POST 00976E : QUALITY VS IMMUNIZATION COVERAGE

POST 00976E : QUALITY VS IMMUNIZATION COVERAGE Follow-up on Post 00972E 19 September 2006 _____________________________________ This posting contains four contributions : 1- Naresh Goel (mailto:[email protected]) from India 2- Steven Toikilik (mailto:[email protected]) from Papua New Guinea 3- Vijay Kiran (mailto:[email protected]) also from India , and finally 4- Mike Favin (mailto:[email protected]) from the United States _____________________________________ Dear All This is in addition to Dr Babu's excellent observations on improving coverage through improving quality. I am in total agreement that quality has a tremendous impact on the demand generation and thereby improving coverage. In addition to introduction of ADS the concept of quality overall has many components. Some of these are : 1. Observing timeliness at session site 2. Meeting the commitment of organizing a scheduled session in spite of holiday 3. Smiling behaviour of health care provider 4. Cleanliness at site and 5. Maintaining privacy of clients. All these have played a major role in generating demand and improving coverage. Tamil Nadu in India is a good example. Regards. Naresh Goel WHO-NPSP INDIA -------------------------------- Dear Doctor Babu, Yes indeed, Papua New Guinea immunization program has experienced similar phenomenon when it introduced AD Syringe 4 years ago. I think the experience on AD Syringe is among many other innovations that could increase immunization demand. There is one that I have been trying to adapt to improve the system rather than the specific program. And that is to create standards based on "Quality, Efficiency and Consistency". This is a concept where each program or service provided is centered on the QEC model. I believe by improving the system we could be able to realize increased demand for immunization and other services at the district or facility level. Thank you, Best regards, Mr. Steven Toikilik, National EPI Manager, Department of Health, Papua New Guinea -------------------------------- This is in response to Dr. Giridhar Babu's queries. Firstly Government of India has to be commended for taking such a decision to introduce AD syringes for immunizations throughout the country. The basic intention of introduction was to ensure 'Injection safety" and GOI could achieve the same. Though the safe disposal issues are presently in a fluid state probably in a few months the same can be addressed. Unless we do an operational research we may not be in a position to say weather the initiative has improved the demand. On the other hand, let me quote some negative observations during the field visits, 1. The mothers were apprehensive about more bleeding from the site of injection 2. Mothers were complaining that the length of the needle was more and hence were bringing their own disposable syringes 3. Habit of touching the needle by the health worker still continues. These are the training and advocacy issues which need to be addressed. Vijay --------------------------------------- This is an interesting question on several levels. Firstly, I think that most of us would agree that most people in general are attracted by new gadgets and gizmos, so that introduction of new syringes or vaccines, for example, may cause a temporary spike in coverage. Secondly, I find the term "demand generation" in relation to immunization a bit misleading. In most countries and local areas – although clearly there are exceptions -- lack of demand for immunization is not a major reason for unsatisfactory coverage. Most mothers or other caregivers, in most places, are highly motivated to have their children immunized, an act that they may not fully understand but which they know is good for their children's health and survival. Finally, I think it's impossible to generalize about what is needed to increase coverage, because the important appropriate actions will vary by local situation. The list of possible helpful actions includes: improving the availability of immunization services via outreach and/or modifying service hours; improving the reliability of immunization services, so that when a caregiver and child arrive for services they be confident that the health worker and vaccine needed will be available; improving the manner in which health staff treat and communicate with caregivers and children; improving defaulter tracking and community participation in ensuring that each caregiver understands when their children's next immunization is due. Mike Favin Technical Officer, IMMUNIZATIONbasics ______________________________________________________________________________ All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. 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