Introduction of PCV-10 in Ethiopia: Effects on the health system

Abstract

Abstract Background: Pneumonia is a leading cause of death for children under the age of five in Ethiopia. An important tool in the fight against the disease, the pneumococcal-conjugate vaccine (PCV-10), was introduced into the routine immunisation schedule in 2011. This study, which was part of a larger, six-country research project, aimed to understand the effects of the introduction on the Expanded Programme for Immunisation (EPI) and the wider health system. Methods: Our study design and analysis were based on the World Health Organisation’s health systems building blocks theoretical framework. A mixed-methods approach was used. Twenty-three key semi-structured interviews were carried out at the national, regional and district levels and questionnaires were completed by staff at 26 health facilities. Data on routine service activity were collected at 25 facilities. Results: There were minor or no effects to the majority of components of the health system. Positive effects were seen in training and capacity-building, an increase in health worker motivation, as well as in improved collaborations between government actors and greater political commitment towards the immunisation programme. Negative effects were found in increased workload for health facility staff, both immediately after introduction and in the medium-term. Mixed effects were found on data collection and reporting, adverse effect following immunisation (AEFI) surveillance, cold chain management and financing. Conclusion: Our study found that PCV-10 integrated smoothly into the EPI and the wider health system. However, questions remain about longer-term capacities and limits of the programme. [Ethiop. J. Health Dev. 2015; Special Issue 1:08-16]