Related Resources

Integrating HCD in Subnational CEA v3 Nov 2020.pdf

Embedding a Human-Centred Design (HCD) Approach into Sub-national Coverage and Equity Assessments

Immunization Agenda 2030 underscores the importance of prioritizing underserved population groups and communities to improve immunization outcomes. This equity principle requires that PHC programmes systematically identify and reach the least visible and most marginalized communities to achieve the desired immunization coverage with equity. The Equity Reference Group (ERG) on Immunization recommends tailoring of interventions at subnational level to address immunization inequities. The immunization coverage and equity assessment (CEA) guidance note which elucidates the process of assessing equity within a country, is organized around three themes; identify, tailored strategies, and monitoring. This Journey to Health framework, which embeds Human-Centred Design (HCD), aims to facilitate equity assessments at subnational levels (provinces/districts/councils/communities) and can be used for the Reaching Every District and Every Community (RED-REC) planning cycle.

For more information or to share your comments and experiences of using this Concept Note, please contact Niklas Danielsson at ndanielsson@unicef.org.

UNICEF_CEA_Guidance_Note_Final_Field_test_Draft_for_review_NYHQ_10_June_2019.pdf

UNICEF Guidance: How to conduct a Coverage and Equity Assessment (CEA) of immunization services

The ERG Discussion Papers describe the contexts where most unvaccinated (zero dose) and incompletely vaccinated children are likely to live: in urban poor and remote rural communities, populations affected by conflict and societies where gender-related barriers restrict uptake of vaccination services. The relative importance of these contexts and barriers will differ from country to country, and there will be country specific determinants of vaccination to consider when planning pro-equity strategies. To help immunization programs identify key determinants of differences in vaccination use and select a set of pro-equity strategies for implementation, UNICEF has developed the Coverage and Equity Assessment Guidance Note. The document describes the data required for the evidence-based CEA process and provides a template for presenting the findings and recommendations. A CEA is typically performed as part of a program review, strategic planning or the development of a grant proposal. Intended users of the CEA Guidance Note include national immunization programs and their global partners.

For more information on how to conduct a CEA or to share your comments and experiences of using this draft CEA Guidance Note, please contact Niklas Danielsson at ndanielsson@unicef.org

Pro-Equity Immunization and Health Systems Strengthening Strategies for Potential use by Program Managers, Policy and Decision Makers

As part of the Implementation Research to Accelerate Immunization Coverage and Equity initiative (IR Accelerator) funded by Gavi, The Vaccine Alliance, the Implementation Research and Delivery Science (IRDS) Unit at UNICEF HQ conducted a global mapping of country-specific immunization and health system strengthening strategies implemented by select Gavi-supported countries to reach underserved children and populations, referred to as pro-equity strategies. Through a systematic search conducted manually and by using the qualitative analysis software MAXQDA Pro, over 250 pro-equity strategies were identified to have been implemented across 13 Gavi-supported countries over the period of 2016 to 2019. These strategies were identified using specific criteria and search terms which were then organized into a database and a dashboard, and organized using consolidated equity framework determinants and domains.

On the dashboard, data can be filtered by country and year of implementation according to any of the determinants and equity domains which include: legislation & policy, management & coordination, human resource, social norms, utilization, social context, healthcare and policy context, provider and recipient factors, among others. In addition, open search is enabled to facilitate quick access to strategies relevant to specific search term(s) of criteria. These functionalities are meant to assist policy makers and program managers in countries we support, as well as UNICEF colleagues and other stakeholders in identifying relevant pro-equity strategies that fit their context and needs. The dashboard also has, on its second page, recommended immunization supply chain interventions to enable coverage and equity in different settings. The IRDS team is available to assist countries interested to further contextualize some of these pro-equity strategies through implementation research to equitably reach the most vulnerable and zero-dose children.

For further information about the dashboard, contact health@unicef.org.