Countries: Cameroon, Ethiopia, Ghana
Client(s): Bill & Melinda Gates Foundation
Services: Assessment, Monitoring, Evaluation, and Research
Technical Expertise: Maternal, Newborn & Child Health, Immunization
Promising interventions and innovations to improve the performance of routine immunization systems are underway throughout Africa, but many have not been systematically captured nor shared. From 2009 to 2012, the Africa Routine Immunization System Essentials - ARISE - project reviewed and documented existing evidence and conducted case studies in 12 districts across Africa to identify and explore factors that drive routine immunization coverage improvement. Funded by the Bill & Melinda Gates Foundation, JSI Research & Training Institute worked with Dartmouth University (USA), George Washington School of Public Health (USA), Makerere School of Public Health (Uganda), ministries of health and global stakeholders under ARISE to translate findings into strategies and investment options to optimize available resources to support routine immunization in sub-Saharan Africa. The ARISE project had two components: Systems strengthening and system innovation.
The Africa Routine Immunization System Essentials (ARISE) project was created to assemble and expand the evidence base about what drives strong routine immunization (RI) system performance in Africa.
In contrast with the typical approach of assessing programs by focusing on deficiencies and obstacles, ARISE employed an assets-based approach to identify factors contributing to routine immunization coverage improvements and to learn how and why they worked within specific settings. Through in-depth studies at district level in three countries, ARISE asked: “Why did coverage improve in some districts and remain unchanged in other districts? What drives coverage improvement?"
In the first year of the ARISE project, a landscape analysis was conducted to examine written documentation and existing data on RI systems in Africa, and to seek input from implementers and technical and development partners to improve understanding of the drivers of system performance. To confirm the relevance of these drivers and better understand how they work in practice, ARISE conducted in-depth studies of selected districts in Ghana, Cameroon, and Ethiopia. Through a mixed methods case study approach ARISE partners undertook a consultative process of investigation to build on and contribute to the evidence base and to generate solutions to both old and new challenges. The articulation of strategies and steps to improve performance based on ARISE will involve a process of reflecting on the findings from these in-depth studies with global and local stakeholders.