Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study
Abstract Background Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immuniz...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-08-01
|
| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12961-021-00691-4 |
| _version_ | 1819138077593960448 |
|---|---|
| author | Amna Tanweer Yazdani Ameer Muhammad Muhammad Imran Nisar Uzma Khan Yasir Shafiq |
| author_facet | Amna Tanweer Yazdani Ameer Muhammad Muhammad Imran Nisar Uzma Khan Yasir Shafiq |
| author_sort | Amna Tanweer Yazdani |
| collection | DOAJ |
| description | Abstract Background Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums. Methods Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12–23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further six IDIs were then conducted with immunization policy-makers and policy influencers to determine strategies to address these barriers, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data. Results The survey revealed 49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient utilization of funds, unreliable immunization and household data and interference of polio campaigns with immunization. The implementation framework’s policy recommendations to address these barriers include: (1) improved human resource management; (2) staff training on counselling; (3) re-allocation of funds towards incentives, outreach, salaries and infrastructure; (4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff; (5) use of digital platform for immunization targets and generating dose reminders; and (6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programmes for improved coverage. Conclusions The implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programmes in limited-resource settings, with possible application at a larger scale. In particular, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use. |
| first_indexed | 2024-12-22T11:01:02Z |
| format | Article |
| id | doaj.art-103e0f3174404bdc913d5db9b36ac946 |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-12-22T11:01:02Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Research Policy and Systems |
| spelling | doaj.art-103e0f3174404bdc913d5db9b36ac9462022-12-21T18:28:30ZengBMCHealth Research Policy and Systems1478-45052021-08-0119S21910.1186/s12961-021-00691-4Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods studyAmna Tanweer Yazdani0Ameer Muhammad1Muhammad Imran Nisar2Uzma Khan3Yasir Shafiq4VITAL Pakistan TrustVITAL Pakistan TrustDepartment of Pediatrics and Child Health, Aga Khan UniversityVITAL Pakistan TrustVITAL Pakistan TrustAbstract Background Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums. Methods Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12–23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further six IDIs were then conducted with immunization policy-makers and policy influencers to determine strategies to address these barriers, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data. Results The survey revealed 49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient utilization of funds, unreliable immunization and household data and interference of polio campaigns with immunization. The implementation framework’s policy recommendations to address these barriers include: (1) improved human resource management; (2) staff training on counselling; (3) re-allocation of funds towards incentives, outreach, salaries and infrastructure; (4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff; (5) use of digital platform for immunization targets and generating dose reminders; and (6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programmes for improved coverage. Conclusions The implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programmes in limited-resource settings, with possible application at a larger scale. In particular, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use.https://doi.org/10.1186/s12961-021-00691-4Demand-sideSupply-sideBarriersImmunizationCoveragePeri-urban |
| spellingShingle | Amna Tanweer Yazdani Ameer Muhammad Muhammad Imran Nisar Uzma Khan Yasir Shafiq Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study Health Research Policy and Systems Demand-side Supply-side Barriers Immunization Coverage Peri-urban |
| title | Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study |
| title_full | Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study |
| title_fullStr | Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study |
| title_full_unstemmed | Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study |
| title_short | Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study |
| title_sort | unveiling and addressing implementation barriers to routine immunization in the peri urban slums of karachi pakistan a mixed methods study |
| topic | Demand-side Supply-side Barriers Immunization Coverage Peri-urban |
| url | https://doi.org/10.1186/s12961-021-00691-4 |
| work_keys_str_mv | AT amnatanweeryazdani unveilingandaddressingimplementationbarrierstoroutineimmunizationintheperiurbanslumsofkarachipakistanamixedmethodsstudy AT ameermuhammad unveilingandaddressingimplementationbarrierstoroutineimmunizationintheperiurbanslumsofkarachipakistanamixedmethodsstudy AT muhammadimrannisar unveilingandaddressingimplementationbarrierstoroutineimmunizationintheperiurbanslumsofkarachipakistanamixedmethodsstudy AT uzmakhan unveilingandaddressingimplementationbarrierstoroutineimmunizationintheperiurbanslumsofkarachipakistanamixedmethodsstudy AT yasirshafiq unveilingandaddressingimplementationbarrierstoroutineimmunizationintheperiurbanslumsofkarachipakistanamixedmethodsstudy |