Drawing on key informant interviews (KIIs) and focus group discussions (FGDs) with more than 200 vaccinators, health facility managers, subnational and national stakeholders, the report details how immunization service delivery functioned before the funding cuts, the disruptions that followed, and the consequences for coverage, equity, and system performance. Major impacts include significant reductions in the immunization workforce due to the loss of stipends; dramatic shifts in service delivery modalities, moving away from outreach and mobile strategies toward fixed-post sessions; delays and increased costs for last-mile vaccine transport and distribution, resulting in more frequent stockouts and session cancellations; and, incomplete, compromised and/or delayed data for tracking coverage and planning. In the countries assessed, there is already evidence of declining coverage rates and loss progress in reaching zero-dose children.

Findings are presented both across countries and in country-specific sections, illustrated with direct quotes from anonymized participants. The report concludes with a discussion on the most actionable findings for governments, donors and implementing partners seeking to rapidly recover coverage and prevent further losses.

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At Results for Development (R4D), Ms. Gaspard is a senior program associate providing technical, program management and operational support for the Strategic Purchasing Africa Resources (SPARC) initiative. SPARC aims to strengthen strategic purchasing expertise in sub-Saharan Africa and move countries closer to universal health coverage.

Before joining R4D, Naomi worked as a research assistant for the Global Health Justice and Governance Program at Columbia University where she supported a mixed-methods reproductive health study in Kenya, Madagascar and Nepal. Ms. Gaspard has worked at the United Nations Population Fund (UNFPA), International Women’s Health Coalition, Planned Parenthood Federation of America and served as an AmeriCorps member in Washington.

Ms. Gaspard holds an MPH in health policy and management from Columbia University and a BA in psychology from the College of the Holy Cross. She is a native speaker of English and speaks French and Haitian Creole.

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At Results for Development, Dr. Tonoukouen is Benin Project Lead for the African Collaborative for Health Financing Solutions (ACS). He manages and directs all aspects of the ACS project in Benin. He is responsible for: managing team members; working with the executive team to develop strategy, workplan and reporting tools for ACS; developing and managing relationships with partners; and overseeing project staff recruitment.

Throughout his career, Dr. Tonoukouen has focused on improving quality of care for people living with HIV/AIDS. He contributed to the reduction of mother to child HIV/AIDS transmission in Benin and scaling up HIV care by implementing a framework for health system strengthening to achieve universal health coverage. He was awarded the Cooperation for Development prize by the city of Antwerp, Belgium in 2013.

Dr. Tonoukouen is a medical doctor and holds a master’s degree in public health from the Institute of Tropical Medicine of Antwerp, Belgium. He also studied public management from University of Arkansas. He is a native speaker of French and speaks fluent English.

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Since joining R4D in 2018, Ms. Ewald has managed immunization, COVID-19, and learning activities under USAID’s Health Systems Strengthening Accelerator, including overseeing immunization system strengthening activities in Guinea and Togo, managing qualitative assessments of nine countries’ efforts to integrate COVID-19 vaccination into their routine immunization systems, overseeing the design and launch of USAID’s Health Systems Strengthening Case Competition, and synthesizing project-wide learning around health equity, subnational stakeholder engagement, social and behavior change, and collaborative learning. Ms. Ewald managed technical workstreams around vaccine hesitancy, private sector engagement, decentralization, and human resource capacity development under the Gavi and Gates Foundation’s Learning Network for Countries in Transition (now Gavi’s Linked Immunisation Action Network). She also conducted qualitative research funded by the Gates Foundation on strategies and challenges for promoting the use of statistical models for health decision making and supported a consultative process to inform the Global Financing Facility’s private sector strategy.

Under FAN, Leah is currently managing the launch of a network of regional NCD Financing Accelerators in Sub-Saharan Africa and Latin America and the Caribbean that provide countries with tailored, on-demand technical assistance, cross-country learning opportunities, and catalytic seed funding to promote NCD financing. She also supports measurement and evaluation activities for R4D’s health financing portfolio in Nigeria.

Before joining R4D, Ms. Ewald was an immunization program officer working on USAID’s Maternal and Child Survival Program at John Snow, Inc., where she supported a learning agenda around improving the generation, quality and use of routine immunization data in 11 countries, as well as backstopping the global immunization team and country teams in Kenya and Madagascar.

Ms. Ewald holds an MS in public health and an MA in international relations and economics from Johns Hopkins University, and a BA in anthropology from Washington University in St. Louis. She is a native English speaker and speaks Spanish and French.

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At Results for Development, Mr. Yemane is a senior program officer overseeing the Strategic Purchasing Africa Resources (SPARC) initiative and the Joint Learning Network (JLN) for Universal Health Coverage. He provides technical and program management leadership on SPARC, a new initiative to strengthen strategic purchasing expertise in sub-Saharan Africa and move countries closer to universal health coverage. As a technical facilitator for the JLN Provider Payment Initiative, Mr. Yemane works with JLN countries to identify practical challenges and creative solutions related to health care provider payment systems in support of integrated health service delivery.

Before joining R4D, Mr. Yemane was a technical advisor with Population Services International (PSI), providing technical and program management support to the implementation of maternal/child health, reproductive health, and malaria service delivery programs. Most recently, he was based in Madagascar with PSI where he managed a USAID- funded integrated social marketing program that supported the delivery of essential health products and services with a focus on reaching rural and underserved areas. In this role, he designed and implemented a community-based supply chain strategy, spearheaded a WASH strategic plan,and led development of annual implementation plans and project reports.

Mr. Yemane holds an MA in international relations from Webster University and BA in political science from Saint Louis University. He speaks English and is conversational in French.

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