The Issue

Although tremendous progress has been made in vaccination programming in the last decade, those programs are still unable to reach all children with the necessary vaccines. To address this issue, UNICEF and the Bill & Melinda Gates Foundation have convened a high-level Equity Reference Group for Immunisation (ERG). This group is in place to generate innovative ideas and to accelerate progress on equity in immunisation, leveraging expertise from WHO, GAVI, World Bank, BMGF and UNICEF with academics and senior leaders. One of ERG's four priority areas of work is gender-related inequities and barriers to immunisation.

Immunisation is widely perceived as gender-neutral, yet in many countries, there are distinct gender barriers at both household and community levels. The drivers of these gender barriers are multifaceted – influenced by factors such as; household status impacting resource allocation and decision-making making capacity, health literacy, mobility and lack of access to health centres, as well as women's experience of quality of services deterring attendance.

Why Does it Matter?

Article 24 of the UN Convention on the Rights of the Child states that all children have a right to life and health. Similarly, the UN Sustainable Development Goals have set targets to end all preventable deaths under five years of age; and achieve universal health coverage, which aims to achieve equitable access to healthcare services for all men and women. One of the means to achieving this target is to support research, development and universal access to affordable vaccines and medicine.

Immunisation averts millions of deaths every year. In 2020, global coverage rates for the third dose of diphtheria, tetanus-pertussis vaccine (DTP3) and the first dose of measles-containing vaccine (MCV1) reached 83 per cent and 84 per cent of all children globally, respectively. However, the Covid-19 pandemic and associated disruptions strained health systems in 2020, resulting in 22.7 million children missing out on vaccination, 3.7 million more than in 2019 and the highest number since 2009.

Knowing where children are in order to get them vaccinated is one part of the puzzle (which we are working on in our Population Estimation Project). Understanding the barriers to getting them vaccinated, mapping those barriers and looking at the relationship between these barriers and immunisation coverage is another part of the puzzle that can support tailoring equity-focussed strategies to increase immunisation coverage.

Our Project

This project aims to strengthen the availability of timely and granular data to identify gender-related barriers to immunisation better and inform targeted pro-equity strategies. Geographic Information Systems (GIS) allow the linkage of existing data sources on population characteristics, health outcomes and health infrastructure to provide insights into the determinants of health inequities.

The team will look at a range of data and methods, using proxy indicators where required, to map the social and physical gender barriers to immunisation identified by the ERG. For example, the Data for Children Collaborative recently delivered a project to use GIS to look at travel time to health centers for children living in poverty, generating travel time maps in a number of countries in Sub-Saharan Africa. Leveraging the tools created from that project, we can use those maps to validate whether there is a relationship between travel time and immunisation coverage.

This project will:

• identify existing georeferenced datasets to capture the spatial distribution,

• identify two GAVI priority countries with sufficient georeferenced data available to undertake analysis,

• map travel time to health services using the model created as part of the Child Poverty Access to Services project,

• create a map of georeferenced indicators/proxy indicators identified by the ERG using existing methods, look at the need to develop new methods and identify new/additional proxies,

• map vaccination coverage and barriers data along with maps of population density,

• produce a technical report for dissemination documenting the methodology and the analysis performed for the two focus countries, including assumptions and caveat for future replication to other countries.

Theme

Poverty

Who is involved

• The University of Edinburgh

• UNICEF

Estimated delivery dates

February 2023 – September 2023

Our Outputs