ARISE — African Routine Immunization Systems Essentials

Ann Larson was the Team Leader for an in-depth study of routine immunization performance in four districts in Ghana.  The research was part of a larger study of three countries to advance understanding of the factors contributing to successful routine childhood immunization performance.  Although African countries have achieved solid advances in immunization programming in the past ten years (e.g., increasing coverage rates, reducing measles mortality and introducing new vaccines against common childhood killers), the underlying reasons behind improvements in immunization performance in certain countries or districts and not others are still not well understood.

Routine immunization (RI), an ongoing system that provides timely protection to all  children born in a single country, is the core of these immunization efforts.  The Africa Routine Immunization System Essentials (ARISE) project was created to learn from the countries whose RI systems are performing well by documenting their experiences and  consolidating them into a body of evidence.

Established in late 2009, ARISE is managed by the JSI Research & Training Institute, Inc. (JSI). Literature reviews, the case studies such as the ones in Ghana and stakeholder mapping generated an understanding of how practices and interventions in RI systems are introduced, adapted, diffused, and scaled up, and how they contribute to sound and sustained performance in Africa.  See these and other ARISE outputs at

ARISE found that successful routine immunization services are not possible without commitment by the government and donor partners and essential EPI infrastructure such as fuel and vaccines available at the district and sub-district.  However, for coverage rates to raise above a threshold of 65-75 per cent to near universal coverage, more effort is needed. Drawing from the fieldwork in Ethiopia and Cameroon as well as Ghana, the findings point to the importance of well-managed district health systems which engage the community and support community-based workers to adapt delivery to suit local needs.

Ann is currently working with JSI colleagues to translate ARISE findings into a Theory of Change model for reaching and maintaining high coverage through routine immunization services.



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