Academic journal article Bulletin of the World Health Organization

The Impact of the Global Polio Eradication Initiative on the Financing of Routine Immunization: Case Studies in Bangladesh, Cote d'Ivoire, and Morocco. (Policy and Practice)

Academic journal article Bulletin of the World Health Organization

The Impact of the Global Polio Eradication Initiative on the Financing of Routine Immunization: Case Studies in Bangladesh, Cote d'Ivoire, and Morocco. (Policy and Practice)

Article excerpt

Voir page 828 le resume en francais. En la pagina 828 figura un resumen en espanol.

Introduction

Considerable progress has been made in eradicating poliomyelitis, thanks to the Polio Eradication Initiative (PEI), led by WHO, the United Nations Children's Fund (UNICEF), and a number of bilateral donors. However, the initiative has required considerable financial and other resources from ministries of health and other local and external sources, which raised the question as to whether resources for routine immunizations were adversely affected by the focus on the PEI. In the 1990s, global funding for routine immunization programmes in developing countries declined sharply for several reasons, including funding reductions from the United States Agency for International Development (USAID) after the cold war ended; competition from health services, such as those for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and other health priorities; and a reduction in UNICEF funding after Universal Child Immunization ended in 1990. During the 1990s, initiatives to control and eliminate diseases also became more frequent.

The PEI began in 1988 and has since reduced the global incidence of poliomyelitis. The WHO Region of the Americas was the first region to certify eradication in 1994, although one outbreak of vaccine-derived poliomyelitis has since occurred. The WHO Western Pacific region was certified poliomyelitis free in October 2000, and the WHO European Region was declared poliomyelitis free in June 2002. The two regions with the highest incidence of poliomyelitis are the WHO African Region and the WHO South-East Asia Region, although the frequency of cases is much lower than a decade ago.

Critics of eradication initiatives have argued that they divert resources and undermine efforts to maintain and strengthen routine health services. In the least-developed countries poliomyelitis eradication has had both positive and negative impacts on the development of health systems (1, 2). The positive impacts on routine health services resulted from the emphasis on social mobilization and improving management as part of the targeted initiatives. In poorer countries, however, targeted immunization programmes diverted resources away from routine services, especially during mass immunization campaigns.

Other studies also found that poliomyelitis eradication efforts had both positive and negative impacts. The development and strengthening of acute flaccid paralysis surveillance in the Philippines, for example, improved surveillance for other diseases (3), whereas poliomyelitis eradication initiatives in the Lao People's Democratic Republic, Nepal, and United Republic of Tanzania had both positive and negative impacts on the health system, depending on the level of development of the health system, the management capacity of personnel, and the level of integration of the health infrastructure (4). Positive impacts were more likely when sufficient planning was in place. It should be noted, however, that these three countries may not have been representative of other countries in their respective regions.

In the present study, we examined whether trade-offs occurred for routine immunization programmes, when governments, donors, and international organizations provided funding for the PEI.

Data collection

We collected data in Bangladesh, Cote d'Ivoire, and Morocco--chosen as part of a larger study on the financing of immunization programmes--since the countries had a mix of financing sources and were located in different geographical regions. However, the countries all had diphtheria, pertussis, and tetanus coverage rates greater than 60% and are not representative of countries with programmes that function less well.

We collected information on sources and uses of funds for routine immunization programmes and poliomyelitis eradication activities by the governments, donors, and other contributors (5-7). …

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