Routine immunization in Ethiopia

Abstract

Abstract
Background: Ethiopia is a large, low-income country in the Horn of Africa with the challenge of providing equitable health services across a highly dispersed population. The country’s health system is decentralised, with authority devolved to the Regional Health Bureaus, Zonal Health Departments and Woreda Health Offices. Immunisation is one of the earliest forms of introduction of modern medicine in Ethiopia; smallpox vaccination was introduced in the mid-1800s and childhood immunisation started in the late 1940s before a major immunisation drive was conducted for smallpox eradication.
The Ethiopian Expanded Program on Immunisation (EPI) was launched in 1980, with six antigens namely BCG, Diphtheria, pertussis, tetanus, polio and measles. From 1980 up to 2003, the country’s vaccination coverage has been rather low and erratic, reflecting major socio-political events such as government transitions and the Ethiopia-Eritrea war. However, coverage has shown gradual increments with the introduction of the Reach Every District (RED) approach in 2004 and the health extension program in 2003. Hepatitis B and Haemophilus influenza type B vaccines were introduced to the routine immunisation programme in 2007.

Methods: This is a review of the routine immunization performance in Ethiopia based on official documents and reports from the health sector.

Results: The annual routine immunisation plan is prepared based on the Comprehensive Multi-Year Plan which is developed every 5 years. The EPI has been strengthened in recent years and has involved rehabilitation and enhancing of cold chain capacity, as well as scaling up health extension program in rural areas. Pneumococcal-10 and rotavirus vaccines were introduced in 2011 and 2013 respectively. The Ethiopian EPI now offers a very comprehensive vaccination schedule. But despite good progress, there remain important discrepancies between different sources of data at regional level in vaccination coverage rates, notably in nomadic and remote populations.

Conclusion and Recommendations: The overall cost of the EPI has now increased significantly and is largely financed by external donors, notably GAVI, which raises longer term sustainability issues. [Ethiop. J. Health Dev. 2015; Special Issue 1:02-07]