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

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.