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System within systems: challenges and opportunities for the Expanded Programme on Immunisation in Pakistan
Zaeem Haq1, Babar Tasneem Shaikh2, Nhan Tran3
1Health Services Academy, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan. drzaeem@hotmail.com.
Health Research Policy and Systems
|May 19, 2019
Summary
Pakistan
Area of Science:
- Public Health
- Health Systems Strengthening
- Vaccinology
Background:
- Pakistan faces high infant and child mortality, largely from vaccine-preventable diseases.
- The Expanded Programme on Immunisation (EPI), established in 1978, struggles with low and delayed vaccination rates.
- Understanding EPI's systemic challenges is crucial for improving child survival.
Purpose of the Study:
- To explore the structural and implementation aspects of Pakistan's Expanded Programme on Immunisation (EPI).
- To identify challenges and opportunities within the broader health governance system affecting immunisation.
- To provide insights for enhancing routine immunisation (RI) services.
Main Methods:
- A qualitative case study approach was employed.
- Semi-structured, in-depth interviews were conducted with 34 key informants.
- The analysis focused on WHO's health system building blocks and their interaction with EPI and external factors.
Main Results:
- Key challenges include resource scarcity, unclear service delivery models, data deficiencies, and logistical hurdles.
- Lack of a dedicated EPI budget, prioritization of polio, security risks, and community misconceptions hinder progress.
- Interactions between EPI and the wider health system components present significant implementation barriers.
Conclusions:
- Most EPI challenges stem from its integration with the broader health system and external socio-political factors.
- Polio eradication efforts have impacted routine immunisation (RI) services.
- Improving Pakistan's immunisation status requires a coordinated effort from local to global stakeholders.
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