Submission ID 130918
| Issue/Objective | Health inequities persist due to upstream determinants embedded in governance systems, financing structures, political priorities, and power dynamics. In fragile and high-burden settings such as Ethiopia, these challenges manifest as uneven immunization coverage, weak surveillance sensitivity, and limited access to essential services among marginalized populations. Additional pressures-including misinformation, declining trust in science, population mobility, and climate-related risks-further widen these gaps. This project aims to examine how governance, leadership, and financial stewardship shape equitable access to immunization and disease surveillance systems, and to identify practical, system-level strategies to address these upstream determinants. |
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| Methodology/Approach | A mixed-methods implementation analysis was conducted, integrating quantitative data from national immunization and vaccine-preventable disease surveillance systems with qualitative insights from stakeholders at national, regional, and local levels. The study draws on operational experiences from supplementary immunization activities (SIAs), outbreak investigations, and emergency coordination platforms within Ethiopia's public health emergency management system. Data sources included routine surveillance reports, campaign monitoring data, and structured field observations from high-priority urban and underserved settings. The implementation period spanned 2024-2026, with technical collaboration from partners such as World Health Organization and Centers for Disease Control and Prevention. Policy and governance frameworks were also reviewed to assess alignment between national strategies and implementation realities. |
| Results | The findings reveal that upstream determinants significantly influence health equity outcomes. Key challenges identified include: • Fragmented governance and weak coordination across levels of the health system • Dependence on external financing, limiting sustainability and national ownership • Persistent misinformation and low community trust affecting service uptake • Inequitable distribution of health resources and workforce • Limited integration of climate and mobility considerations into planning At the same time, several system-level improvements were observed: • Strengthened coordination and accountability mechanisms across governance levels • Enhanced use of real-time data for decision-making and targeted interventions • Improved immunization coverage and identification of zero-dose children in high-risk populations • Increased effectiveness of community engagement and risk communication strategies |
| Discussion/Conclusion | The findings underscore that achieving health equity requires addressing upstream determinants through governance reform, strengthened leadership, and sustainable financing mechanisms. Disease-specific interventions alone are insufficient without systemic changes that improve accountability, coordination, and inclusivity. Investments in trust-building, community engagement, and combating misinformation are critical, particularly in immunization programs. Furthermore, integrating emerging priorities-such as climate change, population mobility, and digital health governance-into national health strategies can enhance system resilience and responsiveness. Experiences from Ethiopia highlight the importance of aligning global health financing and partnerships with national leadership to ensure context-driven, sustainable solutions. Scaling these approaches requires reinforcing public-private partnerships, decentralizing decision-making, and embedding equity-focused governance across all levels of the health system. This work directly contributes to the conference theme by demonstrating how governance, power, and leadership can be leveraged to address upstream determinants and advance equitable health outcomes in complex and resource-constrained settings. |
| Presenters and Affiliations | Yonas Assefa Tufa Ethiopian Public Health Institute (EPHI) Yonas Tufa Ethiopian Public Health Institute (EPHI) Fasika Argaw Kirkos Subcity Regional Health Office Yonas Assefa Tufa Ethiopian Public Health Institute (EPHI) |
