Vaccines and Immunization

Biography

Biography: Mohammad Ismail Zubair

Abstract

Afghanistan's Expanded Program on Immunization (EPI) annually targets around 1.4 million children aged below 1 year to protect against 10 vaccine-preventable diseases and 4.1 million pregnant women to protect them and their newborns from tetanus through routine immunization services. Despite significant efforts by the Government and partners, Afghanistan’s immunization indicators have not met the expected benchmarks.

Objectives: To assess the factors affecting Immunization coverage in Afghanistan and explore the NEPI present situation and the way forward.

Methods: A mixed-method operational research design was used. Desk review, quantitative and qualitative data collection approaches used. The study participants were EPI frontline workers, mid-level and senior management staff.  Quantitative data collection methods included vaccine centers observation and immunization services provider’s interviews. Vaccine centers observation was executed by using a comprehensive checklist. Structured interviews were conducted through a universal sampling technique. Qualitative arm included semi-structured interviews with children caregivers, child barring age women and community people. These in-depth interviews were performed till the point saturation was achieved in study findings. For quantitative part, bio-statistical method that is reporting of descriptive frequencies is performed and data was analyzed using SPSS 19.0 software. Analysis of qualitative data was done manually and codes and themes were generated from findings. 

Finding: At community level the main constraints of demand side are low community awareness, myths about vaccines, and low community ownership; supply side barriers are ambiguous micro-planning, white areas, unequal geographical distribution of fixed centers, lack of female vaccinators, weak outreach and mobile services. Whereas, low management and technical capacity, minimum salary, weak coordination and communication, low performance accountability are mid-level constraints. Meanwhile, lack of clarity in strategic directions; using old management; no growth opportunity for staff; weak data management and use; lack program evaluation are the senior management/ policy level barriers. Aforementioned factors have direct effect on national coverage of immunization in Afghanistan.   

Conclusion: It is important that the various factors affecting coverage of immunization services become explicit to healthcare providers, health system managers, and policy makers in order to continuously monitor and improve vaccine service provision in the country and to meet the expected benchmarks.