Drivers of routine immunization coverage improvement in Africa: Findings from district-level case studies

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance

Harnessing the Power of Collaboration to Expand the Coverage and Equity of COVID-19 Vaccinations in India: A Community Collaboration Model

Early in 2021, India embarked on the uphill journey of the COVID-19 vaccination of the largest population group in the world in a prioritized manner and in the shortest possible time. Considering the endless variety of geography and diverse socio-economic demographic, religious, and community contexts, there was a high likelihood of certain population subgroups with known vulnerabilities facing inequities, which were anticipated to be further accentuated by a digital divide. This necessitated devising solutions for such communities in a localized manner to aid the local government in breaking the service access and uptake barriers with an inclusive approach. To bridge this vital gap, the Momentum Routine Immunization Transformation and Equity project implemented a three-tiered collaboration, viz., government, non-governmental organizations (NGOs), and a wide range of vulnerable and at-risk communities, utilizing knowledge exchange and use of data. The project implemented localization strategies through the NGOs for community engagement in conjunction with government vaccination teams to universalize COVID-19 vaccination uptake up to the last mile. The collaboration resulted in reaching close to 50 million beneficiaries through messaging and facilitated the administration of more than 14 million vaccine doses, including 6.1 million doses for vulnerable and marginalized communities in 18 States and Union territories in India, along with suggesting implications for public health practice and research

Percentage Age Distribution of Total Male Population, Zimbabwe.

<p>Percentage Age Distribution of Total Male Population, Zimbabwe.</p

Percentage age distribution of VMMC clients in Zimbabwe, by 2009–2012.

<p>Percentage age distribution of VMMC clients in Zimbabwe, by 2009–2012.</p

Percentage Age Distribution of Total Male Population in Tanzania (all regions).

<p>Percentage Age Distribution of Total Male Population in Tanzania (all regions).</p

Percent distribution of circumcisions by intensity of service (campaign vs. routine), Zimbabwe, 2009–2012.

<p>Percent distribution of circumcisions by intensity of service (campaign vs. routine), Zimbabwe, 2009–2012.</p

Total number of VMMC procedures in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.

<p>Total number of VMMC procedures in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.</p

Percentage distribution of VMMC procedures by intensity (campaign vs. routine), in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.

<p>Percentage distribution of VMMC procedures by intensity (campaign vs. routine), in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.</p