Impact of an Emergency Strategy to Revitalize the Routine Immunization System of the Democratic Republic of the Congo, the “Mashako Plan” Policy

Background: Vaccines have been a major medical achievement in modern history, significantly reducing the spread of infectious diseases worldwide. Routine immunization (RI) systems have become a global standard for providing consistent access to vaccination services and protecting communities against vaccine-preventable diseases. The Democratic Republic of Congo (DRC) is the largest country in sub-Saharan Africa with an estimated population between 86 to 106 million and a median age of 17 years. DRC has struggled with low vaccination coverage, with only 35-45% of children being fully immunized for all antigens in the DRC RI schedule. To address this challenge with childhood immunization coverage, the Congolese government, DRC national immunization program worked in conjunction with international partners to develop the Mashako Plan, an emergency strategy to revitalize the routine immunization system. The policy targets key areas such as vaccine availability, equity in vaccination services, monitoring and evaluation, workforce development, and data quality and management. Since its initial rollout of the Mashako Plan in 2018, there have been very few formal evaluations to understand the impact of the policy on the DRC RI system. Methods: By utilizing monthly District Health Information Software 2 (DHIS2) administrative data and Expanded Programme on Immunizations (EPI) mobile supervision data, this study assesses the efficacy of the Mashako plan on the RI system in the DRC. Descriptive analyses of the EPI mobile supervision data identify trends in RI process indicators and an interrupted time series analysis assesses the impact of the Mashako plan on vaccine doses administered for pentavalent (penta) vaccine doses 1 and 3 and measles vaccine. Pentavalent vaccine is a conjugate vaccine that includes Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib and is given at 6, 10 and 14 weeks in the DRC RI system. Furthermore, a comparative interrupted time series analysis determines the effect of the rotavirus vaccine on ...