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Background: The COVID-19 pandemic has disrupted health systems globally, affecting various services, including immunization programs. This study evaluates the impact of COVID-19 on immunization program financing and service delivery in Zambia, a lower-middle-income country, to understand how such disruptions could reshape future healthcare priorities and funding. Methods: The study employed a mixed-methods approach, integrating both qualitative and quantitative data collection. Data were gathered at national and subnational levels, including in-depth interviews with 36 healthcare workers and an online survey completed by 44 staff members. The evaluation focused on the changes in government funding, the effect on static and outreach immunization activities, vaccine supply distribution, and the impact on human resources within the Expanded Programme on Immunisation (EPI). Results: Findings indicated that while regular disbursements to districts improved in 2020, there was heightened competition for limited resources due to COVID-19, leading to a redirection of funds from routine immunization to pandemic-related activities. The study revealed a significant decline in immunization coverage, attributed to reduced health facility visits and outreach sessions. Additionally, financial constraints heightened by the pandemic made it challenging for districts to accommodate the extra costs associated with implementing COVID-19- compliant immunization services. Human resources for immunization were also impacted, with staff being reallocated to COVID-19 response activities, thus increasing workload and stress levels among remaining personnel. Conclusion: COVID-19 has substantially affected the funding, delivery, and human resource components of Zambia's immunization program. Despite an increase in regular funding disbursements, the redirection of funds to COVID-19 activities has strained routine immunization services. The pandemic has highlighted the need for robust health systems that can withstand global health crises without compromising essential services like immunization. Recommendations include closer monitoring of immunization service delivery impacts, assessment of COVID-19's financial implications on immunization, development of clear protocols for service delivery under pandemic conditions, and a re-investment in community engagement and education post-pandemic. [ABSTRACT FROM AUTHOR]

Background: Global health partnerships have grown rapidly in number and scope, yet there has been less emphasis on their evaluation. Gavi, the Vaccine Alliance, is one such public-private partnership; in Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework - the partnership framework - and analytic approach for evaluating the perceptions of partnerships' added value as well as the results from an application to one case in Uganda. Methods: We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations (FCE) to test the partnership framework on Uganda's human papillomavirus (HPV) vaccine application partnership. Data from document review, interviews, and social network surveys enabled the testing of the relationships between partnership framework domains (context, structure, practices, performance, and outcomes). Topic guides were based on the framework domains and network surveys identified working together relationships, professional trust, and perceptions of the effectiveness, efficiency, and legitimacy of the partnership's role in this process. Results: Data from seven in-depth interviews, 11 network surveys and document review were analyzed according to the partnership framework, confirming relationships between the framework domains. Trust was an important contributor to the perceived effectiveness of the process. The network was structured around the EPI program, who was considered the leader of this process. While the structure and composition of the network was largely viewed as supporting an effective and legitimate process, the absence of the Ministry of Education (MoE) may have had downstream consequences if this study's results had not been shared with the Ministry of Health (MoH) and acted upon. The partnership was not perceived to have increased the efficiency of the process, perhaps as a result of unclear or absent guidelines around roles and responsibilities. Conclusion: The health and functioning of global health partnerships can be evaluated using the framework and approach presented here. Network theory and methods added value to the conceptual and analytic processes and we recommend applying this approach to other global health partnerships to ensure that they are meeting the complex challenges they were designed to address. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine well as for full immunisation of two doses., Methods: For HPV costing, both top-down and micro-costing approaches were used, depending on the cost data source, and economic costs were gathered from Expanded Programme for Immunisation Costing and Financing Project (EPIC). Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, district and provincial levels., Results: Findings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest cost economic cost at USD13.2 per dose and USD 26.4 per fully immunised child (FIC). Overall financial costs were US$6.0 per dose and US$11.9 per fully immunised child. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$46.0 per FIC. The main cost drivers were human resources, building overhead and vehicles, microplanning, supplies and service delivery/outreach. were the top cost drivers. Nurses, environmental health technicians and community-based volunteers were the most involved in HPV vaccination., Conclusions: Future planning in Zambia and other African countries conducting HPV vaccination needs to prioritise these cost drivers as well as possibly find strategies to minimise some costs. Although not a challenge now due to Gavi support, vaccine costs are a major threat to sustainability in the long run. Countries like Zambia must find strategies to mitigate against this., Competing Interests: Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.