Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies
JSI staff and the ARISE project conducted in-depth case studies to gain a deeper understanding as to why routine immunization coverage improves in some settings in Africa and not in others. In-depth case studies were used to determine pathways to routine immunization coverage improvement by comparing immunization programme experience in 12 districts in three countries. Research was conducted in Ethiopia, Cameroon and Ghana. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance.