title: Efficiency of immunization service in the Gambia: results of a stakeholder analysis.
abstract: OBJECTIVE
  The literature demonstrates that conducting a stakeholder analysis to better understand the immunisation context and to involve the stakeholders in the assessment improves the quality and relevance of the assessment and increases the use of results by policy makers thereby ensuring that the programme provides efficient services. This stakeholder analysis is part of a study to assess the sustainability of the expansion of the expanded programme of immunisation in The Gambia. This paper reports and discusses the results of the study on the dimension of attaining high levels of technical efficiency of immunization programmes. Methods: The study, was conducted on the Immunisation service of the Gambia in West Africa.
  
  
  METHODS
  The method used was a series of in-dept interviews with sixteen key stakeholders at the central, divisional and facility levels. A stakeholder analysis tool that incorporates key indicators of financial sustainability of the EPI was used in the interviews.
  
  
  RESULTS
  Results show that overall the majority of stakeholders strongly support the use of additional resources for implementing several actions (indicators) that can foster the financial sustainability of the EPI, including those that fall under the dimension of efficient immunisation services. Results further demonstrate that wastage is a very serious problem in the immunization system, which stakeholders generally felt is unacceptable. The causes could be grouped into four groups of factors: staff factors, resource factors, client factors and management/policy factors.
  
  
  CONCLUSIONS
  Inefficiencies in the immunisation system, leading to, amomg other things, wastage of resources make expenditures in the EPI system unsustainable for a country that is experiencing slow economic growth and decreasing donor support. More intensified efforts to minimise the inefficiencies are needed to bring about more significant changes for the better
authors.affiliation: Department of Nursing & Reproductive Health, University of the Gambia, West Africa. frasarr@yahoo.com
authors.forename: Francis
authors.initials: F
authors.lastname: Sarr
mesh_terms: D017598:Efficiency, Organizational; D005260:Female; D005714:Gambia; D006291:Health Policy; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration*; D007407:Interviews as Topic; D008297:Male; D011314:Preventive Health Services / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014612:Vaccines / Q000191:economics / Q000600:supply & distribution*
chemical_list: D014612:Vaccines