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At the 2010 World Health Assembly, milestones toward measles eradication were endorsed. However, the potential impacts on routine immunization services and the overall health system remains one of the key concerns in determining the appropriateness of a measles eradication program. Because of the targeted and time-limited nature of an eradication goal and the prevalent resource constrained environment, authors are divided with some arguing that health system development may be compromised while others argue that eradication programs have great potential to contribute to health system strengthening. More recently, a new terminology of a “diagonal” approaches has been coined, arguing that resources earmarked for disease control can serve to spearhead improvements in health systems.
In this article, the authors evaluated the impact of accelerated measles elimination activities (AMEAs) on routine immunization services and health systems. They document that there were both positive and negative implications on immunization and in most of the health system functions depending on national systems capacity and context as well as the way the AMEAs were implemented. Paper concludes by asking all programs to actively seek opportunities to strengthen routine immunization service and the health system. More details are available at: http://jid.oxfordjournals.org/content/204/suppl_1/S82.long
Abstract
BACKGROUND. One of the key concerns in determining the appropriateness of establishing a measles eradication goal is its potential impact on routine immunization services and the overall health system. The objective of this study was to evaluate the impact of accelerated measles elimination activities (AMEAs) on immunization services and health systems in 6 countries: Bangladesh, Brazil, Cameroon, Ethiopia, Tajikistan, and Vietnam.
METHODS. Primary data were collected from key informant interviews and staff profiling surveys. Secondary data were collected from policy documents, studies, and reports. Data analysis used qualitative approaches.
RESULTS. This study found that the impact of AMEAs varied, with positive and negative implications in specific immunization and health system functions. On balance, the impacts on immunization services were largely positive in Bangladesh, Brazil, Tajikistan, and Vietnam, while negative impacts were more significant in Cameroon and Ethiopia.
CONCLUSIONS. We conclude that while weaker health systems may not be able to benefit sufficiently from AMEAs, in more developed health systems, disruptions to health service delivery are unlikely to occur. Opportunities to strengthen the routine immunization service and health system should be actively sought to address system bottlenecks in order to incur benefits to eradication program itself as well as other health priorities.