BRIEFING - April 2003
Is eighty percent coverage achievable?
Analysts review countries' performance and assess what steps are needed if the Alliance is to meet internationally agreed targets for immunizing more children
DESPITE early signs that a number of countries are improving their vaccination coverage, it looks unlikely that the GAVI goal of 80% of the poorest countries reaching 80% coverage in all districts by 2005 -- the "80/80 goal" -- will be reached. This is according to an analysis (1) carried out for the GAVI Board by management consultants McKinsey & Company.
|There can be no "one-size-fits-all" approach to improving the delivery of immunization -- each country's solution is likely to differ
The McKinsey team pored over the multiyear plans submitted to GAVI, examined data from UNICEF and WHO, and interviewed national, regional and international experts to assess the current coverage situation and forecast the likely evolution over the coming years. There are encouraging preliminary signs that GAVI may be contributing to a "modest" increase in overall coverage rates in countries supported by the Vaccine Fund in the past two years. However, the overall conclusion is that on current levels of activity, most GAVI-supported countries will not achieve 80% district-level coverage until after 2010.
Worldwide every year, about 34 million children miss out on immunization, resulting in nearly 3 million preventable deaths. At least 31 million of the unimmunized children live in countries supported by GAVI and the Vaccine Fund. Two out of every three unimmunized children can be found in five countries -- India, Nigeria, China, Pakistan and Indonesia.
It is clear that unless countries increase vaccination coverage, the United Nations Millennium Development Goals (MDGs) will not be reached. The MDGs pledge to reduce deaths in children under age five by two-thirds before 2015. To support this goal, at the 2002 Children's Summit the UN General Assembly pledged to "ensure full immunization of children under one year of age, at 90% coverage nationally, with at least 80% coverage in every district or equivalent administrative unit", by 2010.
Faced with the findings of the McKinsey report, the GAVI Board is considering the most appropriate actions to meet the global goals. At its most recent meeting in New York on 6 March, Board members expressed a reluctance to launch brand new initiatives, wishing to work within established policies and programs. And, as the report warns, localized and tailored solutions are required to ensure sustainable improvements in coverage that eventually benefit the entire health system.
The McKinsey team was able to identify some broad groupings of countries by looking at the barriers they face. The team identified five key health system "drivers" that determine the performance of a national immunization programme: the degree of political and financial commitment; the physical infrastructure; the monitoring and information system; the management of service delivery and staff; and the degree of demand for immunization, or social mobilization.
While there are some countries that have all areas well in hand, most countries are lacking in at least in one or two areas, creating "barriers" to improved performance. Weak management of service delivery and staff was found to be the most common barrier to improved performance, affecting some 40 countries. In a handful of countries, all barriers exist. A systemwide approach would be needed to overcome the barriers, according to the report.
On the positive side, McKinsey concluded that, when the value of immunization is well communicated, and social mobilization is strong, a "virtuous circle" can follow, with strong political commitment, ensured resource flow to districts, and appropriate service delivery with good monitoring.
One finding is clear: there can be no "one-size-fits-all" approach to improving the delivery of immunization -- each country's solution would differ. Therefore the McKinsey report is being shared this month with countries; the GAVI Board will consider their reactions before taking decisions about how to accelerate the growth in coverage.
Lisa Jacobs and Phyllida Brown
(1) McKinsey & Company. Achieving our immunization goal. Read it here
Immunization Focus April 2003 - Contents