Health system barriers and levers in implementation of the Expanded Program on Immunization (EPI) in Pakistan: an evidence informed situation analysis

Shaikh, Babar Tasneem; Haq, Zaeem; Tran, Nhan; Hafeez, Assad

doi:10.1186/s40985-018-0103-x

Cited by 23 publications

(30 citation statements)

References 17 publications

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“…Findings from the reviews show that half of the countries were experiencing limitations in their human resource capacity within the national program and at sub-national levels. Health worker training plays an important role in improving overall performance including vaccination coverage [ 15 , 16 ]. Other studies and program reviews have also shown the critical role of human resource in immunisation program delivery [ 17 - 19 ].…”

Section: Discussionmentioning

confidence: 99%

Immunisation program reviews in East and Southern Africa. 2012-2018; key lessons

Shibeshi¹,

Masresha²,

Daniel³

2021

Pan Afr Med J

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Introduction the World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation program reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets. Methods we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the sub-region in the course of 2012-2018. We generated descriptive analysis of the findings across the sub-region. Results the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stock out of vaccines and supplies was documented in 9 countries during the review. The full components of the RED strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews. Conclusion the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into coasted multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

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Section: Discussionmentioning

confidence: 99%

Immunisation program reviews in East and Southern Africa. 2012-2018; key lessons

Shibeshi¹,

Masresha²,

Daniel³

2021

Pan Afr Med J

View full text Add to dashboard Cite

show abstract

“…Findings from the reviews show that half of the countries were experiencing limitations in their human resource capacity within the national program and at sub-national levels. Health worker training plays an important role in improving overall performance including vaccination coverage [ 16 , 17 ]. Other studies and program reviews have also shown the critical role of human resource in immunisation program delivery [ 18 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

Immunisation program reviews in East and Southern Africa: 2012-2018; key lessons

Shibeshi¹,

Masresha²,

Daniel³

2020

Pan Afr Med J

View full text Add to dashboard Cite

Introduction World Health Organisation (WHO) recommends that countries conduct comprehensive national immunisation programme reviews regularly to help them identify systems wide-barriers or gaps and monitor performance against the set targets. Methods we reviewed reports from the latest national immunisation program reviews conducted in the 20 countries in the subregion in the course of 2012-2018. We generated descriptive analysis of the findings across the subregion. Results the 20 program reviews included field observations to the subnational levels as well as interviews with program staff and stakeholders. At the time of the reviews, only 11 countries had functional National Immunisation Technical Advisory Groups. Operational funding was inadequate in half of the countries. The reviews documented the cancellation of outreach services, supportive supervision visits and maintenance of cold chain equipment due to the lack of fuel or operational funding. Immunisation programs in 10 countries had major human resource gaps. Vaccine stock management tools were not effectively used in 10 countries, and stockout of vaccines and supplies was documented in 9 countries during the review. The full components of the Reaching Every District (RED) Strategy were implemented in only 3 of the 20 countries. Twelve countries reported challenges with the availability and accuracy of target populations. Four countries had documented the presence of vaccine hesitant groups at the time of the reviews. Conclusion the reviews demonstrated challenges in various aspects of the programs in different countries. The implementation of the review recommendations should be built into the annual program plans, as well as into costed multi-year plans, in order to address the gaps and helps the program to attain the set targets. With the rapid evolution of the scope and complexity of the immunisation programs in recent years, countries should invest their efforts in building the capacity of their human resources as well as updating their logistics and data systems.

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“…Health system barriers in relation to the implementation of the Expanded Program on Immunization (EPI) in Pakistan include problems with program nancing, governance, service delivery, human resources (HR), information systems, and supplies and vaccines [4]. Demand side barriers in Pakistan include low awareness and knowledge of immunization, concerns and misperceptions about vaccines, belief in local remedies and religious beliefs [4].…”

Section: Introductionmentioning

confidence: 99%

Unveiling and Addressing Implementation Barriers to Routine Immunization in the Peri-Urban Slums of Karachi, Pakistan: A Mixed-Methods Study

Yazdani¹,

Muhammad²,

Nisar

et al. 2021

Preprint

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BackgroundGreat disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums.MethodsConducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12-23 months, and 155 in-depth interviews through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further 6 IDIs were then conducted with immunization policymakers and policy influencers to determine strategies to address them, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data.Results49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines, and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient funds utilization, unreliable immunization and household data, and interference of polio campaigns with immunization. The implementation framework’s policy recommendations to address these barriers include: 1) improved Human Resource management 2) staff training on counseling, 3) re-allocation of funds towards incentives, outreach, salaries and infrastructure, 4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff 5) use of digital platform for immunization targets and generating dose reminders, and 6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programs for improved coverage.ConclusionsThe implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programs in limited-resource settings, with possible application at a larger scale. Particularly, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use.

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Health system barriers and levers in implementation of the Expanded Program on Immunization (EPI) in Pakistan: an evidence informed situation analysis

Cited by 23 publications

References 17 publications

Immunisation program reviews in East and Southern Africa. 2012-2018; key lessons

Immunisation program reviews in East and Southern Africa. 2012-2018; key lessons

Immunisation program reviews in East and Southern Africa: 2012-2018; key lessons

Unveiling and Addressing Implementation Barriers to Routine Immunization in the Peri-Urban Slums of Karachi, Pakistan: A Mixed-Methods Study

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