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To function effectively, delivery systems for routine immunization
need to have adequate financial, technical and managerial capacity. The
impact of immunization is monitored through disease surveillance and the
output of the service delivery is monitored through antigen coverage rates
and drop-out rates. Complete, accurate and timely reporting of cases, antigen
coverage and drop-out rates are essential for guiding disease-control
activities, monitoring programme performance and directing the allocation of
scarce resources. Analysed effectively, this information can be used for
prompt case investigation, laboratory confirmation and monitoring service
delivery progress. This increases efficiency by targeting programme action
for priority EPI diseases.
The challenges now facing the Region are to reinvigorate EPI delivery
mechanisms, within the broader context of comprehensive services, to increase
access to unimmunized children and decrease drop
outs. This will be accomplished by:
 increasing technical and
managerial capacity at all levels
increasing the accuracy of
surveillance and coverage data for use in programme decision-making
advocating for appropriate
mobilization of suitable financial and logistic resources
strengthening planning processes to use scarce
resources more efficiently and sustainably.
Measured in terms of coverage rates, EPI programmes were most
effective in the late 1980s and early 1990s. Since then, rates have declined
to around 75% and the number of cases of disease is now beginning to
increase. Important factors contributing to this decline in coverage include:
weak management of programme coordination; poor maintenance of ageing
cold-chain equipment and vehicles; inadequate training and supervision of
staff; and poor vaccine logistics. These, in turn, have led to weakened
infrastructures delivering poorer quality immunization services and have
decreased the profile of EPI amongst policy-makers deciding where to allocate
scarce resources within each country’s health sector.
Surveillance for other EPI diseases will benefit from the work being
done to strengthen AFP surveillance. The infrastructure for AFP surveillance
will be required well beyond certification and will continue to provide
opportunities to integrate and strengthen surveillance for other important
preventable diseases. This reporting infrastructure will also be used for
monitoring coverage rates and drop-out rates.
Manufacturers
need accurate forecasts to plan their production and make the necessary
investment. WHO will support activities to improve the accurate forecasting
of vaccine and syringe requirements, strengthen procurement procedures for the
public sector, and promote regional collaboration on trade and supply issues.
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