Peer-reviewed article
Challenges, opportunities and best practices in routine childhood vaccination services delivery in urban slums and pastoralist regions of Ethiopia: An exploratory qualitative study in marginalized settings
Nardos Gelana, Finina Abebe, Menen Tsegaw, Yordanos Tadesse, Melkamu Ayalew Kokebie et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at why children in Ethiopia's urban slums and pastoralist areas often miss routine vaccinations. Researchers interviewed 39 health workers and program managers about the challenges and successes they see in delivering immunization services. They found problems like unreliable vaccine supplies, weak cold storage, low funding, and staff being overworked, especially in hard-to-reach areas. They also identified helpful practices, such as involving local communities, using mobile vaccination teams, and working with private health providers. The study recommends better supply systems, more training for health workers, and stronger community engagement to reach children who are currently missing out.
Key points
- Key barriers included inconsistent vaccine supply, limited cold-chain capacity, low financing, and high workloads.
- Reaching pastoralist and urban slum populations was identified as a major challenge.
- Community engagement, local community structures, and mobile teams were identified as best practices.
- Involvement of the private sector showed notable successes in service delivery.
- Recommendations included improving supply chains, enhancing provider training and supervision, and increasing community awareness.
Limitations
The study is qualitative and based on interviews with health workers and program managers, not vaccination coverage data or caregiver perspectives, so it cannot quantify how much these barriers or practices affect actual immunization rates.
Abstract
BACKGROUND: Despite global progress, significant disparities persist in routine childhood vaccination coverage, commonly in low- and middle-income countries, including Ethiopia. Ethiopia has made considerable progress in extending immunization services through the national Expanded Program on Immunization. However, still significant coverage gaps remain, particularly among the vulnerable population such as urban slums and pastoralist areas. This study seeks to capture the perspectives of healthcare professionals and program managers to understand the challenges, best practices, and opportunities for strengthening immunization service delivery in these marginalized settings. METHODS: An exploratory qualitative study was conducted in urban slum and pastoralist areas of Ethiopian regions from November to December, 2023. Purposive sampling technique was used to select 39 key informants, including healthcare providers, health extension workers, maternal and child health directors, Woreda Immunization officers, and focal persons. The interview guides were developed with Human-Centered Designand the World Health Organization's behavioral and social drivers frameworks. Open Code software version 4.03 was used to perform thematic analysis, employing both deductive and inductive coding approaches. Inter-coder reliability and daily debriefing were used to ensure the trustworthiness of the study. RESULTS: Key barriers affecting the routine childhood immunization service included inconsistent vaccine supply, limited cold-chain capacity, low financing, high workloads, and challenges in reaching these populations. However, best practices such as community engagement, involvement of local community structures, mobile teams and the inclusion of the private sector demonstrated notable successes. Healthcare professionals recommended improving supply chains, enhancing healthcare providers training and supervision, and increasing community awareness as crucial strategies to reach under-immunized groups. CONCLUSION: This study identified that persistent health system challenges remain in delivery of routine childhood vaccination, while there is best practices in some areas. Strengthening health system capacity in terms of human power and necessary, combined with active community engagement, is essential to achieving equitable vaccine coverage among under-immunized populations.