Vaccines are recognised among “best buys” in the global health field. They provide the best return on investment in terms of saved lives and improved health outcomes. Immunisation averts 2 to 3 million deaths each year and results in healthier communities, which in turn, enhance education attainment, labour market productivity, and economic progress. Nonetheless, the World Health Organisation reports that one in five children in sub-Saharan Africa lacks access to basic immunisation and is at risk of vaccine-preventable diseases. Rwanda has become a positive outlier consistently posting routine immunisation coverage of nearly 95 per cent. Furthermore, children in Rwanda were among the first in sub-Saharan Africa to receive several vaccines, including immunization against pneumococcal disease, human papilloma virus (HPV), measles-rubella and rotavirus. So how did Rwanda address on-the-ground challenges and reach high immunization coverage? Here are five strategic approaches that have made a difference and can be adapted to other developing countries. 1. Integrated service delivery and strategic partnerships The African Vaccination Week was observed from April 24 to 30. In Rwanda, the vaccination week was aligned with the Maternal and Child Health Week launched on April 26. This strategy allows the integration of vaccination campaign with other maternal and child health services like the provision of vitamin A supplements, deworming tablets, antenatal consultations and family planning counseling. The integration of services is an efficient use of resources in providing care to infants and families. It also lowers the burden on mothers who use the vaccination visit to receive other health interventions. In order to achieve these objectives, key partnerships were built including through the Ministry of Health, the Ministry of Gender and Family Promotion, Imbuto Foundation, and global partners. 2. Engaging the community at the grassroots level The lack of adequate social mobilization at the community level can produce major setbacks in vaccine uptake due to potential misconceptions and distrust. In Rwanda, however, community health workers (CHWs) provide a strong grassroots structure that facilitates effective immunization outreach and education campaigns. They play a fundamental role in providing care in remote communities and helping to drive health-seeking behaviors. As members of the community, they help build and maintain public trust in vaccines, a core factor in improving the uptake and supply of vaccines. 3. A robust health system and evidence-based prioritization Supplying a full-course of basic immunizations is part of the minimum package of interventions at the primary care level in Rwanda. An effective system was built to handle new vaccine introduction and routine immunization programmes through critical elements like cold chain and logistics management systems, well-trained health workforce, and reliable immunization data. Rwanda has been recognized for this high-performing system and was selected to host the East African Community (EAC) Centre of Excellence for Vaccines, Immunisation and Health Supply Chain Management. The Centre of Excellence was officially inaugurated earlier this year in Kigali and is used to provide training to health professionals from across East Africa. 4. Accountability and local ownership Immunization indicators are included in the performance contracts (Imihigo) signed by local leaders. It provides an incentives system that aligns performance measures with those of monitoring and supervision of immunization coverage. This strategy contributes to increased accountability and local ownership as communities expect adequate access to these life-saving interventions. It also promotes good stewardship and builds trust in government services. 5. Political support and sustainable financing Immunisation programmes have to continually evolve to account for the children born each year, new vaccines introduced, and expansion in age groups receiving vaccines. Furthermore, a strong political support and sufficient funding are required in order to sustain the implementation of a country’s immunization campaigns. In Rwanda, the budgetary allocation reflects a commitment to improving overall health outcomes with an estimated 24 per cent of the general government budget earmarked for the health sector. It places Rwanda among just a handful of countries that have reached the Abuja Declaration threshold of 15 per cent of the total national budget allocated to the health sector. The government’s commitment to protecting children’s health led Rwanda to surpass the Millennium Development Goal 4 to reduce child mortality by two-thirds between 1990 and 2015. This reduction in mortality, is in part, associated with increased vaccination coverage. Although there is still work to be done to maintain high performance in immunization coverage in Rwanda, the strategies highlighted above can be adapted to other countries looking to improve their immunization programmes. The writer is a health policy consultant currently based in Boston- Massachusetts
