Explaining Differential Immunization Coverage: a multi-disciplinary approach

The Universal Childhood Immunization campaign has been hailed as a success story. At the UNICEF summit in 1990 it was declared that the target had been achieved. Since then, however, immunization coverage has deteriorated. But coverage is highly uneven be tween different countries and regions. In different states in India it varies from 11 to 80%, while it seems Malawi has maintained universal coverage. Our central question is therefore: why do some low income countries, or parts of countries, consistently immunize children more effectively than others? Our study will focus on the health system. While holistic approaches to dealing with health systems are being espoused by all donors, little operational guidance exists on how to understand their complex ity or how to configure health systems to improve health outcomes. Since a health system is open and adaptive and responds to interventions in different and often unpredictable ways, it is necessary to take into account a broader set of explanatory facto rs than is commonly the case. It is also important to recognise the significance of factors operating at different levels: local, national and international. The last mentioned is particularly important in the case of poor, aid-dependent countries. We pr opose to establish a multidisciplinary research programme based on comparative case studies. During the period of project development the theory and methodology will be worked out in detail, in collaboration with a group of national and international rese archers, building on SUMs long experience in policy-relevant, interdisciplinary research in developing countries. A workshop will be organised in January 2007, bringing together scholars working in this field which will allow for cross-fertilization of id eas and experience across African and Asian regions. The full research project will be drafted at this workshop, and subsequently refined for submission in March 2007 as a fully developed research proposal.