Abstract
Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti.
Highlights
The 2030 agenda for sustainable development calls upon the international community to prioritize the needs and rights of the most vulnerable, so that no one is left behind.[1]
Determining effective ways to measure and monitor progress in addressing social exclusion is a priority for those involved in implementing the sustainable development goals (SDGs), including for Gavi, the Vaccine Alliance
We conducted a systematic analysis of inequalities in childhood vaccination coverage based on different measurement approaches, using the most recent demographic and health surveys (DHS) in 45 Gavi-supported countries.[6]
Summary
The 2030 agenda for sustainable development calls upon the international community to prioritize the needs and rights of the most vulnerable, so that no one is left behind.[1]. Is the earlier approach, based largely on a single dimension and measure, sufficient to monitor progress in addressing inequalities in the SDG period? To answer these questions, we conducted a systematic analysis of inequalities in childhood vaccination coverage based on different measurement approaches, using the most recent (as of May 2015) demographic and health surveys (DHS) in 45 Gavi-supported countries.[6] Our findings enabled us to formulate recommendations on the equity monitoring approach that would best support policies and practices tailored to the most vulnerable. We illustrate the key advantages of the dashboard using examples from specific countries
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