Comparison of Country Immunization Contexts in Vietnam, Tanzania, and Zambia

Health systemVietnam’s health system consists of 5 main levels: national, regional, provincial, district, and commune. The MOH establishes policies, manages national and regional hospitals/institutes, and provides general oversight of the health system.Tanzania’s health sector operates under the MOHCDGEC, and the President’s Office - Regional Administration and Local Government plays a prominent role in implementations.Zambia’s MOH provides national policy and technical guidance, which is then interpreted at a provincial level to support hospital and district health management teams.
Immunization programThe NEPI was established in 1985 to provide free immunization services to protect children from the most common infectious diseases.
Despite high vaccination coverage, the country faced vaccine data quality challenges, and increasing urbanization and immigration made it challenging to ensure every child received all lifesaving vaccines.
The Immunization and Vaccine Development Program of the MOHCDGEC focuses on administration, M&E, cold chain and logistics, routine immunization, and training.23
Despite high vaccination coverage, the country faces challenges related to subnational inequalities in coverage, low uptake of new vaccines, inaccurate target populations, and insufficient data use.24
Since the mid-1990s, Zambia has decentralized many health services, including immunization, to its 9 provinces and 72 districts. In recent years, Zambia has improved its immunization service delivery and sustained high coverage rates.
However, the country still faces service delivery challenges, including highly mobile populations, vaccine-preventable disease outbreaks, subnational coverage inequalities, and data quality challenges.25
Immunization data and reportingBefore nationwide scale-up of Vietnam’s EIR in 2017, most health facilities across the country used paper-based forms to record, manage, and manually plan for immunization delivery, stock management, and reporting. The paper-based forms were often missing data, time consuming and laborious to complete, and a barrier to complete reporting and efficient vaccine stock management.26 Now all immunization facilities capture data in the National Immunization Information System. Some facilities have transitioned to paperless reporting (using only the EIR), but most use parallel paper-based and electronic systems.Before the launch of its EIR in 2016, Tanzania’s immunization information system was paper-based at the facility level and digital from the district level up. At the facility level, health workers recorded monthly reports on paper before submitting them to district managers who entered digital reports into the DHIS2 system. In addition to the DHIS2, the Excel-based District Vaccine Management Tool and the Stock Management Tool supported immunization service delivery.10 Where the Tanzania Immunization Registry has been introduced, most facilities are using it in parallel to these paper-based tools. Facilities in 2 regions have transitioned to paperless reporting.In Zambia, facility health care workers capture immunization data using paper-based forms and submit a monthly report of aggregate data to the district using the HIA2 form.11 At the district, data are entered into the DHIS2, the country’s primary health information system.27 The facility paper-based forms continue to be the standard and are used in parallel to the Zambia EIR where it has been introduced.
Vaccination coverage of childrena
 Third dose of DTP83%81%91%
Birth cohort1.4 million (2022)292.3 million (2022)30683,355 (2022)31
National digital health market maturityb222
  • Abbreviations: BCG, bacille Calmette-Guerin; DHIS2, District Health Information Software 2; DTP, diptheria-tetanus-pertussis; EIR, electronic immunization registry; HIA2, Health Information Aggregation 2; M&E, monitoring and evaluation; MOH, Ministry of Health; MOHCDGEC, Ministry of Health, Community Development, Gender, Elderly and Children; NEPI, National Expanded Program on Immunization.

  • a World Health Organization/UNICEF estimates from 2021.28

  • b Based on a 5-point scale where 1 is the lowest maturity and 5 is the highest maturity.32