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A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms.

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Sub-Saharan Africa faces challenges in achieving Sustainable Development Goal 3 due to under-immunisation. A new conceptual model, developed from studies in Kenya and Rwanda, aims to improve immunisation systems in low- and middle-income countries for better vaccine coverage.

Keywords:
System designimmunisationproblem structuringresiliencesub-saharan africasustainability

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Area of Science:

  • Public Health
  • Health Systems Research
  • Vaccinology

Background:

  • Sub-Saharan Africa lags in global vaccination coverage, hindering Sustainable Development Goal 3 achievement.
  • Sub-national disparities in immunisation rates contribute significantly to the problem.
  • Existing immunisation systems in low- and middle-income countries (LMICs) require redesign for improved performance.

Purpose of the Study:

  • To propose a conceptual model for redesigning immunisation systems in LMICs.
  • To capture the complexity of immunisation systems and identify areas for sustainable improvement.
  • To provide a framework for enhancing vaccine delivery and coverage.

Main Methods:

  • Literature review and stakeholder engagement in Rwanda and Kenya.
  • Development of a conceptual model integrating planned and emergency immunisation paradigms.
  • Analysis of synchronised flows (vaccinee, vaccinator, vaccine) and feedback loops.

Main Results:

  • A novel model conceptualises immunisation systems as integrated, dynamic entities.
  • Six key feedback loops identified as primary system governance mechanisms.
  • Sustainability and resilience assessed via loop dominance and external factor dependency.

Conclusions:

  • The proposed model offers a systems approach for structuring problems in immunisation.
  • It provides directions for sustainable redesign of immunisation systems in LMICs.
  • The framework facilitates stakeholder collaboration and policy design for improved health outcomes.