Some possible local causes of low immunization uptake or high dropout rates are summarised in this section, which includes two new key terms (in bold).
Service organisation problems:
- Community not clearly informed of dates/times of immunization sessions at the Health Post, at outreach sites, or via mobile teams
- Immunization sessions not frequent enough, or at inconvenient sites
- Immunization session dates/times conflict with farming or family duties
- Poor vaccine quality, e.g. due to cold chain breakdown or usage after the expiry date
- Vaccine or other equipment shortages.
Staffing problems:
- Inadequate staffing levels to provide enough immunization sessions
- Inadequate training or supportive supervision for a high quality immunization service
- Health staff perceived as hostile or poor communicators by parents
- Incorrect contraindication practices, e.g. not immunizing children with minor illnesses, low grade fever, etc. which should not prevent them from receiving vaccines
- Missed opportunities to immunize, e.g. not immunizing children who visit the Health Post for another reason, unrelated to immunization.
Data collection and reporting problems:
- Incomplete or inaccurate data collection and analysis
- Failure to report monitoring data regularly
- No active follow-up of defaulters.
Can you suggest some possible solutions for the problems identified above?
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You may have thought of these (and other) examples:
- Improved communication with the community (see Study Session 9)
- Better in-service training for health staff and adequate supportive supervision
- Mobilisation of additional resources, e.g. increased staffing levels, more reliable cold-chain equipment, better delivery times for vaccines and other supplies, etc.
- Apply other immunization strategies, e.g. sustainable outreach delivery, local immunization days, partnership with private and other sectors (see Study Session 8)
- Apply an effective system for tracing defaulters (see Section 10.5 below)
- Make timely, accurate reports to the higher level, so problems can be addressed collectively at the earliest opportunity.
We conclude this study session by explaining how the last two solutions in the above list should be implemented.