Systems innovation, ARISE’s second focal area, is designed to explore how routine immunization coverage in high-performing settings can be sustained and increased. The Global Immunization Vision and Strategy, developed by WHO and UNICEF, states that by 2010 or earlier, developing countries will reach at least 90% national vaccination coverage (of DTP3) and at least 80% vaccination coverage in every district or equivalent administrative unit. Although considerable progress has been made on achieving this goal over the last decade in African countries, it has not yet been met and there is real need to better understand how to achieve and sustain high vaccination coverage rates by reaching under-served children. With new, expensive vaccines being introduced into many countries, it is even more vital to learn from and document experience in the field.

Through a partnership with the Dartmouth Institute for Health Policy and Clinical Practice, the ARISE project’s systems innovation component seeks to explore what is needed for high-performing countries and districts to maintain and continue to improve levels of immunization coverage. ARISE is exploring this question through a straightforward, iterative, and ongoing learning process for health systems innovation and strengthening focusing on the routine immunization system. It is being developed collaboratively in Uganda and is exploring the contextual forces holding current levels of performance in place.

This effort is taking place in one district and five health units in Uganda which have demonstrated sustained high levels of immunization coverage. The approach seeks to challenge convention, assumptions, and long-held beliefs, and will enable the front line of immunization research to reexamine and test system innovations. The outcome of this work will determine whether a promising model can be created for improving routine immunization in the Uganda and more broadly in Africa.

There are four overall phases to this pilot learning initiative:

• PHASE I: Planning, partnership, advisory panel formation, and site selection (completed)
• PHASE II: Developing and adapting methodology and tools (completed)
• PHASE III: Introducing, testing, and refining the systems innovation model; building in-country ownership and facilitators of change  (ongoing)
• PHASE IV: Documenting, sharing, and spreading learning on the systems innovation model (ongoing)