African Health Sciences
Makerere University Medical School
Vol. 15, No. 3, 2015, pp. 868-877
Bioline Code: hs15119
Full paper language: English
Document type: Research Article
Document available free of charge
African Health Sciences, Vol. 15, No. 3, 2015, pp. 868-877
© Copyright 2015 - African Health Sciences
New pneumococcal conjugate vaccine introductions in four sub-Saharan African countries: a cross-country analysis of health systems’ impacts|
Torres-Rueda, Sergio; Burchett, Helen E. D.; Griffiths, Ulla K.; Ongolo-Zogo, Pierre; Edengue, Jean-Marie; Kitaw, Yayehyirad; Molla, Mitike; Gelmon, Lawrence; Onyango-Ouma, Washington; Konate, Mamadou & Mounier-Jack, Sandra
Background: Pneumonia is a main cause of under-five mortality in low-income settings. The pneumococcal conjugate
vaccine (PCV) has been introduced in many countries as a tool in the disease’s prevention. Although PCV’s effectiveness
has been established, less is known about the effects of introducing additional injectable vaccines into routine immunisation
programmes, particularly in the context of resource-constrained settings.
Objectives: To explore the effects of PCV introduction on the immunisation programmes and health systems in four
Methods: This study was carried out in Cameroon, Ethiopia, Kenya and Mali. Three to four regions and nine to 10 districts
were selected within each country. Semi-structured interviews were carried out at national, regional and district levels
(n=173). Researcher-administered questionnaires were completed with facility staff (n=124). Routine data on monthly vaccination
activities were collected at district and facility levels.
Results: PCV was generally well integrated into existing routine immunisation. Little or no impact was found in most areas
of the health systems. Some minor effects were found on immunisation programmes, particularly in areas with either
planning activities or investments e.g. staff skills were strengthened and there were limited improvements in surveillance.
Although health sector workers perceived increases in the coverage of other vaccines following the introduction of PCV,
routine service data did not confirm this claim. No substantial impacts were seen in health system management, service
delivery or performance.
Conclusions: The introduction of PCV had marginal impacts on the Expanded Programme for Immunisation and little to
none on broader health systems.
pneumococcal conjugate vaccine, sub-Saharan, health systems’ impacts