From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization
Summary: Ensuring sufficient financial resources for improving effective and efficient procurement of vaccines was highlighted by the Immunization Agenda 2030, which is particularly challenging for middle-income countries (MICs) that are ineligible for support from Gavi, the Vaccine Alliance. In res...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606525001877 |
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| author | Khanh Phuong Nguyen The Due Ong Xinyu Zhang Tra My Do Thi Quynh Trang Do Shenglan Tang |
| author_facet | Khanh Phuong Nguyen The Due Ong Xinyu Zhang Tra My Do Thi Quynh Trang Do Shenglan Tang |
| author_sort | Khanh Phuong Nguyen |
| collection | DOAJ |
| description | Summary: Ensuring sufficient financial resources for improving effective and efficient procurement of vaccines was highlighted by the Immunization Agenda 2030, which is particularly challenging for middle-income countries (MICs) that are ineligible for support from Gavi, the Vaccine Alliance. In response to the broader decentralization of the governance system and decreased international development aid, the central government of Vietnam decentralized the responsibility of financing the Expanded Program on Immunization (EPI) to provincial governments in 2023 but rapidly reversed it considering its following negative consequences, for example, severe vaccine stockouts and the largest decline in childhood immunization coverage in over 20 years. This paper analyzed the consequences closely linked to decentralization in Vietnam, the underlying reasons, and lessons for other MICs. To avoid recurrence, MICs should ensure the primary role of the central government in EPI financing and management, improve the local management capacity, and allocate more resources toward less-developed areas to narrow the intra-country disparities. |
| format | Article |
| id | doaj-art-ce9c4f0bd6994512b86dc1047993c2b6 |
| institution | Kabale University |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-ce9c4f0bd6994512b86dc1047993c2b62025-08-20T03:43:55ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-08-016110164810.1016/j.lanwpc.2025.101648From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on ImmunizationKhanh Phuong Nguyen0The Due Ong1Xinyu Zhang2Tra My Do3Thi Quynh Trang Do4Shenglan Tang5Health Strategy and Policy Institute, Ministry of Health, Hanoi, VietnamHealth Strategy and Policy Institute, Ministry of Health, Hanoi, VietnamGlobal Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Corresponding author. Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, 215316, China.Health Strategy and Policy Institute, Ministry of Health, Hanoi, VietnamHealth Strategy and Policy Institute, Ministry of Health, Hanoi, VietnamGlobal Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA; SingHealth Duke-NUS Global Health Institute, Duke-NUS, SingaporeSummary: Ensuring sufficient financial resources for improving effective and efficient procurement of vaccines was highlighted by the Immunization Agenda 2030, which is particularly challenging for middle-income countries (MICs) that are ineligible for support from Gavi, the Vaccine Alliance. In response to the broader decentralization of the governance system and decreased international development aid, the central government of Vietnam decentralized the responsibility of financing the Expanded Program on Immunization (EPI) to provincial governments in 2023 but rapidly reversed it considering its following negative consequences, for example, severe vaccine stockouts and the largest decline in childhood immunization coverage in over 20 years. This paper analyzed the consequences closely linked to decentralization in Vietnam, the underlying reasons, and lessons for other MICs. To avoid recurrence, MICs should ensure the primary role of the central government in EPI financing and management, improve the local management capacity, and allocate more resources toward less-developed areas to narrow the intra-country disparities.http://www.sciencedirect.com/science/article/pii/S2666606525001877Expanded Program on ImmunizationDecentralizationFinancingManagementMiddle-income countriesVietnam |
| spellingShingle | Khanh Phuong Nguyen The Due Ong Xinyu Zhang Tra My Do Thi Quynh Trang Do Shenglan Tang From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization The Lancet Regional Health. Western Pacific Expanded Program on Immunization Decentralization Financing Management Middle-income countries Vietnam |
| title | From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization |
| title_full | From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization |
| title_fullStr | From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization |
| title_full_unstemmed | From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization |
| title_short | From decentralization to re-centralization: lessons learned from Vietnam's rapid reversal in the financing of the Expanded Program on Immunization |
| title_sort | from decentralization to re centralization lessons learned from vietnam s rapid reversal in the financing of the expanded program on immunization |
| topic | Expanded Program on Immunization Decentralization Financing Management Middle-income countries Vietnam |
| url | http://www.sciencedirect.com/science/article/pii/S2666606525001877 |
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