Bangladesh’s Expanded Programme on Immunisation (EPI) is currently confronting a significant staffing shortfall, with 40% of vaccinator positions remaining unfilled, according to a recent joint review. This shortage is undermining the effectiveness of a programme previously hailed as a model of success in South Asia.
The findings were detailed in a report by a Joint Independent Review Team, which included experts from the World Health Organization (WHO), UNICEF, Gavi, the Vaccine Alliance, the health ministry, EPI officials, and public health specialists. Tasked with assessing the EPI’s performance amid outbreaks of measles and other infectious diseases, the team conducted field visits across Bangladesh’s eight divisions between October 3 and October 14.
The 70-member group, divided into nine teams, collected data from vaccination centres, schools, madrasas, and within communities, consulting mothers who had encountered barriers to vaccination and frontline health workers. The report highlighted critical issues including staffing gaps, inadequate vaccine storage and cold-chain management, uneven service coverage, and funding constraints—particularly for transportation and field operations.
Bangladesh’s EPI, launched in 1979, has long been recognized for its ability to deliver vaccines to large populations despite limited resources. However, the review found that staffing levels have not kept pace with the country’s demographic growth, urbanization, and expanded immunization demands. The report noted that although over 120,000 vaccination centres were mapped using GIS technology, their distribution is uneven, with remote and high-risk areas underserved.
Under the Urban Immunisation Strategy 2019 and the EPI Microplan 2024, the target staffing level calls for six vaccinators per 50,000 urban residents, approximately one vaccinator per 8,300 people. This benchmark has not been met, and the shortage has compromised the ability to conduct the required number of vaccination sessions—eight per month per ward and 24 outreach sessions per union.
The report also raised concerns about vaccine storage conditions. Dr. Tajul Islam A Bari, a public health specialist involved in the review, emphasized the risks posed by insufficient temperature control and inadequate funding for transporting vaccines from district to sub-district levels. He underscored the need to recruit more personnel and enhance cold-chain logistics to protect vaccine efficacy.
State Minister for Health and Family Welfare MA Muhit acknowledged the staffing deficiencies and affirmed the government’s commitment to recruiting personnel to address the gaps. He noted that the national immunisation programme’s strong monitoring systems had deteriorated over the past eight years, partly due to a lack of periodic independent reviews in that period. The recent assessment represents the first comprehensive evaluation in eight years, replacing the usual four- to five-year review cycle.
The state minister said that the expert team’s recommendations had been shared with civil surgeons and health directors nationwide, and steps were underway to implement necessary improvements in staffing, funding, and vaccine management to sustain and strengthen the programme’s achievements.