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Original research
Partnerships in the introduction of new routine vaccines in Bangladesh: evidence from a prospective process evaluation
  1. Sharmin Khan Luies1,
  2. Tahmina Sultana2,
  3. Ashwin Budden3,
  4. Mohammad Asaduzzaman4,
  5. Md. Billal Hossain5,
  6. Matthew Kelly6,
  7. Darren Gray6,
  8. Md. Jasim Uddin7,
  9. Haribondhu Sarma6
  1. 1Infectious Diseases Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
  2. 2Research Program, Bangladesh Institute of Governance and Management, Dhaka, Bangladesh
  3. 3D'EVA Consulting, Washington, District of Columbia, USA
  4. 4SanMarkS at iDE (International Development Enterprises), iDE Bangladesh, Dhaka, Bangladesh
  5. 5Department of Sociology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
  6. 6National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
  7. 7Health Systems and Population Studies Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhal, Dhaka 1212, Bangladesh
  1. Correspondence to Sharmin Khan Luies; sharminkhan.luies{at}gmail.com

Abstract

Objective To assess the contribution of partners in the introduction of two new vaccines concurrently: pneumococcal 10-valent conjugate vaccine (PCV-10) and inactivated polio vaccine (IPV) into the routine Expanded Programme on Immunization (EPI) in Bangladesh.

Design We conducted a prospective process evaluation that included the theory of change development, root cause analysis and in-depth investigation. As part of process tracking, we reviewed relevant documents, observed trainers’ and vaccinators’ training and key stakeholder meetings. We analysed the data thematically.

Setting We purposively selected eight Upazila (subdistrict) and one city corporation covering nine districts and seven administrative divisions of Bangladesh.

Participants Nineteen national key informants were interviewed and 16 frontline health workers were invited to the group discussions considering their involvement in the vaccine introduction process.

Results The EPI experienced several challenges during the joint introduction of PCV-10 and IPV, such as frequent changes in the vaccine introduction schedule, delays in budget allocation, vaccine supply shortage and higher wastage rates of IPV. EPI addressed these challenges in collaboration with its partners, that is, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), who provided technical assistance to develop a training curriculum and communication materials and enhanced demand generation at the community level. In addition, the WHO conducted a country readiness assessment for PCV-10, and UNICEF supported vaccine shipment. Other government ministries, City Corporations and municipalities also supported the EPI.

Conclusions The partnership among the EPI stakeholders effectively addressed various operational challenges during the joint introduction of PCV-10 and IPV helped strengthen Bangladesh’s immunisation systems. These accomplishments are attributed to several factors that should be supported and strengthened for future vaccine introductions in Bangladesh and other low and-middle countries.

  • public health
  • qualitative research
  • organisation of health services

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors HS, MA and AB designed the qualitative part of the study, and HS was the principal investigator and responsible for the overall content as the guarantor. TS, SKL and MBH conducted key informant interviews, moderated focus group discussions, analysed the qualitative transcripts. HS and AB also conducted a few high-level, in-depth interviews. HS, AB supported the implementation of the study and the analysis and interpretation of findings. SKL drafted the paper, along with AB and HS. MK, DG and JU reviewed and helped revise various drafts of the manuscript and supported finalising the paper for submission. JU served as PI for the FCE and was responsible for the design and oversight. All authors reviewed and approved the final version of this article.

  • Funding This study was funded by Gavi, the Vaccine Alliance. Award/grant number (N/A).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Please see the methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • data-availability-free-text Data supporting findings are not publicly available due to participants’ confidentiality. For further information regarding access, please contact Haribondhu Sarma (haribondhu.sarma@anu.edu.au).