Critical success factors for routine immunization performance: A case study of Zambia 2000 to 2018
Authors: Rodriguez Katie , Hester Kyra A. , Chanda Chama , Darwar Roopa , Dounebaine Bonheur , Ellis Anna S. , Keskinocak Pinar , Leslie Abimbola , Manyando Mwangala , Manyando Maurice Sililo , Nazzal Dima , Ogutu Emily Awino , Sakas Zoe , Castillo-Zunino Francisco , Kilembe William , Bednarczyk Robert A. , Freeman Matthew C. ,   the Vaccine Exemplars Research Consortium
Published: November 2021

Introduction

The essential components of a vaccine delivery system are well-documented, but robust evidence on how and why the related processes and implementation strategies prove effective at driving coverage is not well-established. To address this gap, we identified critical success factors associated with advancing key policies and programs that may have led to the substantial changes in routine childhood immunization coverage in Zambia between 2000 and 2018.

Methods

We conducted mixed-methods research based on an evidence-based conceptual framework of core vaccine system requirements. Additional facilitators and barriers were explored at the national and subnational levels in Zambia. We conducted a thematic analysis grounded in implementation science frameworks to determine the critical success factors for improved vaccine coverage.

Results

The following success factors emerged: 1) the Inter-agency Coordinating Committee was strengthened for long-term engagement which, complemented by the Zambia Immunization Technical Advisory Group, is valued by the government and integrated into national-level decision-making; 2) the Ministry of Health improved the coordination of data collection and review for informed decision-making across all levels; 3) Regional multi-actor committees identified development priorities, strategies, and funding, and iteratively adjusted policies to account for facilitators, barriers, and lessons learned; 4) Vaccine messaging was disseminated through multiple channels, including the media and community leaders, increasing trust in the government by community members; 5) The Zambia Ministry of Health and Churches Health Association of Zambia formalized a long-term organizational relationship to leverage the strengths of faith-based organizations; and 6) Neighborhood Health Committees spearheaded community-driven strategies via community action planning and ultimately strengthened the link between communities and health facilities.

Conclusion

Broader health systems strengthening and strong partnerships between various levels of the government, communities, and external organizations were critical factors that accelerated vaccine coverage in Zambia. These partnerships were leveraged to strengthen the overall health system and healthcare governance.

Highlights

This paper describes how policies and programs contributed to improved vaccine coverage in Zambia

Communication, coordination, and collaboration between implementing levels were imperative

Adjacent successes in health systems strengthening and governance were leveraged

Policies in Zambia include flexibility in implementation for tailored approaches in each district