A health needs assessment is the process of identifying and understanding the health needs of your community. It includes identifying any problems and their possible causes that make it harder to meet those needs. In relation to immunization, the key questions that you need to address are:
- Has the immunization coverage rate reached the targets that were planned in the previous year? If not, what were the problems?
- If there were outbreaks of vaccine-preventable diseases in your coverage area, what does this imply about the effectiveness of your immunization service? For example, has it been difficult for people to get to your health facility or attend outreach events?
- Have there been many defaulters — clients who began a series of routine immunizations but ‘dropped out’ before the EPI schedule was completed? What are the possible reasons for dropouts?
Make a list of possible problems that might need to be addressed in your community if your target population is large and very widespread;
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You may have thought of other problems in addition to those below:
- The people who live a long way from the health facility find it difficult to get to immunization sessions
- The roads to the health facility are flooded in the rainy season
- Immunization is only available on certain days; some people cannot attend on those days
- Communicating about immunization sessions is difficult; some people come on days when immunization is not available
- Vaccine supplies are sometimes not enough to immunize all the children and mothers who come
- The refrigerator is unreliable and vaccines have to be moved to a higher level health facility for safety
- There is a high dropout rate, possibly because a child had a severe allergic reaction after an immunization last year, and negative rumours spread; some parents refused to bring children for immunization.
If you have identified problems that contribute to low immunization coverage rates in your area, discuss them with your supervisor and local health officials, and make a list of possible solutions. For example, if the problem is low immunization coverage, then the solution might be one (or more) of those listed in below.
Some ways to address low immunization coverage rates
- Improved communication with the local community about the huge benefits and very low risks of immunization
- More in-service training, updating or supportive supervision for you and other health professionals, including community volunteers
- Mobilisation of additional people, equipment, finances or other resources to improve delivery of the immunization programme
- Change of immunization strategy, e.g. increased use of outreach or local immunization days
- Focus group discussions with community members to find out why immunization coverage is low
- Regular review meetings with community leaders and local health officials to assess progress
- Partnerships with other organisations (e.g. community associations, charities, private sector) to assist in delivering the programme.
Remember that some solutions may not be appropriate to your setting, or may not be feasible in your community. For example, additional in-service training may not be affordable in the short term, or there may not be a suitable local organisation willing to assist with your immunization activities.