Activity 14: Planning and Health Systems Research

PI: Dr. Charles P Larson

Under the Planning and Health System Research activity of the Improved Health for the Poor project, ICDDR,B has been working on strategies to improve the low child immunization coverage in urban slums and conducting a feasibility study in selected hard-to-reach haor areas of Bangladesh.

Improving Immunization Coverage

FPI: Dr. Md. Jasim Uddin

The Expanded Programme on Immunization (EPI) coverage has been predominantly low in urban slums and hard-to-reach rural areas in Bangladesh. After collecting baseline data from Kalapani and Beguntilla slums of Mirpur, Dhaka, ICDDR,B analyzed the situation to determine the reasons behind the low immunization coverage in these areas. The majority of mothers in urban areas, particularly in urban slums, are working women and it can be difficult for them to take their children for immunization during normal EPI session hours, resulting in drop-outs and left-outs. In active collaboration with Directorate General of Health Services (DGHS), Dhaka City Corporation (DCC) and NGOs, EPI services are being provided by NGOs through special EPI sessions held outside normal hours in the evening, which enable working mothers to bring their children for vaccination at a more suitable time.      

We helped to form EPI support groups jointly with staff members of Dhaka City Corporation and local NGOs. To build the capacity of our partners implementing the strategies we organized workshops with the EPI programme managers from the DGHS, Dhaka City Corporation, National Service Delivery Programme (NSDP) and other NGOs currently working at the slums. To identify and address unmet needs, a checklist was developed that is being used by service providers in static and satellite clinics. The DCC and NGO field staff and their supervisors were trained in providing valid dosing to reduce the number of invalid doses administered. Strategy implementation began in September 2006. Data collection for the end-line is under way and findings will be disseminated by the end of 2007.

A Feasibility Study in a Haor Area

FPI: Dr. Md. Jasim Uddin

ICDDR,B in collaboration with DGHS conducted a feasibility study in Jamalganj Upazilla of Sunamganj district, a hard-to-reach rural haor area. The reasons found for low complete-immunization coverage in hard-to-reach areas included:

• irregular/cancelled EPI sessions,
• less time spent in EPI spots by field staff,
• absence of any alternative strategy for remote areas,
• absence of any mechanism to involve the community with the EPI programme,
• invalid doses,
• mothers’ poor knowledge about benefits of complete vaccination,
• less/absence of supervision,
• mothers do not get information about EPI sessions,
• an inadequate number of field workers for the increased population,
• Health Assistant vacant positions,
• geographical barriers, and
• lack of money to meet necessary transportation costs.

The findings suggest that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas.

These results were shared with interest group members in November 2006, including: programme managers of DGHS, representatives from WHO, UNICEF and NGOs. Based on the findings of the feasibility study a proposal has been developed in collaboration with the EPI programme of MOHFW to test evidence-based strategies in rural hard-to-reach areas of Bangladesh. It is expected that successful implementation of the strategies will contribute to improving the child immunization coverage in these haor areas of Bangladesh.

Collaborating Institutions:

• EPI Programme of DGHS
• Dhaka City Corporation
• IEDCR-DGHS

Results:

• Continue to work with planning wings of DGHS and DGFP to utilize research findings.
• Continue to work with DGHS and other stakeholders of EPI Programme to accelerate immunization coverage by involving GO, NGOs.
• EPI:
• Improving capacity of participating institutions (MOHFW, City Corporations, Municipalities and NGOs) in implementing strategies to improve child immunization coverage in urban slums.
• Develop and test alternative strategies to improve child immunization coverage in rural hard-to-reach areas of Bangladesh.
• Essential Laboratory Services:
• Monitoring and evaluation of strategies to improve utilization of laboratory services at Upazilla Health Complexes.
• Street Dwellers:
• Develop and test strategies to improve health care services for urban marginalized population (urban floating people).