Community-suggested approaches for improving immunisation coverage and equity among under-five children in hard-to-reach areas and under-performing facilities in Nkhata-Bay and Mchinji districts in Malawi
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Date
2020-03-01
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Abstract
In Malawi, immunisation coverage for all basic vaccinations for children age 12- 23 months is 76%, below the WHO target of 80%. Some districts have been consistently under performing (less than 80% in immunisation coverage) and have low-performing health facilities located in hard to reach areas. However, limited information exists on community-proposed strategies for improving immunisation coverage and equity. Objectives: The study was aimed at identifying approaches suggested by the communities and care-givers for improving immunisation coverage and equity in under-five children in hard-to reach areas and low-performing facilities in Mchinji and Nkhata-Bay districts.The study was a cross-sectional mixed methods design. Qualitative data was collected from 6 Focus Group Discussions (FGDs) and 32 In-depth Interviews (IDI) with primary care-givers, community health volunteers (CHVs), traditional leaders and members of Health Centre Advisory Committees (HCACs) and was analysed using thematic content analysis. Quantitative data was extracted from household survey done in March, 2019 and descriptive analysis was done using STATA version 13. Suggested approaches were; task-shifting of immunisation to CHVs, establishing more outreach clinics, male involvement, involving community health action groups (CHAG) in follow-ups on care-givers who missed immunisation, and ensuring consistent immunisation clinics. Immunisation challenges gathered were: long distance and competing priorities for care givers, lack of transport for health workers and volunteers, and illicit charging for immunisation by health workers. Knowledge of care-givers of vaccines was low. Immunisation programmes should consider task-shifting of administering vaccines to community health volunteers, introducing more outreach clinics, ensure no cancelation of immunisation clinics, and promote male involvement and community engagement in immunisation services.