellation and lack of supplies.



  • ·Some technology-based interventions that engage communities might work well (but more evidence is required):a number of respondents highlighted the role of technology in improving service delivery and tailoring services so that they meet the needs of beneficiary communities.


Our scoping paper points to the potential key role that a community can and should play in almost all aspects of the causal chain of programmes that aim to increase immunisation coverage in developing countries.