Following successful establishment of Expanded Program on Immunization
(EPI) in the 1970's as vertical program, the burden of disease for many
of the vaccine preventable diseases was pushed to low levels. The
current round of health reforms in Tanzania calls for decentralization
and integration of vertical programs. This has the potential to assist
or erode generally good performance of EPI. Reforms on the programme
have been undertaken in Tanzania since 1996, and have included 1)
integration of the procurement, storage, and distribution of vaccine
and related equipment into the operations of a quasi-autonomous drug
procurement agency. 2) government financing of procurement of the oral
polio vaccine, cold chain kerosene, and 3) the integration of kerosene
and vaccine distribution, supervision and monitoring to district health
system. Our analysis shows that the integration of the procurement and
distribution of vaccines into the operations of the drug procurement
agency, and privatization of the distribution of the cold chain
kerosene initially stalled EPI reforms for several reasons and had an
adverse effect on EPI decentralization and coverage. The major cause of
the problems was opposition from the EPI providers at district level
who had to accept decreased income consequent to the reforms. We
conclude that greater involvement of all stakeholders in the planning
of the programme, would have presented an opportunity for forecasting
the opposition and developing mitigating strategies