Shaikh Babar Tasneem, Haq Zaeem Ul, Tran Nhan, Hafeez Assad
1Health Services Academy, Chak Shahzad, Park Road, Islamabad, 44000 Pakistan.
Johns Hopkins Center for Communication Programs, Islamabad, Pakistan.
Public Health Rev. 2018 Sep 17;39:24. doi: 10.1186/s40985-018-0103-x. eCollection 2018.
In Pakistan, immunization coverage has been quite low since the program's inception, and the 2012-2013 population-based survey recorded it at 54%. Much has been written about the issues, challenges, and constraints in the implementation of Pakistan's immunization program. However, there is a need to better understand the health system barriers as well as levers that influence progress. This review aims to bridge the information gaps on system-level barriers that currently impede the optimal delivery and uptake of immunization services to the children of Pakistan through the Expanded Program on Immunization (EPI).
We conducted a comprehensive literature review, using PubMed and Google Scholar to find peer-reviewed literature, and also reviewed EPI-related international and national reports. Additionally, we consulted government reports, surveys, and publications on the health system. Employing the basic tenets of WHO's health systems framework for health system strengthening, and a socio-ecological model, this study cataloged the service delivery and the demand side perspective on various pillars of Pakistan's immunization program.
Themes generated from the literature review included financing, governance, service delivery, human resources, information systems, and supplies and vaccines. Findings suggest that certain areas in the larger health system need to be improved for a more coordinated implementation of EPI in Pakistan. Moreover, it is imperative to understand community behaviors and perceptions as well as demand side issues in order to achieve the desired results.
For better immunization coverage and ultimately a reduction in child mortality due to preventable diseases, EPI operations and performance must be improved. Further systematic implementation research could help to develop an even finer understanding of the system-wide bottlenecks encumbering the coverage and efficiency of the program.
在巴基斯坦，自免疫规划启动以来，免疫接种覆盖率一直很低，2012 - 2013年的全国人口调查记录显示覆盖率为54%。关于巴基斯坦免疫规划实施过程中的问题、挑战和制约因素，已有大量论述。然而，仍有必要更好地了解影响进展的卫生系统障碍以及推动因素。本综述旨在弥合目前阻碍通过扩大免疫规划（EPI）向巴基斯坦儿童最佳提供和接受免疫服务的系统层面障碍方面的信息差距。
我们进行了全面的文献综述，利用PubMed和谷歌学术搜索同行评议文献，并查阅了与EPI相关的国际和国家报告。此外，我们还参考了政府关于卫生系统的报告、调查和出版物。本研究运用世界卫生组织加强卫生系统框架的基本原则以及社会生态模型，从服务提供和需求方角度梳理了巴基斯坦免疫规划各支柱方面的情况。
文献综述得出的主题包括筹资、治理、服务提供、人力资源、信息系统以及供应品和疫苗。研究结果表明，为在巴基斯坦更协调地实施EPI，更大的卫生系统中的某些领域需要改进。此外，为取得预期效果，了解社区行为和认知以及需求方问题至关重要。
为提高免疫接种覆盖率并最终降低可预防疾病导致的儿童死亡率，必须改进EPI的运作和绩效。进一步的系统实施研究有助于更深入地了解阻碍该规划覆盖率和效率的全系统瓶颈。
