Routine from the Start
How Jordan’s health system paves the way for its successful vaccination program
“People in Jordan know when and where to get vaccines,” says a nurse from Abu Nssier Comprehensive Health Care Center, a primary health care center in Amman, Jordan.
Vaccines are considered a necessary and routine health service, thanks to the trust established between individuals and communities, and the health system. This sentiment is significant because many countries are now facing the challenge of fully vaccinating their children against highly contagious diseases like measles and polio.
Jordan’s strong vaccine policy has been in place for years, requiring all residents to receive routine vaccinations to protect the population from contagious and preventable diseases.
More than a third of Jordan’s population is from other countries. And at the Abu Nssier health center, more than 20 percent of the registered patients are refugees. Despite a diverse and transient population, Jordan hasn’t had a case of polio since 1992, nor measles and rubella since 2015. This is an accomplishment since cases of all three diseases have been reported recently in neighboring countries.
Vaccines are offered for free in all 540 health facilities throughout Jordan, which provide primary health care to the majority of the population. Free health services are an incentive, but a successful vaccine program like Jordan’s requires a health system that supports it. Planning for annual increases in population, ensuring temperature-controlled supply chain, training health workers in handling and dosage and implementing campaigns to educate the population are all critical and interdependent functions of the health system.
The Ministry of Health credits the routine scheduling of the campaigns as the biggest contribution to its success. Between 2012 and 2016, the Government of Jordan conducted nine polio campaigns — six were nation-wide and three targeted high-risk communities along the borders with Syria and Iraq. They were publicized through TV, radio, SMS messages, printed communications and networks of community leaders, teachers, and health workers.
As a result, one million children under five were successfully vaccinated. Four hundred thousand children were from high risk areas. In 2013, a national campaign for the Measles, Mumps and Rubella (MMR) vaccine led to three million children receiving vaccinations.
Integrated Health Systems Functions
Infrastructure and supply chain management are also functions of the larger health system and central to any vaccine program. Jordan centrally stores its vaccines in 21 temperature-controlled rooms in the capital city, Amman, and distributes them in temperature-controlled vehicles on a monthly basis and on demand to all 14 health directorates in the country. The health directorates then distribute the vaccines to the health centers.
Recently, the Ministry of Health’s Communicable Disease Directorate added 10 cold rooms in Amman to prepare Jordan to serve as a regional storage center of vaccines. This is a strategic step the Government of Jordan is taking to prepare in case diseases enter the country due to instability in the region.
Several health centers across the country are piloting a computer-based system to collect and monitor national vaccination records so health workers and the government can better determine vaccine needs and health trends among the population.
In addition, the government is investing in a national public health surveillance system through the World Health Organization (WHO), with support from USAID, to better monitor vaccine coverage. These new tools can help policy makers identify future investments that will have the most impact in the health sector.
The extensive network of primary health care centers, including comprehensive health centers with specialty services, also play a critical role in the high vaccination rate in Jordan. Abu Nssier, for example, provides specialty services like dentistry, gynecology, antenatal and postnatal care, testing for HIV and TB, in addition to primary health care.
As a comprehensive health center, it is open six days a week, with emergency services available 24/7. Although registration is typically required for services at Abu Nssier and other health facilities in Jordan, no one is turned away. If someone turns up who is unvaccinated, they can still receive vaccinations and health services that keep them healthy and help protect the community.
Every newborn baby in Jordan must be registered at a local health center. The health centers provide parents with vaccination information and education they need, as well as a card with their child’s vaccination schedule and future appointments.
According to Jordan’s 2017–2018 Demographic Health Survey, the total vaccination coverage was 86 percent of the population. According to WHO, the worldwide vaccination rate is around 85 percent.
On average, nurses vaccinate 75 children a day at Abu Nssier. On the day I visited, 64 children from Jordan, Iraq, Syria, Lebanon, Yemen, and Egypt received routine vaccinations.
Amal, a nine-month-old girl from Jordan, was among that group. Her mother, Tabal, didn’t question the need for the scheduled vaccine and didn’t have to pay anything. She knew what to expect because she learned about the need for vaccination through the health center.
Thanks to the interrelated health system functions that come together to make Jordan’s vaccine program successful, Amal stands a good chance of getting all of the vaccines she will need for a strong start and a healthy future.
About the Author
Jennifer Jackson is the Senior Communications Advisor for the Office of Health Systems in USAID’s Bureau for Global Health.