Strategies to revitalize immunization service provision in urban settings of Ethiopia

Abstract

Abstract
Background: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.
Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.
Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.
Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.
Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]
Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopia