*2.5. Characteristics of Guidance and Operational Frameworks*

Across the Region, while countries and immunization programmes vary widely in their immunization service delivery systems, they are also at different stages of recognizing, considering and addressing issues of immunization inequity. Thus, guidance and tools should contain pragmatic operational frameworks for all levels of the healthcare system, from the local health facility to the Ministry of Health.

The operational frameworks should be cohesive, implementable and relevant to the immunization stakeholders at national, sub-national, regional and local health facility levels. With a primary focus on "how to", pragmatic guidance and tools should focus on the following stakeholders to achieve a local demonstrable impact on immunization inequity:


The TIP tools and guidance developed by the WHO Regional Office for Europe are already available to support the immunization programme managers and their staff in identifying and characterizing population groups with lower immunization uptake and to diagnose vaccination behaviour barriers, system barriers and motivators.

An operational guide which contains pragmatic, cohesive and implementable operational frameworks relevant to the immunization stakeholders for all levels of health system and relevant, simple and action-oriented tools to address immunization inequity at the local health facility level is being developed by the WHO Regional Office for Europe in consultation with the countries in the Region, to empower subnational immunization managers to address determinants of immunization inequities closer to the location where the immunization inequity exists. Together with developing these pragmatic tools to address immunization inequity at the local health facility level, the WHO Regional Office for Europe will support capacity building of the national and subnational immunization

programme managers on the use of these tools. Successful implementation of interventions to reduce or prevent immunization inequities at the local levels will require multipronged actions involving the stakeholders who have roles in vaccine programme planning and delivery and those involved in advocating for immunization equity in underserved groups. Only through developing and implementing robust local-level interventions will countries in the Region be able to achieve EIA2030- s strategic priority on immunization equity: namely, ensuring that routine immunization coverage is high in every community and that all individuals have equitable access to and adequately utilize all vaccines in national immunization schedules.

Addressing immunization inequity between population groups within a country will have an impact on the healthcare delivery and population health as a whole. Like immunization coverage, achieving equity should be viewed as a systematic and continuous process.
