The Expanded Program on Immunization in Pakistan : Recommendations for Improving Performance
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World Bank, Washington, DC
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The Expanded Program on Immunization
(EPI) in Pakistan protects against eight vaccine-preventable
diseases and immunizes children below 23 months of age. The
program was implemented under the Ministry of Health (MOH)
until July 11, 2011, when amendment 18 to the constitution
devolved health as a subject completely to the provinces.
Currently, the EPI is managed and implemented at the
provincial level with coordination provided by the Ministry
of inter provincial coordination. During the last decade,
EPI performance has been stagnant with only 40-60 percent of
children receiving the vaccines age-appropriately. Vaccine
preventable diseases are still a major cause for the high
infant and child mortality rates in Pakistan. Evidence
suggests that underachievement of the EPI is due to a
combination of factors including; inadequate performance in
the areas of service delivery, program management,
monitoring and evaluation, logistics control, human
resources management and financing, as well as community
health-seeking behaviors and other demand-side issues. The
recommendations include: (i) increasing focus on
supervision, monitoring and evaluation, (ii) considering
performance-based incentives, (iii) exploring partnerships
with the private sector, (iv) expediting polio eradication
initiatives, (v) improving management, (vi) increasing
targeted capacity development, (vii) concentrating on the
target age group for immunization, (viii) developing
socially acceptable strategies, (ix) developing a human
resource strategy and implementation plan, and (x) improving
planning at the local level.
Palabras clave
ACUTE FLACCID PARALYSIS, AGE GROUPS, AGED, ANTIGENS, BABIES, BASIC HEALTH, BCG, BEHAVIOR CHANGE, BILATERAL DONORS, BIRTH RATES, BIRTHS, CAPACITY BUILDING, CHILD HEALTH, CHILD MORTALITY, CHILD MORTALITY RATES, CHILDBEARING, CHILDHOOD ILLNESS, CHILDHOOD IMMUNIZATION, CHILDREN FULLY IMMUNIZED, CIVIL SOCIETY ORGANIZATIONS, COLD CHAIN, COMMUNITY HEALTH, COMPLICATIONS, DANGERS, DEATHS, DEMAND FOR SERVICES, DEVELOPING COUNTRIES, DEVELOPMENT PLANS, DIARRHEA, DIPHTHERIA, DISABILITY, DISASTERS, DISEASE BURDEN, DISEASE CONTROL, DISEASE SURVEILLANCE, DISPENSARIES, DOSES OF VACCINE, EARTHQUAKE, EMERGENCIES, EMERGENCY RESPONSE, EXPENDITURES, FACT SHEET, FAMILY PLANNING, FATIGUE, FOCUS GROUP DISCUSSIONS, GOOD GOVERNANCE, HEALTH CARE, HEALTH CARE DELIVERY, HEALTH CARE PROVIDERS, HEALTH CARE SERVICES, HEALTH CARE WORKERS, HEALTH CAREDELIVERY, HEALTH CENTERS, HEALTH CENTRES, HEALTH DELIVERY, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH INITIATIVES, HEALTH POLICIES, HEALTH POLICY, HEALTH REGULATIONS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH SYSTEM, HEALTH SYSTEM STRENGTHENING, HEALTH WORKERS, HEPATITIS, HEPATITIS B, HOSPITAL, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCE DEVELOPMENT, HUMAN RESOURCES, HUMAN RESOURCES MANAGEMENT, ILLNESS, ILLNESSES, IMCI, IMMUNIZATION, IMMUNIZATION ACTIVITIES, IMMUNIZATION ACTIVITY, INCOME, INFANT, INFANT MORTALITY, INFANT MORTALITY RATES, INFANTS, INFECTION, INFLUENZA, INSERVICE TRAINING, INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS, INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES, INTEGRATION, INTERNATIONAL COOPERATION, INTERNATIONAL HEALTH REGULATIONS, INTERVENTION, LARGE POPULATION, LIMITED RESOURCES, LIVING STANDARDS, LOCAL COMMUNITY, LOCAL GOVERNMENTS, LOCAL POPULATION, MALARIA, MALARIA CONTROL, MALNUTRITION, MANAGEMENT OF HEALTH, MATERNAL AND CHILD HEALTH, MATERNAL CHILD HEALTH, MCH, MEASLES, MEDICAL EQUIPMENT, MEDICAL OFFICER, MEDICAL OFFICERS, MEDICAL PRACTITIONERS, MEDICINE, MENINGITIS, MIDWIFERY, MIGRATION, MILLENNIUM DEVELOPMENT GOAL, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MOBILE TEAMS, MORBIDITY, MORBIDITY AND MORTALITY, MORTALITY, NATIONAL HEALTH POLICY, NATIONAL HEALTH SYSTEMS, NATIONAL LEVEL, NATIONAL LEVELS, NEGATIVE EFFECTS, NEONATAL TETANUS, NNT, NUMBER OF CHILDREN, NUTRITION, OBSTETRICS, OUTREACH ACTIVITIES, PERTUSSIS, PLACE OF RESIDENCE, PNEUMONIA, POLICY MAKERS, POLIO, POLIO ERADICATION, POLIO ERADICATION INITIATIVE, POLIO VACCINE, POLIOMYELITIS, POPULATION ESTIMATES, POPULATION GROUPS, PRACTITIONERS, PREGNANT WOMEN, PREVENTABLE DISEASE, PREVENTABLE DISEASES, PREVENTIVE HEALTH SERVICES, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PROGRESS, PUBLIC HEALTH, REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH PROGRAM, RESOURCE ALLOCATION, RESPECT, ROOMS, ROTAVIRUS, RURAL AREAS, SAFE MOTHERHOOD, SAFETY MEASURES, SECRETARY OF HEALTH, SERVICE DELIVERY, SERVICE PROVIDER, SERVICE PROVIDERS, SERVICE PROVISION, SERVICE UTILIZATION, SOCIAL MOBILIZATION, SOCIAL SERVICES, SOCIOECONOMIC STATUS, SYRINGES, TB, TB CONTROL, TEACHING HOSPITALS, TECHNICAL ASSISTANCE, TETANUS, TREATMENT, TUBERCULOSIS, URBAN AREAS, VACCINATION, VACCINE COVERAGE, VACCINE PREVENTABLE DISEASES, VACCINE VIAL MONITORS, VACCINES, VIRUS, VIRUSES, WOMEN OF CHILDBEARING AGE, WORKERS, WORLD HEALTH ORGANIZATION