Community's perceptions of barriers to childhood routine immunization : a qualitative post-intervention comparative study done in district Tando Mohammad Khan, Sindh

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Pakistan in spite of having an active Expanded Program of Immunization (EPI) since midseventies is still lagging behind the target of achieving 80% at district and 90% RI coverage at provincial/national levels as declared by Global vaccination action plan (GVAP). Recent PDHS survey reveals that overall RI coverage of Pakistan is 54% while in Sindh it is only 29%. Many quantitative studies have been conducted to evaluate the multifaceted issues that restrain community access to routine immunization (RI), but less focus has been given to qualitative researches specifically in terms of community's perception after Health System Strengthening (HSS) interventions for improving RI. This nested study was conducted as part of a larger post HSS- intervention study done under umbrella study of pneumococcal conjugate vaccine impact in Pakistan project (PVIP). The aim of study was to explore the community's perceptions about barriers towards childhood routine immunization, and improvement if any has occurred among community within intervention area. Methods: An exploratory qualitative study was done across all UCs that revived HSS interventions and control UCs. 24 focus group discussions (FGDs) with mothers, caregivers and LHWs, while 10 key informant interviews (KIIs) with local teachers, religious and other community leaders were conducted in intervention and control. Participants were probed on vaccine and other resource availability, awareness, quality of service provision, perceptions about vaccination and abilities to seek and reach for it. Information collected was grouped into codes guided by the analytical framework approach. Information across caregivers, LHWs and community stakeholders were triangulated during analysis. Findings: Some of the key issues reported in both areas were similar in terms of deficient awareness about all the VPDs, complete RI schedule and financial constraints including transport in reaching out to the EPI center; which emerged as bigger factors. Whereas underperforming outreach services, mismanaged supply chain, mistrust on vaccine and vaccinator, religious reasons were the leading barriers in control UCs, which has been improved in intervention area after behavior change communication strategies. Another interesting finding common to both areas was social autonomy where mothers have equal rights of making decision about her child's immunization. Conclusion: Community barriers to routine immunization were noticeably less in intervention areas compared to control. After concerted attention in terms of HSS interventions, community awareness has improved. Better quality RI services by skilled health care provider (HCP) is provided at EPI center and mainly in outreach, whereas vaccinator is not able to reach out to community in control. Real time monitoring has escalated RI coverage in intervention than control UCs. Recommendations: Based on the results it is recommended that implementation of combination of HSS interventions through multi-sectorial innovative approaches are the apt method for achieving globally set RI targets.

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