Abstract
Pneumonia is a main cause of under-five mortality in low-income settings. The pneumococcal conjugate vaccine (PCV) has been introduced in many countries as a tool in the disease's prevention. Although PCV's effectiveness has been established, less is known about the effects of introducing additional injectable vaccines into routine immunisation programmes, particularly in the context of resource-constrained settings. To explore the effects of PCV introduction on the immunisation programmes and health systems in four low-income countries. This study was carried out in Cameroon, Ethiopia, Kenya and Mali. Three to four regions and nine to 10 districts were selected within each country. Semi-structured interviews were carried out at national, regional and district levels (n=173). Researcher-administered questionnaires were completed with facility staff (n=124). Routine data on monthly vaccination activities were collected at district and facility levels. PCV was generally well integrated into existing routine immunisation. Little or no impact was found in most areas of the health systems. Some minor effects were found on immunisation programmes, particularly in areas with either planning activities or investments e.g. staff skills were strengthened and there were limited improvements in surveillance. Although health sector workers perceived increases in the coverage of other vaccines following the introduction of PCV, routine service data did not confirm this claim. No substantial impacts were seen in health system management, service delivery or performance. The introduction of PCV had marginal impacts on the Expanded Programme for Immunisation and little to none on broader health systems.
Highlights
Pneumonia is a main cause of under-five mortality in low-income countries around the world; an estimated 540,000 children died from the disease in 2010 in sub-Saharan Africa[1]
This paper aims to explore the impact of pneumococcal conjugate vaccine (PCV) introductions on Expanded Programmes on Immunisation (EPI) and health systems in four countries in sub-Saharan Africa
PCV was generally well integrated into existing routine immunisation programmes
Summary
Pneumonia is a main cause of under-five mortality in low-income countries around the world; an estimated 540,000 children died from the disease in 2010 in sub-Saharan Africa[1]. In Ethiopia there was alignment between PCV introduction planning activities and other health systems planning. In Ethiopia the inter-agency coordination committee (ICC) was reported to have been strengthened by the introduction, notably because of active thematic sub-committees which continued to meet after PCV was introduced. PCV’s effectiveness has been established, less is known about the effects of introducing additional injectable vaccines into routine immunisation programmes, in the context of resource-constrained settings. Objectives: To explore the effects of PCV introduction on the immunisation programmes and health systems in four low-income countries. Health sector workers perceived increases in the coverage of other vaccines following the introduction of PCV, routine service data did not confirm this claim. Conclusions: The introduction of PCV had marginal impacts on the Expanded Programme for Immunisation and little to none on broader health systems
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