Improving Routine Immunization Coverage and Equity Through Financial System Strengthening and Integration

Here, Rahama, 30, plays with her 9-month-old daughter, Maradiatu, inside their home.
Photo: Kate Holt/MCSP

The Challenge

Despite efforts to improve Guinea’s vaccination coverage post-Ebola, results show little progress. The proportion of fully-immunized children decreased from 37% to 24% between 2012 to 2018, while the percentage of zero-dose children increased from 11% to 22%.[1] In Togo, immunization coverage lags after the first year of life, with only 49% of children 12-23 months fully immunized,[2] and only 67% having received the second dose of measles vaccine.[3] Low coverage stems from a range of systematic factors in each country, including funding shortages for the operational costs of service delivery, funding bottlenecks, supply shortages, human resource fragmentation, and access issues including household poverty and distance to health facilities. The COVID-19 pandemic has placed an additional financial and human resource strain on both countries as resources are diverted to pandemic response.

The Opportunity

The Accelerator is building on the momentum and platforms of ongoing activities in Guinea and Togo to address systemic challenges for improving routine immunization coverage and equity in accordance with the objectives laid out in WHO’s Immunization Agenda 2030 and Gavi’s five-year strategy for 2021-2025 (Gavi 5.0). In Guinea, the Accelerator will support the integration of immunization into the National Community Health Policy by addressing resource and funding flow challenges and other systemic barriers to the full utilization of community health workers for reaching children with equitable immunization services. In Togo, the Accelerator will support the integration of immunization into the Universal Health Coverage strategy, with a focus on securing adequate resources for all aspects of immunization service delivery over the life course and on equity.

Our Work

The Accelerator will work closely with the Ministry of Health and other stakeholders in each country to mutually identify key systemic barriers to routine immunization strengthening, develop strategies to address them, and agree on paths forward. To aid in this process, the Accelerator will draw on Results for Development’s expertise in health systems strengthening and health financing to support the adaptation of tools and other resources to the Guinean and Togolese contexts to aid the implementation of the agreed-upon activities and goals in each country. As work progresses, the Accelerator is committed to supporting the global dissemination of lessons learned from its work in Guinea and Togo.

[1] Institut National de la Statistique/INS et ICF. 2018. Enquête Démographique et de Santé en Guinée 2018. Conakry, Guinée, et Rockville, Maryland, USA : INS et ICF.
[2] Institut National de la Statistique et des Etudes Economiques et Démographiques (INSEED), 2018. MICS6 TOGO, 2017, Rapport final. Lomé, Togo.
[3] World Health Organization (2021). Immunization, Vaccines, and Biologicals.


Cover Image for Health Systems Strengthening Accelerator report on immunization campaigns

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This brief summarizes lessons from a systematic literature review to inform the planning of immunization campaigns, including identifying ways COVID-19 vaccine campaigns in low and middle-income countries can contribute to longer-term immunization system strengthening.

Leveraging Immunization Campaigns to Strengthen Routine Immunization and Health Systems: A Systematic Review of Literature

This systematic literature review synthesizes key learnings and identifies gaps in evidence that would support practical approaches for more holistic country-level planning among rutine immunization, campaigns, and other immunization service delivery modalities to achieve immunization goals.