Public Health
Learnings from supplementary immunization activities to improve routine immunization in Balochistan
By Haroon Rasheed Kasi & Muhammad Shehzad Shareef
Balochistan has the lowest rate of fully immunized children in Pakistan. However, applying best practices from supplementary immunization activities (SIAs) to routine immunization (RI) can help change that.

Immunization coverage in Balochistan stands at 38%1- the lowest in Pakistan2. The province faces unique challenges in increasing routine immunization: it is the largest province in terms of land area but the least populated3. This means that vaccinators in Balochistan must travel long distances to vaccinate each child.


There is hope however. Mass vaccination campaigns - called SIAs - have proved effective in improving immunization coverage in Balochistan. During these campaigns, health workers establish additional outreach service points (e.g., for measles vaccination) or go door-to-door (e.g., for polio vaccination) to vaccinate children.


Number of children vaccinated on routine immunization vaccines in outreach campaign vs. routine months, 20214


Number of COVID-19 vaccines administered in Balochistan, 20215


Applying three learnings from SIAs can help improve routine immunization:

  1. Resource mobilization: Allocation of travel allowances during SIAs incentivizes vaccinators to conduct outreach vaccinations effectively. However, during RI outreach activities, these allowances are either not paid are delayed. Ensuring timely and complete disbursement of travel allowances can help increase coverage through outreach activities.
  2. Better planning: For SIAs, the Health Department leverages the polio program’s expertise and field staff to develop guidelines on resource utilization, timelines, and targets of specific areas. Collaboration with the polio program on RI outreach planning can help Balochistan improve its immunization coverage.
  3. Enhanced supervision: During SIAs, Union Council (UC) health staff - such as paramedics and doctors - are responsible for monitoring vaccination activities. However, this UC-level monitoring and supervision is absent for RI. Utilizing the existing supervisor workforce or recruiting new supervisors to increase supervision can lead to better implementation of the routine outreach plans.


Despite better outcomes, SIAs require intensive planning and resources and, hence, are unsustainable over an extended period of time. However, applying learnings from SIAs to routine immunization can help strengthen routine immunization.



1 TPVICS’20. Note: Fully immunized child (FIC) denotes having received all vaccines from birth to 9 months excluding rota


3 Pakistan Population Census 2017

4Provincial EPI Balochistan

5COVID19 Operations Cell, Health Department, Balochistan.

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