By Jamie Hansen, Global Health Communications Manager

Improving nationwide immunization rates is a complex undertaking, requiring leaders to collaborate across disciplines and engage local communities to best understand the unique logistical, political, and cultural context and challenges.

In 2019 and 2020, Dr. Alemayehu Teklu Toni, who is currently a Stanford African Scholar in Global Health, served as a researcher and project manager for a large, collaborative effort to tackle persistently low rates of childhood immunization coverage within Ethiopia. The collaboration included the University of Gondar, Ethiopia’s Federal Ministry of Health, and the Alliance for Health Policy and Systems Research — in partnership with Gavi, the Vaccine Alliance, and United Nations Children’s Fund (UNICEF). 

Despite Ethiopia’s goal of 90 percent full vaccine immunization coverage, rates had stalled at just over 40 percent, due to a wide range of barriers. These included: changing demand for vaccines, challenges with vaccine supply and distribution, and a shortage of trained healthcare workers.

The Gavi-funded initiative used an approach called “embedded implementation research” to strengthen and improve vaccination efforts. This approach establishes early and sustained collaboration between researchers, implementers, and policy-makers to ensure that studies are relevant and recommendations feasible. The team sought to identify key immunization programming issues and support attempts to solve them, while also mitigating wider system barriers.

“This approach is effective because it addresses real-world problems, leading to context-specific solutions that can be directly used by decision-makers to tackle the challenges,” said Dr. Toni. 

The collaboration conducted 12 implementation research projects and identified several key challenges affecting immunization services. These included issues related to urbanization, displacement, and a shortage of health workers. There were also systemic challenges, such as poor immunization data quality and problems effectively transporting and storing vaccines at the needed temperatures. The results of their efforts were published in 2021 in a special issue of the Ethiopian Journal of Health Development, along with an editorial reflecting on the role embedded implementation research can play in strengthening efforts towards improving primary health care. The authors also proposed strategies for addressing these challenges, such as: improving vaccine demand through communication and community engagement, improving immunization service delivery, and increasing women’s participation in household decision-making 

In addition to these findings, another significant outcome was the importance of the learning process itself, Dr. Toni said. “The strategy we implemented has now become a common approach, which can be used to identify other health system challenges. For example, the same approach was applied to improve the delivery of Compassionate and Respectful Care in Ethiopia,” he said. 

Researchers and healthcare leaders emphasize that adequate funding is critical for such global collaborations, which have the potential to both solve specific challenges and drive long-term, sustainable improvement of nations’ health systems. 

Dr. Toni emphasized the importance of committed collaboration. 

By Jamie Hansen, Global Health Communications Manager

Improving nationwide immunization rates is a complex undertaking, requiring leaders to collaborate across disciplines and engage local communities to best understand the unique logistical, political, and cultural context and challenges.

In 2019 and 2020, Dr. Alemayehu Teklu Toni, who is currently a Stanford African Scholars in Global Health (SASH) Scholar, served as a researcher and project manager for a large, collaborative effort to tackle persistently low rates of childhood immunization coverage within Ethiopia. The collaboration included the University of Gondar, Ethiopia’s Federal Ministry of Health, and the Alliance for Health Policy and Systems Research — in partnership with Gavi, the Vaccine Alliance, and United Nations Children’s Fund (UNICEF). 

Despite Ethiopia’s goal of 90 percent full vaccine immunization coverage, rates had stalled at just over 40 percent, due to a wide range of barriers. These included: changing demand for vaccines, challenges with vaccine supply and distribution, and a shortage of trained healthcare workers.

The Gavi-funded initiative used an approach called “embedded implementation research” to strengthen and improve vaccination efforts. This approach establishes early and sustained collaboration between researchers, implementers, and policy-makers to ensure that studies are relevant and recommendations feasible. The team sought to identify key immunization programming issues and support attempts to solve them, while also mitigating wider system barriers.

“This approach is effective because it addresses real-world problems, leading to context-specific solutions that can be directly used by decision-makers to tackle the challenges,” said Dr. Toni. 

The collaboration conducted 12 implementation research projects and identified several key challenges affecting immunization services. These included issues related to urbanization, displacement, and a shortage of health workers. There were also systemic challenges, such as poor immunization data quality and problems effectively transporting and storing vaccines at the needed temperatures. The results of their efforts were published in 2021 in a special issue of the Ethiopian Journal of Health Development, along with an editorial reflecting on the role embedded implementation research can play in strengthening efforts towards improving primary health care. The authors also proposed strategies for addressing these challenges, such as: improving vaccine demand through communication and community engagement, improving immunization service delivery, and increasing women’s participation in household decision-making 

In addition to these findings, another significant outcome was the importance of the learning process itself, Dr. Toni said. “The strategy we implemented has now become a common approach, which can be used to identify other health system challenges. For example, the same approach was applied to improve the delivery of Compassionate and Respectful Care in Ethiopia,” he said. 

Researchers and healthcare leaders emphasize that adequate funding is critical for such global collaborations, which have the potential to both solve specific challenges and drive long-term, sustainable improvement of nations’ health systems. 

Dr. Toni emphasized the importance of committed collaboration.

“Addressing global health challenges requires meaningful collaboration among key stakeholders, including policymakers, researchers, implementers, and affected communities,” he said.