Enhancing coverage and sustainability of vaccination programs: an explanatory framework with special reference to India.

The article addresses the question in what form and under what conditions vaccination programs can be expected to continue once the 'take off' period is over. This matter is of great importance because of the need to continuously vaccinate new cohorts of children with a high degree of coverage and in an appropriate manner. Using data from India, where vaccination programs are integrated in regular health care delivery, an explanatory framework is presented which, first, analyses the vaccination program in terms of different levels, organizational cultures and inner-level linkages and, second, addresses the relation between the program and its socio-cultural context. The analysis provides starting points for changes that could enhance coverage and sustainability. Such changes include alterations in program design and adjustments in the views of different categories of program staff. The article discusses strategies directed at achieving such changes.