ABSTRACTThis study starts out with recent global immunisation history; the success in achieving high immunisation coverage, and later the failure to sustain the same. With this in mind, the study is looking into effects of support from the Global Alliance for Vaccines and Immunization on district health care services in Uganda.
The Global Alliance for Vaccines and Immunization (GAVI) is supplying Uganda with the new DPT/HepB/hib vaccine as well as safety equipment, as commodities in kind. In addition, GAVI provides extra financial support through the Immunisation Services Support System (ISS).
This is a study applying three methods: A literature review, supplemented by statistical information from Uganda Ministry of Health, as well as substantial qualitative information in the form of interviews gathered under a visit to Uganda in November/December 2004. The period under study is mainly from 2002 - 2004.
Outpatient attendance (OPD attendance) and Diphtheria, Pertussis, Tetanus, Hepatitis B, Haemophilus influenzae (Hib) vaccine (DPT3/hepB/hib) coverage are used as main indicators. OPD attendance is used as proxy indicator for health service delivery, and DPT3/hep/hib coverage as proxy for immunisation services.
Both main indicators improved significantly between the years 2002 - 2003. They were also significantly correlated – i.e. in districts with high OPD attendance; the DPT3/HepB/hib coverage was also high. Any causal relationship was not found. However, there was no correlation between the increases in the two indicators between 2002 and 2003, indicating that these increases were happening independently of one another.
Thus in the period under review, separate and external inputs were put in place:
For the district health services, a new system of drug supply and financing was made operational, making the supplies of the most required drugs more readily available when needed. The user fee on health services which were introduced in the ‘90’ies, were recently abolished (March 2001), having made district health services more accessible and available also to the rural population. No data were available for the study period that could determine any changes in outcome indicators like infant and under-5 mortality rates.
The increase in immunisation coverage is seen in distinct relation to the use of the newly “appointed” immunisation mobilisers who assist in their parishes, encouraging and reminding parents to immunise their children at the proper timing. These mobilisers are remunerated in Uganda through some of the ISS funds.
These two observations were reiterated and confirmed in interviews with health staffs in the four districts visited.
It is beyond doubt that GAVI support to Uganda GAVI has contributed to a significant increase in DPT3/HepB/hib coverage in Uganda over the last few years. It could not be shown that GAVI support to Uganda has played a role in the increase in OPD attendance.
Recent data on infant and under-5 mortality and morbidity rates in Uganda are not available. Further research is recommended to investigate the influence of high immunisation coverage on these vital statistics.
How to keep up the high immunisation rate and the running of the intensified programme, when the era of GAVI support is over is an open question. The continued under-funding of the health sector as such remains a large challenge to Uganda.