Re: Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives
Just like India and most countries, immunization services are offered free in public health facilities in Kenya, but often than not, access to and quality of these services is hampered by shortage of health workers especially in rural areas.
The use of community health workers (CHWs) has been identified as one strategy of enhancing the promotion of individual health and can make a valuable contribution to community development and, more specifically, improvement in access to and coverage of communities with basic health services. These services include preventive vaccination in human resource–poor settings. An evaluation using a meta-analysis found evidence in the effectiveness of CHWs in promoting childhood vaccination uptake, though as pointed out in your study, these evidence-based validations are not reported in developing countries
In addition to financial or non-financial incentives, adding other health services to a vaccination platform has been proposed as a way to increase coverage of those services and/or vaccinations. In Kenya for example, “Reaching Every District (RED)” approach strategy was found to be very effective in increasing uptake and coverage of immunization services (78% Diphtheria-Pertussis-Tetanus 3 (DPT3) coverage). RED is a district-focused, comprehensive strategy developed to tackle the common obstacles in improving access to and utilization of immunization services. The integration includes provision of immunisation with other maternal and child health services with outreach sessions for example Vitamin A supplementation, family planning, antenatal care, bed net distribution, deworming, growth monitoring and curative care. DPT1 coverage was a principal indicator of access to immunisation services; while DPT3 coverage measured the utilisation of these services. However, another integration strategy of hygiene interventions with vaccinations only increased vaccine coverage in urban areas while that of rural areas either remained unchanged or increased.
Based on these findings as well as your findings which reported large positive impacts of small incentives on the uptake of immunisation services in resource poor areas, socio-economic status may be an important consideration when designing sustainable strategies for scale up of immunization coverage and utilization.
Rose Kiriinya Kinyua
Project Data Analyst; Emory University Kenya Project
Research Inter, Great Lakes University of Kisumu
Email: rose.kiriinya@emorykenya.org
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Re: Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives
Just like India and most countries, immunization services are offered free in public health facilities in Kenya, but often than not, access to and quality of these services is hampered by shortage of health workers especially in rural areas.
The use of community health workers (CHWs) has been identified as one strategy of enhancing the promotion of individual health and can make a valuable contribution to community development and, more specifically, improvement in access to and coverage of communities with basic health services. These services include preventive vaccination in human resource–poor settings. An evaluation using a meta-analysis found evidence in the effectiveness of CHWs in promoting childhood vaccination uptake, though as pointed out in your study, these evidence-based validations are not reported in developing countries
In addition to financial or non-financial incentives, adding other health services to a vaccination platform has been proposed as a way to increase coverage of those services and/or vaccinations. In Kenya for example, “Reaching Every District (RED)” approach strategy was found to be very effective in increasing uptake and coverage of immunization services (78% Diphtheria-Pertussis-Tetanus 3 (DPT3) coverage). RED is a district-focused, comprehensive strategy developed to tackle the common obstacles in improving access to and utilization of immunization services. The integration includes provision of immunisation with other maternal and child health services with outreach sessions for example Vitamin A supplementation, family planning, antenatal care, bed net distribution, deworming, growth monitoring and curative care. DPT1 coverage was a principal indicator of access to immunisation services; while DPT3 coverage measured the utilisation of these services. However, another integration strategy of hygiene interventions with vaccinations only increased vaccine coverage in urban areas while that of rural areas either remained unchanged or increased.
Based on these findings as well as your findings which reported large positive impacts of small incentives on the uptake of immunisation services in resource poor areas, socio-economic status may be an important consideration when designing sustainable strategies for scale up of immunization coverage and utilization.
Rose Kiriinya Kinyua
Project Data Analyst; Emory University Kenya Project
Research Inter, Great Lakes University of Kisumu
Email: rose.kiriinya@emorykenya.org
Competing interests: No competing interests