The Expanded Program on Immunization(EPI) in Pakistan protects against eight vaccine-preventablediseases and immunizes children below 23 months of age. Theprogram was implemented under the Ministry of Health (MOH)until July 11, 2011, when amendment 18 to the constitutiondevolved health as a subject completely to the provinces.Currently, the EPI is managed and implemented at theprovincial level with coordination provided by the Ministryof inter provincial coordination. During the last decade,EPI performance has been stagnant with only 40-60 percent ofchildren receiving the vaccines age-appropriately. Vaccinepreventable diseases are still a major cause for the highinfant and child mortality rates in Pakistan. Evidencesuggests that underachievement of the EPI is due to acombination of factors including; inadequate performance inthe areas of service delivery, program management,monitoring and evaluation, logistics control, humanresources management and financing, as well as communityhealth-seeking behaviors and other demand-side issues. Therecommendations include: (i) increasing focus onsupervision, monitoring and evaluation, (ii) consideringperformance-based incentives, (iii) exploring partnershipswith the private sector, (iv) expediting polio eradicationinitiatives, (v) improving management, (vi) increasingtargeted capacity development, (vii) concentrating on thetarget age group for immunization, (viii) developingsocially acceptable strategies, (ix) developing a humanresource strategy and implementation plan, and (x) improvingplanning at the local level.
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