Abstract
BackgroundRoutine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessment that aimed to document immunization service provision so as to review a new national strategy, and consider how routine immunization could be better strengthened.MethodsIn East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools.ResultsWe documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found an immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, included more reliable on-demand services, integration of other family health services and increased involvement of men.ConclusionsThe national strategy addresses most local gaps, but implementation and resourcing requires greater commitment. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization especially through better population-based local planning, and stronger community engagement. Our results also suggest areas where vaccination campaigns in PNG can contribute to routine immunization services.
Highlights
Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health
Stronger routine immunization programs are critical to the ambitious Global Vaccine Action Plan (2011–2020), immunization coverage is not increasing as planned in many difficult settings challenged by expanding childhood cohorts, population displacement by conflict or natural disasters, and limited resources to overcome geographical and infrastructural challenges [1, 2]
This paper reports on a cross-sectional health services assessment investigating Papua New Guinea (PNG) government efforts to improve routine immunization prior to the polio outbreak
Summary
Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. PNG was one of five countries experiencing outbreaks of circulating vaccine-derived poliovirus disease [6, 7], the rare mutated form that results from persistent low coverage with the oral polio vaccine. This has required one of PNG’s largest public health emergency responses, led by the national government with support from Global Polio Eradication Initiative and other development partners [8]. In the short-term, the response entailed repeated SIAs, with longer term plans for program reform, recognizing that it is sustained gaps in routine immunization services that are the primary cause of this form of polio [7]
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