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Measuring National Immunization System Performance: A Systematic Assessment of Available Resources.

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Assessing immunization system performance requires more than vaccination coverage data. This review found variability and gaps in monitoring and evaluation resources, highlighting the need for tailored approaches to improve immunization programs.

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Area of Science:

  • Public Health
  • Health Systems Research
  • Immunization Programs

Background:

  • Vaccination coverage is a common but insufficient metric for evaluating immunization performance.
  • Assessing immunization systems' underlying components is complex, with various monitoring and evaluation (M&E) resources available.
  • Understanding how immunization system performance is measured is crucial for improving global health outcomes.

Purpose of the Study:

  • To review and analyze existing monitoring and evaluation (M&E) resources for immunization systems.
  • To identify national-level indicators used to measure the performance of immunization systems and their components.
  • To understand the scope and limitations of current M&E tools in the field of immunization.

Main Methods:

  • A systematic review of peer-reviewed and gray literature published since 2000.
  • Identification of M&E resources containing national-level indicators for immunization system components.
  • Categorization and narrative summary of indicators by system component (governance, financing, etc.) and outcomes.

Main Results:

  • Twenty resources with 631 distinct indicators were identified.
  • Immunization program outcomes, primarily vaccination coverage, were the most common indicators.
  • Indicators for vaccine logistics were prevalent, while those for regulation and demand generation were least common.
  • Significant heterogeneity was observed in assessing information systems and workforce performance.
  • Key indicators for adult vaccination, data use, equity, safety surveillance, and public health workforce availability were notably absent.

Conclusions:

  • Considerable variability and gaps exist in indicators for assessing immunization system performance.
  • Policymakers should tailor M&E resources to specific contexts for better insights.
  • Improving data use in decision-making is essential for enhancing immunization programs.