title: Impact of measles elimination activities on immunization services and health systems: findings from six countries.
abstract: BACKGROUND
  One of the key concerns in determining the appropriateness of establishing a measles eradication goal is its potential impact on routine immunization services and the overall health system. The objective of this study was to evaluate the impact of accelerated measles elimination activities (AMEAs) on immunization services and health systems in 6 countries: Bangladesh, Brazil, Cameroon, Ethiopia, Tajikistan, and Vietnam.
  
  
  METHODS
  Primary data were collected from key informant interviews and staff profiling surveys. Secondary data were collected from policy documents, studies, and reports. Data analysis used qualitative approaches.
  
  
  RESULTS
  This study found that the impact of AMEAs varied, with positive and negative implications in specific immunization and health system functions. On balance, the impacts on immunization services were largely positive in Bangladesh, Brazil, Tajikistan, and Vietnam, while negative impacts were more significant in Cameroon and Ethiopia.
  
  
  CONCLUSIONS
  We conclude that while weaker health systems may not be able to benefit sufficiently from AMEAs, in more developed health systems, disruptions to health service delivery are unlikely to occur. Opportunities to strengthen the routine immunization service and health system should be actively sought to address system bottlenecks in order to incur benefits to eradication program itself as well as other health priorities.
authors.affiliation: Department of Global Health and Development, LSHTM, Faculty of Tropical Medicine, Bangkok, Thailand. piya.hanvoravongchai@lshtm.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Hanvoravongchai
authors.forename: S
authors.initials: S
authors.lastname: Mounier-Jack
authors.forename: V
authors.initials: V
authors.lastname: Oliveira Cruz
authors.forename: D
authors.initials: D
authors.lastname: Balabanova
authors.forename: R
authors.initials: R
authors.lastname: Biellik
authors.forename: Y
authors.initials: Y
authors.lastname: Kitaw
authors.forename: T
authors.initials: T
authors.lastname: Koehlmoos
authors.forename: S
authors.initials: S
authors.lastname: Loureiro
authors.forename: M
authors.initials: M
authors.lastname: Molla
authors.forename: H
authors.initials: H
authors.lastname: Nguyen
authors.forename: P
authors.initials: P
authors.lastname: Ongolo-Zogo
authors.forename: U
authors.initials: U
authors.lastname: Sadykova
authors.forename: H
authors.initials: H
authors.lastname: Sarma
authors.forename: M
authors.initials: M
authors.lastname: Teixeira
authors.forename: J
authors.initials: J
authors.lastname: Uddin
authors.forename: A
authors.initials: A
authors.lastname: Dabbagh
authors.forename: U K
authors.initials: UK
authors.lastname: Griffiths
mesh_terms: D000349:Africa; D001208:Asia; D001938:Brazil; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards*; D005376:Financial Management; D014943:Global Health; D006280:Health Workforce / Q000191:economics / Q000592:standards; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000379:methods* / Q000639:trends; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000191:economics; D011159:Population Surveillance
chemical_list: D008458:Measles Vaccine