The Expanded Program on Immunization (EPI) in Pakistan protects against eight
vaccine-preventable diseases and immunizes children below 23 months of age. The
program was implemented under the Ministry of Health (MOH) until July 11, 2011,
when Amendment 18 to the constitution devolved health as a subject completely to the
provinces. Currently, the EPI is managed and implemented at the provincial level with
coordination provided by the Ministry of Inter Provincial Coordination.
During the last decade, EPI performance has been stagnant with only 40–60 percent of
children receiving the vaccines age-appropriately. Vaccine preventable diseases are still a
major cause for the high infant and child mortality rates in Pakistan. Evidence suggests
that underachievement of the EPI is due to a combination of factors including; inadequate
performance in the areas of service delivery, program management, monitoring and
evaluation, logistics control, human resources management and financing, as well as
community health-seeking behaviors and other demand-side issues.
An assessment of the EPI was conducted at the request of the Secretary of Health,
Government of Pakistan from January to June 2011, by a group of independent local and
international experts. The assessment provided recommendations to improve program
performance in the short and medium terms within the context of the newly devolved
health sector.
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The recommendations include (i) increasing focus on supervision, monitoring and
evaluation, (ii) considering performance-based incentives, (iii) exploring partnerships
with the private sector, (iv) expediting polio eradication initiatives, (v) improving
management, (vi) increasing targeted capacity development, (vii) concentrating on the
target age group for immunization, (viii) developing socially acceptable strategies, (ix)
developing a human resource strategy and implementation plan, and (x) improving
planning at the local level.