VoICE Immunization Evidence: Health Systems Strengthening
Health systems strengthening
A study of over 80,000 children in Kenya designed to understand the role of inadequate health systems on childhood survival beyond 59 months of age showed that a higher per capita density of heath faciities resulted in a 25% reduction in the risk of death. However, user fees for sick-child visits increased the risk of death by 30%.
Investments made in polio eradication contribute to health systems strengthening and health service delivery.
Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. Polio eradication legacy efforts include documenting and applying the lessons learned from polio eradication and transitioning the capacities, assets, and processes of polio to other key health priorities.
The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region, leading to the rapid detection of, and response to, what eventually became a novel pandemic virus.
The Government of Nigeria used the Incident Management System (IMS) to establish a national Emergency Operations Center (EOC) as part of a new national emergency plan for the global polio eradication initiative. The use of IMS through the EOC changed the operational tempo, accountability measures, and programmatic success of the polio program. This existing infrastructure was in place and leveraged to contain the outbreak of Ebola.
Vaccination in combination with other interventions or infrastructure investments offers opportunities for cost-sharing between programs.
This paper presents the first cost-benefit comparison of improved water supply investments and cholera vaccination programs. The study results showed that improved water supply interventions combined with targeted cholera vaccination programs are much more likely to yield attractive cost-benefit ratio outcomes than a community-based vaccination program alone.
A systematic review of studies examining the broader economic impact of vaccination in low-middle income countries (LMICs) found that vaccination programs may improve the financial sustainability and affordability of healthcare programs in LMICs. The use of vaccines as part of a treatment cluster, or in combination with other infrastructure projects (such as water management systems) to maximize community health outcomes, offers opportunities for cost sharing between programs.
Vaccinations delivered in early infancy have high uptake, even where a large proportion of births occur outside of a medical facility. This early immunization moment provides an opportunity for critical newborn developmental screening.
A recent review looks at evidence linking vaccinations in early infancy to childhood development services. BCG and DPT have the highest coverage of any vaccines worldwide and are typically administered within 6 weeks of birth. This timing offers the opportunity to deliver a range of early childhood development interventions such as newborn hearing screening, sickle cell screening, treatment and surveillance, maternal education around key newborn care issues such as jaundice, and tracking early signs of poor growth and nutrition.