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Strengthening service delivery =>> Enhanced efforts in large population countries =>>

Seven large population countries have made analysis of the barriers and possible solutions, and have agreed with their ICCs on action plans.

Status Achievement of overall target
Slightly delayed • The primary expected outcome of target was achieved to various degrees by all of the seven countries.
Status of Coverage Improvement Plans (CIP):
DR Congo: CIP is finalized and endorsed by ICC
Indonesia: CIP is finalized and endorsed by the government
India: CIP not yet available
Bangladesh: CIP finalized and endorsed by ICC
Pakistan: CIP is under preparation and is expected by mid October/November
Ethiopia: CIP has been finalized and endorsed by ICC
Nigeria: National Programme on Immunization (NPI) is unlikely to develop a CIP

Responsible entity: UNICEF
Completed by: July 2004
Total budget: $70,000

Target description and how it will help reach GAVI milestones

This is the first of four targets that aim to ensure that the seven selected countries with the largest populations get back on track towards their goals of immunization coverage. The McKinsey study has confirmed that all 7 countries are not meeting their immunization targets, and some 34 million children remain unimmunized. Multiple challenges and barriers towards improving immunization coverage have to be addressed through concerted efforts and focused attention by the various partners. Unless these countries mount special efforts, global immunization targets will not be achieved as planned.

ACCESS MILESTONE: 75% of un-immunized children live in just 5 large population countries (India, Nigeria, Pakistan, Ethiopia, DRCongo). In addition, attention must be paid to Indonesia and Bangladesh for coverage improvements. This has potential of reducing global under-5 mortality by 20%.

Justification for selection of activities

Coordination and consensus-building among GAVI partners and local partners is required. The main output will be a MOH/ICC endorsed coverage improvement plan including:

  1. Partners’ agreement on a limited list of major bottlenecks impeding expansion of immunization coverage
  2. Agreement on key programmatic and geographic activities in order to overcome identified bottlenecks
  3. Consensus on the resources requirements, financing, and timeline of the planned activities
  4. Consensus on partners’ role and responsibility in support of implementation and follow-up


ActivitiesBudgetCoordinating partner/ support partnersExpected outcomes
Seven country-led review/planning meetings with partners to identify barriers and priority activities$70,000UNICEF WHO MoH ICC• All seven countries have identified barriers and priority activities for acceleration with role and accountability of partners;
• ICC endorsement of proposed activities and commitment to follow-up and monitor progress (becomes regular agenda item)

Detailed information on activities

There is a need for each country to recognize and prioritize major bottlenecks/ barriers to improving EPI coverage; to identify the root causes, and take into account all past and existing efforts to improve coverage; and finally, develop a coverage improvement plan with corresponding budgets, follow-up mechanisms and specific roles and responsibilities of the various partners. Ministries of Health (MoH) and ICCs approve and endorse country-specific action plans and budgets and agree to follow-through the implementation of the plans. UNICEF/WHO to work with MoH and key partners dependent on country (e.g. CDC, PATH, BASICs, BRAC, bilaterals, etc).

Targets by priority area

Strengthening service delivery

==> Health information and monitoring systems

==> Contributing to alleviation of system-wide barriers

==>> Enhanced efforts in large population countries

Seven large population countries have made analysis of the barriers and possible solutions, and have agreed with their ICCs on action plans.
GAVI and partners have established new policies to support the seven large population countries.
Lessons from accelerated disease control initiatives (ADCs) applied in the large population countries as appropriate.
The large population countries are back on track or show tendency of getting back on track in immunization coverage.

Ensuring access to vaccines and related products

==>> Procurement/Supply of existing products

==>> Development and introduction of new, near-term products

==>> Managing process for country support from Vaccine Fund

Securing long-term financing

==>> Financial sustainability

==>> Recapitalization of The Vaccine Fund

Strategic planning & monitoring

==>> Setting priorities

==>> Monitoring progress


==>> Alliance coordination

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