Table 4.

Identifying the determinants of sub-optimal coverage of new vaccines in Mozambique

In 2015 Mozambique set out to introduce rotavirus vaccine, inactivated poliovirus vaccine (IPV) and MSD. The FCE team in Mozambique observed the planning for introduction closely, as the joint introduction of three vaccines was hypothesized to be a significant stretch of a relatively small national immunization programme. Through observation, document review and interviews, we concluded that the launch of these vaccines and their related activities (health worker trainings, communications activities, updating data systems) went smoothly in large part due to lessons learned from previous vaccine introductions (pentavalent in 2009; PCV in 2013) and high political will and commitment. However, using HMIS data, the FCE team observed that the number of doses administered of these new vaccines was lower than of the existing routine vaccines (Figure 5), prompting the development of a hypothesized RCA to identify potential root causes. Through meeting observation, interviews and document review, the team identified the following causes, illustrated in the final RCA (Figure 4): Late arrival of first-quarter vaccine consignments. Customs clearance challenges which protracted the procurement process. Lack of regional warehouses in the central and northern regions. Insufficient air transport capacity to deliver stock to central and northern regions. Global supply shortages of IPV. Because the FCE team was also continually tracking the process of implementing the country’s Health Systems Strengthening grant, they understood that many of the observed issues were caused by delays in receiving and implementing HSS funding from Gavi, which in turn had their own global and local root causes. The team’s ability to demonstrate the consequences of the HSS delays on vaccine coverage and suggest actionable recommendations led to changes in technical assistance in Mozambique and informed Gavi’s global reforms to HSS funding in 2016.