3.2.4. Mobilizing Resources for Sustaining Immunization Services

Early intervention by governments to provide clear directives to health facilities was instrumental in minimizing service delivery disruptions. For example, the mid-2020 nationwide directive in Nigeria to continue routine outreach sessions resulted in an 11.6% increase [8] in service provision since the early disruptions. In Uganda, by engaging non-traditional health stakeholders, particularly at the district level, the immunization program was able to mobilize additional financing and resources, including human resources to support data management and operational aspects of delivering vaccinations, which tremendously eased pressure on system capacities and helped sustain routine immunization services.

### 3.2.5. Restructuring Health Systems to Build Resilience

Learning from the largest disruption to immunization service delivery in three decades and the largest vaccination rollout in history, a few countries are prioritizing investments in systems that enable multisectoral collaboration with strong community participation for agile decision making. For example, the Cambodian government is in the process of developing a PHC booster strategy to ensure all individuals can access a quality package of care in the public sector—from prevention to early diagnosis and management across the life course, encompassing maternal and child health, communicable diseases, selected non-communicable diseases, mental health, and other ageing-related illnesses. This strategy aims to emphasize stronger community engagement and new models of service delivery that could strengthen the resilience of health systems. CHAI is supporting by updating the community participation policy, which will redefine the governance, roles, and responsibilities for community heath workers within existing community structures. In Uganda, the government is adapting routine immunization for the use of Smart Paper Technology, which enables individual-level tracking of COVID-19 vaccine recipients and includes a reminder function for subsequent doses. CHAI is supporting the country to develop systems and processes that reduce missed opportunities for vaccination at every encounter with the health system, which has had a demonstrable impact on all antigens of note, including sustained increase in the number of vaccinated (11% in DTP3, 4% in MCV1, 72% in HPV2) in the supported districts in 2021 [7]. These health system capacities and processes will facilitate improved preparedness and operations to rapidly respond to emergent system shocks while maintaining the effectiveness of routine programs.
