Policy opportunities and limitations of evidence-based planning for immunization: lessons learnt from a field trial in Bangladesh.
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Date
2016-09
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
Despite success in scaling up immunization, the national immunization programme
in Bangladesh remains challenged by persisting inequities in health access related
to geographic location and social factors, including income and education status.
In order to tackle these inequities in access, the national immunization programme
has conducted a field trial of the evidence-based planning model in Bangladesh
between 2011 and 2013, in 11 low-performing districts and 3 city corporations.
The main elements of this intervention included bottleneck analysis in local areas,
action planning and budgeting to correct the bottlenecks, and establishment of a
monitoring system to track progress. Coverage improved in 8 out of 14 districts post
intervention. The main success factors associated with the intervention included
more analytic approaches to situation assessment and taking action on health
inequities at the local level, as well as more considered use of local data to track
immunization drop-outs. The main factors associated with coverage declines in trial
areas (6 districts) included poor financial resourcing and supervisory support, and
gaps and turnover in human resources. In order to sustain and improve coverage,
it will be necessary in future to link pro-equity approaches to subdistrict planning
to higher-level health-system-strengthening strategy and planning systems. This
will ensure that local area planners have the required resources, comprehensive
operational plans and political support to sustain implementation of corrective
actions to address identified system bottlenecks and inequities in health access at
the local level.
Description
Keywords
Bangladesh, bottleneck analysis, evidence-based planning, immunization
Citation
WHO South-East Asia Journal of Public Health 2016;5(2): 155-163.