Developing effective systems for delivery of vaccines

Effective immunization performance depends on the development and continuous improvement of systems and processes in each of the settings in which vaccines are given. This article gives some examples of improved performance and the role of a variety of techniques such as reminders in achieving improved performance. Measurement of performance plays an important, indeed, essential role in quality improvement and has notably been lacking in immunization activities. For future improvement, it will be important to link policy-making with the remaining elements of the quality improvement cycle.