{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:18:16Z","timestamp":1793906296979,"version":"4.8.0"},"reference-count":29,"publisher":"BMJ","issue":"2","funder":[{"name":"Gavi, the Vaccine Alliance"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2019,1,4]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region\u2019s population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria\u2013pertussis\u2013tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization.<\/jats:p>","DOI":"10.1136\/bmjgh-2018-001248","type":"journal-article","created":{"date-parts":[[2019,3,30]],"date-time":"2019-03-30T10:44:07Z","timestamp":1553942647000},"page":"e001248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5177-870X","authenticated-orcid":false,"given":"Helen","family":"Saxenian","sequence":"first","affiliation":[{"name":"Independent consultant, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahad","family":"Sadr-Azodi","sequence":"additional","affiliation":[{"name":"United Nations Children's Fund, Regional Office for the Middle East and North Africa, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miloud","family":"Kaddar","sequence":"additional","affiliation":[{"name":"President, MK International Consulting, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamel","family":"Senouci","sequence":"additional","affiliation":[{"name":"United Nations Children's Fund, Regional Office for the Middle East and North Africa, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,3,30]]},"reference":[{"key":"2025072914452090000_4.2.e001248.1","unstructured":"World Bank Middle East and North Africa region . 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Available: https:\/\/infographics.economist.com\/2018\/DemocracyIndex\/"},{"key":"2025072914452090000_4.2.e001248.19","unstructured":"See the indicator percent change GDP constant prices in the International Monetary Fund, World Economic Outlook , 2018. Available: https:\/\/www.imf.org\/external\/pubs\/ft\/weo\/2018\/01\/weodata\/index.aspx [Accessed 13 May 2018]."},{"key":"2025072914452090000_4.2.e001248.20","unstructured":"WHO Global Health Expenditure Database , 2018. Available: http:\/\/apps.who.int\/nha\/database [Accessed 6 June 2018]."},{"key":"2025072914452090000_4.2.e001248.21","unstructured":"World Bank , 2017. World development indicators. Available: http:\/\/databank.worldbank.org\/data\/reports.aspx?source=world-development-indicators [Accessed 1 Dec 2017]."},{"key":"2025072914452090000_4.2.e001248.22","unstructured":"WHO UNICEF Joint Reporting Form , 2018. 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Available: https:\/\/www.who.int\/immunization\/programmes_systems\/procurement\/v3p\/platform\/module2\/V3P_Region_Fact_Sheet_EMR.pdf?ua=1 [Accessed 22 Jan 2019]."},{"key":"2025072914452090000_4.2.e001248.27","unstructured":"IMF The Economic Impact of Conflicts and the Refugee Crisis in the Middle East and North Africa , 2016. Staff discussion note. Available: https:\/\/www.imf.org\/external\/pubs\/ft\/sdn\/2016\/sdn1608.pdf [Accessed Sep 2016]."},{"key":"2025072914452090000_4.2.e001248.28","unstructured":"See the expansion of the vaccine independence Initiative (VII): protecting children with life-saving supplies. 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