Rapid assessment of the quality of services in Rubella immunization provide d through the primary health care service network in the Polonnaruwa district

Abstract

Objective: To assess the quality of services in munization provided through Primary Health Care clinics at the divisional level using the Lot Quality Assurance Sampling method. Methodology: A non-participant observation was carried out at 20 randomly selected clinics using Lot Quality Assurance Sampling (LQAS) method with a threshold level of a triage system of 80 and 50% The-defective elements (clinics) needed to reject the lot and make improvements was six. Taking into account that not only rubella immunization is provided in a clinic, ten deliveries of rubella immunization in a clinic were studied with a triage system of95 %, 75% (provider risk 1%, Consumer risk 23%), These repetitive activities were judged by LQAS10:3 binary rules. The study instrument was a pre-tested, structured observational checklist that comprised essential activities of vaccination referred to as sub-systems. Results: In the subsystem “sterility”, the hand washing procedure proved to be defective. The maintenance of sterilization chart was found to be poor. Cold chain maintenance was extremely good and none of the related activities was found to be defective. The screening of eligible clients was poor. A tegister of eligible women for rubella immunization was not maintained in any of clinics supervised. The register of immunization was completed after vaccination. In none of clinics were immunized clients totalled and categorized according to age groups at the end of sessions leading to inability to detect any unrecorded vaccinated client by comparing the number of vaccinations with the dosages of vaccines used and to calculate the vaccine wastage. Conclusion: Apart from the defective activities already mentioned, overall quality of services was satisfactory in majority of essential activities Recommendations: It is essential to carry out regular supervisions to detect and modify substandard items by supervisory staff. Steps should be taken to improve documentation during and at the end of the clinic session.