Overarching Priority Actions Identified to Drive Further Integration in RI and PHC

Leadership and governance
  • Clearly outline the national strategic long-term view on the future of COVID-19 vaccination and how this translates into country-specific support programs and support activities.

  • Establish cross-sectoral collaboration forums and coordination mechanisms within ministries and national stakeholders and broader PHC partners at national and subnational levels to expand reach and service beyond immunization teams.

  • Define a national set of KPIs based on global KPIs to measure integration progress and effectiveness and monitor progress and reinforce accountability.

Financing and costing
  • Adjust in-country funds beyond COVID-19 vaccination needs to encompass integration into RI/PHC, including targeted health system strengthening measures required to lay the ground for integration.

  • Derive root causes of funds distribution and management at all levels and address bottlenecks to ensure all COVID-19 vaccination related funds are timely deployed and utilized.

Service delivery
  • Develop integration plans with context-specific objectives, targeted strategies to reach priority groups, and clear governance mechanisms (like national deployment and vaccination plans), leveraging behavioral and social driver tools and arranging targeted technical assistance support for plan development where needed.

  • Consider updating national health strategies/guidelines to position COVID-19 vaccination as part of standard patient care (e.g., integrate COVID-19 vaccination as part of standard HIV screening/treatment, NCD, and maternal, newborn, and child health clinics).

Health workforce
  • Map HCWs’ capacity across health care sites and services and identify gaps to facilitate sustainable COVID-19 vaccine integration.

  • Create training curricula for HCWs at all levels on both provision and value-integrated services to increase understanding of value proposition and compliment with service-specific recommendations as needed.

Data management
  • Adapt data platforms (e.g., DHIS2) to enable holistic integration of relevant health information systems and tools beyond immunization, including patient-facing and program management data requirements.

Supply chain and logistics
  • Conduct a facility-level assessment of vaccine storage capacity, cold chain capabilities, logistics, and transportation infrastructure to identify critical bottlenecks and define readiness to integrate COVID-19 vaccine.

  • Adapt vaccine handling and storage practices to prepare for integrated service delivery settings, including non-RI settings (e.g., TB/HIV screening, NCD clinics).

  • Adapt global guidelines on stock waste management (e.g., multidose vials policy) to account for integration-specific considerations.

  • Assess the impact of integration on logistics and distribution systems/practices (especially in non-health settings).

Demand generation and community engagement
  • Adapt and use proven COVID-19 behavioral and social driver tools (e.g., behavioral studies using phone surveys and focus groups) to understand context-specific behaviors, perceptions, and needs to not only optimize demand generation efforts but also implement integration strategies at all levels.

  • Develop a balanced strategy for long-term demand creation activities between COVID-19 vaccination (especially for high-priority groups) and RI/PHC services.

  • Abbreviations: HCW, health care worker; KPI, key performance indicator; NCD, noncommunicable disease; PHC, primary health care; RI, routine immunization.