title: The impact of introducing new vaccines on the health system: case studies from six low- and middle-income countries.
abstract: OBJECTIVE
  We aimed to explore the impacts of new vaccine introductions on immunization programmes and health systems in low- and middle-income countries.
  
  
  METHODS
  We conducted case studies of seven vaccine introductions in six countries (Cameroon, PCV;Ethiopia, PCV; Guatemala, rotavirus; Kenya, PCV; Mali, Meningitis A; Mali, PCV; Rwanda, HPV). Inter-views were conducted with 261 national, regional and district key informants and questionnaires were completed with staff from 196 health facilities. Routine data from districts and health facilities were gathered on vaccination and antenatal service use. Data collection and analysis were structured around the World Health Organisation health system building blocks.
  
  
  RESULTS
  The new vaccines were viewed positively and seemed to integrate well into existing health systems. The introductions were found to have had no impact on many elements within the building blocks framework. Despite many key informants and facility respondents perceiving that the new vaccine introductions had increased coverage of other vaccines, the routine data showed no change. Positive effects perceived included enhanced credibility of the immunisation programme and strengthened health workers' skills through training. Negative effects reported included an increase in workload and stock outs of the new vaccine, which created a perception in the community that all vaccines were out of stock in a facility. Most effects were found within the vaccination programmes; very few were reported on the broader health systems. Effects were primarily reported to be temporary, around the time of introduction only.
  
  
  CONCLUSIONS
  Although the new vaccine introductions were viewed as intrinsically positive, on the whole there was no evidence that they had any major impact, positive or negative, on the broader health systems.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Helen E D
authors.initials: HE
authors.lastname: Burchett
authors.forename: Sandra
authors.initials: S
authors.lastname: Mounier-Jack
authors.forename: Sergio
authors.initials: S
authors.lastname: Torres-Rueda
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.forename: Pierre
authors.initials: P
authors.lastname: Ongolo-Zogo
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Edengue
authors.forename: Enrique
authors.initials: E
authors.lastname: Chavez
authors.forename: Yayehirad
authors.initials: Y
authors.lastname: Kitaw
authors.forename: Mitike
authors.initials: M
authors.lastname: Molla
authors.forename: Mamadou
authors.initials: M
authors.lastname: Konate
authors.forename: Lawrence
authors.initials: L
authors.lastname: Gelmon
authors.forename: Washington
authors.initials: W
authors.lastname: Onyango-Ouma
authors.forename: Mylene
authors.initials: M
authors.lastname: Lagarde
authors.forename: Anne
authors.initials: A
authors.lastname: Mills
mesh_terms: D002163:Cameroon; D003906:Developing Countries; D005002:Ethiopia; D006078:Government Programs / Q000191:economics / Q000458:organization & administration; D006166:Guatemala; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D007630:Kenya; D008302:Mali; D011634:Public Health; D012432:Rwanda; D014611:Vaccination / Q000706:statistics & numerical data*