Developments in immunization planning in Cambodia--rethinking the culture and organization of national program...

As part of its health system reconstruction following decades of civil war, Cambodia undertook a program of health sector reform in 1996 to expand coverage of essential health services to the population of 14 million, 80% of whom are resident in over 13 000 rural villages. During this reform period, one of the major national health programs, the National Immunization Program (NIP), adapted its planning system to accommodate changes in social and health sector structure.

The aims of this article are to review changes made in the approach to national immunization planning and to illustrate how these adaptations can help identify future challenges and opportunities for further improving immunization coverage in Cambodia. Sources of information for the study include immunization plans and data from international and national sources, as well as data from the national health information system. Findings of review: Management and service delivery reforms undertaken by the NIP include (1) strengthening links between immunization, health sector and international health planning; (2) development of immunization program multiyear and financial sustainability plans; (3) strengthening of national program decision making structures and processes; (4) widening of decentralized stakeholder participation in health planning; and (5) implementation of service level micro-planning.

These management reforms have been associated with significant improvement in public health program performance and outcomes during this period (2003-2006). There has been an increase in vaccination coverage for children under the age of one year, over a five-year period (increase of 29% for fully immunized child at one year of age), with no significant differences in vaccination rates between urban and rural areas, and a sharp decrease in the incidence of vaccine preventable diseases.

The NIP is now well positioned to take on additional challenges in coming years associated with expanding international partnerships, the continued development of civil society, further health system decentralization, and the requirement to further improve coverage in support of global and regional disease elimination goals. However, as costs continue to rise, planners in the future will need to emphasize the economic and public health benefits of immunization programs in order to sustain increasing levels of national and international investment.