6th Global Meeting on Implementing New and Under-utilized Vaccines, 15-17 May 2012
Workgroup 3 - New vaccines, immunization and health systems strengthening
Strong health systems are vital to the implementation of successful immunization programmes. The introduction of new vaccines can provide countries with an opportunity to better organize and deliver services and strengthen the overall immunization programme as well as the country health system.
The session aimed to increase awareness of the key drivers of health systems and the determinants of successful primary health care with particular focus on immunization. It also allowed for participants to share their experiences in strengthening district health services and planning processes for improved immunization outcomes as well as to illustrate the issues related to the introduction of new vaccines and its implications for the wider health system.
Main topics of discussion
The presentations and discussions were set within the context of the WHO framework for analysis of health systems which takes into consideration the six building blocks and the primary health care reforms, and highlights the importance of the local (or “district”) health system in integrating programmes targeting specific diseases, risks and populations, as well as personal and public health services. The outcomes of the SAGE (Strategic Advisory Group of Experts) working group on the introduction of new vaccines on health systems were also presented along with the principles for adding a vaccine while strengthening systems that were endorsed by the SAGE in April 2012.
The experience of Mozambique highlighted the need for holistic planning and the integration of cMYPs into the national health strategy. As a SWAp (Sector-Wide Approach) and IHP+ (International Health Partnership) country, Mozambique’s emphasis on participatory planning processes and robust planning tools was essential in capturing immunization priorities within the sector national health plan. Strong political commitment beyond the health sector and coordination mechanisms were instrumental in addressing vertical and stand-alone approaches. Due to an insufficient human resources environment, an integrated service delivery model at the district level was key to implementing a strong immunization programme.
Mongolia presented its experience of an integrated health and social welfare service approach through immunization with the Reach Every District (RED) strategy. Using a problem-solving approach, the country has initiated a pilot in several provinces targeting hard-to-reach populations in high-risk areas by ensuring their access to delivery of immunization, maternal and child health, and related social services. However, challenges include isolation of vulnerable groups affecting their access to services as well as lack of clear mechanisms for partnership between health and social sectors and a dearth of structures for joint funding at the district level by health and social sectors. The Government of Mongolia aims to implement the strategic plan for the RED approach and beyond 2013 plans to roll out the RED strategy nationwide in phased manner.
Bhutan and Sudan shared their experiences with the introduction of new vaccines and its impact on the immunization and health systems. The countries’ discussions illustrated the opportunities provided by the new vaccine introduction to strengthen the overall immunization system, for example, in areas such as supply and logistics. Discussants also highlighted the challenges of moving from planning to implementation and the on-going need to tackle the persistent dichotomy between EPI and health systems strengthening teams within health ministries. The experiences also served to depict the tensions between programmes utilizing coping strategies for the introduction of new vaccines versus presenting long-term, sustainable changes for the system to absorb the new vaccines.
Discussions based on these country illustrations underscored the following main conclusions:
- EPI and HSS still work in silos and more needs to be done at all levels (countries, development agencies and technical partners) to move beyond this dichotomy.
- Even if planning is comprehensive, implementation is often fragmented and the apparent "success" of new vaccine introduction could mask potential sustainability issues.
- There is no systematic process for capturing, sharing and evaluating experiences from new vaccine introduction from the health system perspective.
- The potential of national health planning processes, such as the Joint Assessment of National Health Strategies (JANS) and joint annual reviews, is not fully utilized by immunization programmes.
- It is an artificial divide to think of new vaccines as separate from routine immunization.
- Facilitate institutionalization of the assessment of health systems requirements for new vaccine introduction and the potential implications and impact on the system.
- Support cross-country learning of experiences in making health systems work for the introduction of new vaccines, including facilitating regular and systematic capturing and sharing of lessons learnt and best practices.
- Undertake better coordination at country level among development partners based on their comparative advantages in line with the principles of IHP+.
- Facilitate "one health system approach" that moves beyond the vertical set-up of health systems and instead delivers services to the population in an integrated manner.