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The International Initiative for Impact Evaluation (3ie)

Excerpt below; full text is at http://www.3ieimpact.org/media/filer_public/2015/07/29/3ie_immunisation_scoping_report_3.pdf

Executive summary


Substantial progress has been made in improving immunisation coverage for at least the routine vaccines across the world. The proportion of the world children who receive recommended vaccines, in other words, global vaccination coverage, has remained steady for the past few years. It is estimated that immunisation currently averts at least two to three million deaths every year. However, it is also clear that in some parts of the world, immunisation coverage rates are stagnating or,even worse, declining.

An estimated 21.8 million infants worldwide in 2013 were not covered with routine immunisation services, of whom nearly half live in three countries: India, Nigeria and Pakistan.

The global community and national governments continue to look for novel ways to improve access to and utilisation of immunisation services to reduce vaccine-preventable deaths.

There is an increasing realisation that communities need to be more than just passive recipients of immunisation services; they need to play a more prominent role and their involvement in planning and delivery of services can improve demand and potentially affect the quality of services.

In order to most effectively reach the last mile, health services and their community partners must make special efforts through strong community links to improve access and increase uptake.

Funded by the Bill & Melinda Gates Foundation and led by 3ie, this scoping paper has three main objectives:

1.map the landscape of evidence that shows what works and what doesnt in engaging communities to reverse stagnation and decline in immunisation;

2.draw on evidence from a range of sources and summarise what is already known about community engagement approaches to immunisation; and

3.identify innovative community engagement approaches to increase immunisation coverage.



The scoping paper focuses primarily on interventions and policies that lie at the intersection of immunisation and community engagement approaches. Four instruments were used to cover the scope of the study:

(a) a rapid evidence gap map which identifies and displays existing studies according to what intervention is evaluated and what outcomes are measured;

(b) a survey of key stakeholders, including implementers and researchers in the field of immunisation;

(c) semi-structured interviews with key experts in immunization to get their views on opportunities in and challenges to increasing immunisationcoverage through community engagement approaches; and

(d) evidence profiles that discuss community engagement initiatives in other development sectors.


iii Key Findings:

Co-management, where communities are actively involved in project design, implementation, monitoring and evaluation, is integral to the success of an intervention. 

This is where communities can be most engaged. Programmes and interventions need to be designed at the community level and should be more participatory in nature. 

An overwhelming majority of experts talked about the problems facing beneficiaries at the point where services are delivered.

Two main areas where this is likely are: problems with interpersonal communication between the service provider and beneficiaries, and problems related to scheduling, cancellation and lack of supplies.




Our scoping paper points to the potential key role that a community can and should play in almost all aspects of the causal chain of programmes that aim to increase immunisation coverage in developing countries.