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Complex contextual factors hinder the optimal delivery of recommended vaccines to target populations in the World Health Organization (WHO) African Region. As a consequence, vaccination coverage for multiple antigens continues to fall short of the recommended benchmark for herd immunity across countries. This is precipitating frequent outbreaks of vaccine-preventable diseases with concomitant morbidity and mortality. If this problem is allowed to continue unchecked, it will delay progress toward achieving the child survival targets of the sustainable development goals for both individual countries and the entire region. Implementation science offer tools that country immunization programmes can leverage to address challenges with vaccine delivery. It has frameworks that can enable better understanding of the contextual barriers that affect effective vaccine delivery. It provides models that can foster the use of tailored interventions and strategies to address identified barriers of effective vaccine delivery while generating evidence on real-world effectiveness. There are also models for facilitating adaptation and spread of context-relevant best practices for enhancing vaccine delivery across diverse settings (whether in health facilities or communities) to improve vaccine uptake. In this opinion article, we reflexively outlined some key recommendations to spur greater use of implementation science in addressing challenges with vaccine delivery that are faced by immunisation programmes in the WHO African Region and beyond. [ABSTRACT FROM AUTHOR]

Background: Reallocation of funding to respond the covid-19 pandemic, against a backdrop of longstanding underfunded health systems and high out of pocket expenditures for health, affected access to health services for households, especially those without social protection. These highlighted the urgency in curbing the impact of disruptions on progress towards Universal Health Coverage (UHC) goals. Strategic investments in Primary Health Care (PHC) can help spur the necessary momentum. Methods: Under the collaborative platform of the Harmonization for Health in Africa's Health Financing Technical Working Group; UNICEF Regional Office for East and Southern Africa and WHO Regional Office for Africa convened the first PHC financing forum for 21 countries across the Eastern and Southern Africa Region. The three-day forum engaged key health and financing decision makers in constructive dialogue to identify practical actions and policy changes needed to accelerate delivery of UHC through improvements in PHC financing mechanisms and arrangements. The forum was attended by over 130 senior policy makers and technicians from governments, United Nations agencies and nonstate actors drawn from within country, regional and affiliating headquarter institutions. Results: The Regional Forum engaged participants in meaningful, and constructive discussions. Five themes emerged (1) regular measurement and monitoring of PHC services and spending (2) increasing investments in PHC (3) enhancing efficiency, effectiveness, and equity of PHC spending, (4) ensuring an enabling environment to invest more and better in PHC, and (5) better partnerships for the realization of commitments. An outcome statement summarizing the main recommendations of the meeting was approved at the end of the forum, and action plans were developed by 14 government delegations to improve PHC financing within country-specific context and priorities. Conclusions and recommendations: The aims of this meeting in augmenting the political will created through the Africa Leadership Meeting (ALM), by catalyzing technical direction for increased momentum for improved health financing across all African countries was achieved. Peer exchanges offered practical approaches countries can take to improve health financing in ways that are suited to regional context providing a channel for incremental improvements to health outcomes in the countries. [ABSTRACT FROM AUTHOR]

Objective: To assess how quality and availability of reproductive, maternal, neonatal (RMNH) services vary by district wealth and urban/rural status in Zambia.Methods: We conducted a retrospective analysis of data from the Millennium Development Goal Acceleration Initiative baseline assessment of 117 health facilities in 9 districts. Quality was assessed through a composite score of 23 individual RMNH indicators, ranging from 0 to 1. Availability was evaluated by density of providers and facilities. Districts were divided into wealth groups based on the multidimensional poverty index (MPI). Relative inequity was calculated using the concentration index for quality indicators (positive favours rich, negative favours poor). Multivariable linear regression was performed for the dependent variable composite quality indicator using MPI, urban/rural, and facility level of care as independent variables.Results: 13 hospitals, 85 health centres and 19 health posts were included. The RMNH composite quality indicator was 0.64. Availability of facilities and providers was universally low. The concentration index for the composite quality indicator was -0.015 [-0.043, 0.013], suggesting no clustering to favour either rich or poor districts. Rich districts had the highest absolute numbers of health facilities and providers, but lowest numbers per facility per 1 000 000 population. Urban districts had slightly better service quality, but not availability. Using regression analysis, only facility level of care was significantly associated with quality outcome.Conclusions: Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure. [ABSTRACT FROM AUTHOR]