Abstract
BackgroundPrevious studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda.MethodsMixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Survey data underwent descriptive statistical analysis. Latent content analysis was used for qualitative data.ResultsOf the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years (95% CI 24–27). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents (24%, 95% CI 21–27). This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% (95% CI 30–37) of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% (95% CI 27–34) of the survey respondents utilised these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. Charges ranged from US$ 0.2 to US$4 and these were more commonly reported at private (70%, 95% CI 65–76) than at public (58%, 95% CI 54–63) facilities. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities.ConclusionsComplex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, governments should strengthen health systems to cater for increasing urban populations.
Highlights
Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings
Geographical access to services All data sources reported that there was poor distribution of facilities that provide routine childhood immunisation services, that is, almost all focus group discussions (FGDs) and all key informants. This finding was corroborated by the survey in which a quarter (24% 95% CI 21–27) of the respondents reported living more than 2 km from an immunisation facility
There was no statistical association between distance to the immunisation facility and whether immunisation services were received from public or private facilities
Summary
Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. Three years into the decade of vaccines, 1.5 million child deaths occurred in one year due to vaccine preventable diseases [1] mainly in resource-limited settings These accounted for 29% of all deaths among children aged 1–59 months [1] and occurred amidst unprecedented advances in vaccine technology and availability of new vaccines globally [2]. The coverage in 2011 fell short of GAVI targets of 80% DPT3 coverage in 80% of Ugandan districts This continued failure to meet agreed targets suggests that specific challenges regarding immunisation programmes have not been fully identified, understood, or addressed [7,8]. A few studies, mostly in high vaccination settings, have examined immunisation services [13,16,17,18,19,20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
