Peer-reviewed article

Does outsourcing improve immunisation coverage among children aged 12–24 months in Pakistan?

Shiraz Shaikh, Kashif Shafique · 29 Jan 2026

Summary

Written by AI, not yet AICS's view · claude-sonnet-5-5

In 2017, Pakistan handed management of the vaccination programme in two districts of Sindh Province to a non-government organisation. Between August and October 2024, researchers interviewed caregivers of 1,600 children aged 12–24 months in two outsourced and two non-outsourced districts. Full immunisation coverage was slightly higher in the outsourced districts, but the difference was not statistically significant. The authors describe the improvement as partial, because coverage was better in only one of the outsourced districts. They call for more research on the reasons for the differences and on cost-effectiveness.

Key points

Full immunisation coverage was 78.8% in outsourced districts and 75.8% in non-outsourced districts (P = 0.067, not significant).
At 9 months, compliance fell by 15.0% in outsourced districts and by 19.7% in non-outsourced districts (P = 0.036).
Coverage was better in only one of the two outsourced districts.
Data came from interviews with parents or caregivers of 1,600 children aged 12–24 months in 4 districts of Sindh Province.
The authors recommend research on the reasons for the differences and on the cost-effectiveness of outsourcing.

Limitations

The abstract describes a comparison of four districts after the programme was already running, and gives no baseline from before 2017. It does not say how districts were chosen or what other differences exist between them, so the gap cannot confidently be attributed to outsourcing. It also gives no cost data.

Abstract

Background: In 2017, Pakistan outsourced to a non-government organisation the management of its vaccination programme in 2 Sindh Province districts. Aim: To determine the impact on coverage of outsourcing vaccination programme in 2 districts of Sindh Province, Pakistan. Methods: Between August and October 2024, we interviewed parents or caregivers of 1600 children aged 12–24 months from 4 (2 outsourced and 2 non-outsourced) districts in Sindh Province, to collect sociodemographic and immunisation data. We analysed the data with STATA version 17, using chi-square test and Man-Whitney U test to compare the participants’ characteristics and immunisation status, and regression model to estimate the difference in immunisation rates between the 2 groups at 9 months. Results: Full immunisation coverage was slightly higher in the outsourced (78.8%) than the non-outsourced (75.8%) districts, but there was no statistically significant difference (P = 0.067). At 9 months, a significant difference (P = 0.036) was observed in immunisation rates: 15.0% decrease in compliance in the outsourced, compared to 19.7% in the nonoutsourced, districts. Conclusion: There was a partial improvement in vaccination coverage due to outsourcing: coverage was better only in one of the outsourced districts. There is a need for further research to understand the reasons for the slight differences in immunisation coverage between the outsourced and non-outsourced districts, and the cost-effectiveness of outsourcing.

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

Survival

Problem

Incomplete childhood immunisation coverage in children aged 12–24 months in Sindh Province, Pakistan

Intervention: Outsourcing management of the district vaccination programme to a non-government organisation, started in 2017
Population: Parents or caregivers of 1,600 children aged 12–24 months in 2 outsourced and 2 non-outsourced districts of Sindh Province

Key finding

Full immunisation was 78.8% in outsourced districts versus 75.8% in non-outsourced districts, not statistically significant (P = 0.067).