April 22, 2024

Dar es Salaam study shows pathway to improving urban immunization and reducing zero-dose children

CHAI has published a paper in Advances in Preventive Medicine and Health Care detailing results from a pilot study to improve urban immunization and reduce the number of zero-dose children in Dar-es-Salaam, Tanzania.

Tanzania, like many countries, struggles to reach children who have not received a single vaccine (zero-dose) through its routine immunization program. These children mostly live in urban, new-emerging settlements and remote areas.

Understanding the reach of the immunization program

CHAI partnered with the Ministry of Health on a year-long study to identify zero-dose children in Dar es Salaam and evaluate the impact of potential solutions. The first eight months of the study were dedicated to conducting qualitative research. We reviewed routine immunization data across five councils of Dar es Salaam region selected for their high numbers of zero-dose children. We also evaluated published articles on urban immunization and zero-dose children in Tanzania. Together with the Ministry of Health, we interviewed parents, guardians, and healthcare workers across the selected facilities. We aimed to obtain insights into the barriers to and opportunities for routine immunization. At each step of the process, we engaged stakeholders in the Ministry of Health for insights and feedback

Through field visits, we uncovered barriers influencing immunization uptake within urban settings. We identified the following barriers:

  1. Longer distance to vaccinating health facilities, particularly in new emerging settlements.
  2. Inconsistency in provision of outreach services.
  3. Vaccine stock-outs  and related supplies.
  4. Immunization schedule follow-up.
  5. Shortage and maldistribution of staff at health facilities.
  6. Poor environment in the vaccination area.
  7. Long waiting times

The pathway to improving immunization uptake

CHAI in collaboration with MoH and Dar es Salaam Regional/Community Health Management Teams recommended the following interventions based on the findings,:

  1. Extending vaccination days to include weekends.
  2. Recruiting community leaders in outreach exercises to mobilize clients to vaccination points.
  3. Employing community health workers from target neighborhoods to track children for vaccination.
  4. Establishing vaccination outreach posts in new emerging settlements

The Ministry of Health and CHAI dedicated the remaining months to implementing and evaluating the impact of these solutions.

The impact of the study

As a result of our findings and interventions, we identified a total of 1,266 zero-dose children across targeted areas. Community health workers reintegrated half of the children back into health facilities by the end of the study. In addition, 880 children including the under-vaccinated, received vaccines in the newly formed outreach posts. Finally, more than 1,105 children received vaccinations during weekends. To ensure the sustainability of these interventions, the participating facilities have created a budget for conducting outreaches in new settlements. Further, they have implemented these approaches in their mass routine immunization campaign in February 2024.

The implementation study demonstrated that health facilities can reach more zero-dose and under-vaccinated children by employing data-driven outreach approaches. Furthermore, it showed the utility of working closely with communities in increasing coverage of immunization services.

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