Overview

Vaccine Delivery in Zambia

Zambia increased its DTP3 coverage to 91%, through prioritizing community access and through investing in its health systems infrastructure and workforce.

By involving communities and creating a diverse group of stakeholders, Zambia successfully implemented strategies to build demand for immunization and improve coverage.

Authors

William Kilembe Katie Micek Kyra A. Hester Zoe Sakas Bonheur Dounebaine Anna S. Ellis Pinar Keskinocak Dima Nazzal Francisco Castillo-Zunino Robert A. Bednarczyk Matthew C. Freeman

Mothers wait to get their babies vaccinated.

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KEY INSIGHTS

Zambia’s improvement in DTP3 coverage and the success of its vaccination program was driven by the vision of equitable access to quality health care for all by 2030.

This led the Zambian government to invest in its health system, build strong collaboration and coordination between local and national stakeholders, and work with community leaders to increase demand for vaccination.

Placeholder — Kabamba Rural Health Center, Serenje District, Zambia

©Gates Archive

Zambia’s long-term plan for economic growth prioritizes “equitable access to quality health care by all by 2030” and calls for improved coordination across ministries, partners, and donors. As part of this focus on equity, this plan aims to increase the population of rural households living within 5 kilometers of the nearest health facility from 50 percent in 2006 to 80 percent by 2030. As of 2016, Zambia has increased the number of households living within 5 kilometers of a health facility to 78.6 percent. This has made it easier for families to access immunization services in all but the most rural areas.

Established a target for community access Shifted the focus to number of children vaccinated

In the early 2000s, Zambia lacked the health workers needed to adequately provide services for all its population. Zambia invested in strengthening the capacity, motivation, and professional development of health workers. While vacancies remain a challenge, especially in rural areas, Zambia has made important progress in training, recruiting, and retaining health staff.

In addition, Zambia formalized role of Community Based Volunteers (CBV) and integrated them into health service delivery. These community health workers, who are selected by their communities, assist in many health services and are a crucial link between communities and the formal health system. CBVs play important roles in educating their communities on vaccination and following up on children who are behind on their vaccinations.

Another important investment was Zambia’s expansion of its cold chain infrastructure. This vital step enabled the Gavi-supported introduction of new vaccines and played a significant role in improving immunization.

Expanded Trained Health Workforce, Especially in Communities Prioritized facility readiness

Zambia integrated immunization into the package of primary health care services to provide a “one-stop shop” of essential services for community members, and ensured that polio and measles control programs, new vaccine introductions, and outbreak responses all served to strengthen routine immunization.

This horizontal approach required collaboration both within the Zambian government and with external partners. Zambia’s Inter-Agency Coordinating Committee (ICC) has played a key role in fostering collaboration between the ministry of health and its partners. Originally focused on immunization, Zambia has broadened its ICC to address other aspects of maternal, neonatal, and child health. Through the ICC, partners ranging from faith-based organizations to international and local stakeholders have collaborated with government agencies to provide essential health services.

Engaged faith-based organizations for health service delivery and outreach Expanded the ICC to ensure partner diversity and broadened mandate

Zambia’s Ministry of Health works with community leaders to improve service delivery and build demand for immunization. The ministry regularly holds formal meetings, or indabas, with traditional and religious leaders. Indabas are used to educate community leaders on vaccination and other health matters and to address issues and challenges. Locally, health facility staff meet with community leaders to plan events such as child health weeks and vaccine introductions, and to find solutions to challenges faced in the community.

Health workers, community-based volunteers, educators, traditional leaders and the media all provide health education to increase demand for vaccines. Faith leaders support immunization by allocating time during religious services for health messaging and to promote upcoming activities.