Full scale efforts have been employed by Rangpur city corporation to strengthen routine immunization.
According to Coverage Evaluation Survey 2016, full vaccination valid coverage of less than 12 months old children was 76.6 per cent in Rangpur City Corporation. This is considerably high, but still below the required rate for achieving the goal of Measles and Rubella elimination by 2020 i.e. 95 per cent of children that have received two doses of MR vaccine. The ambitious objective, centred on the health and safety of the community and future generations came from top structure decision maker, the Mayor of Rangpur. Within the 6 months registration and immunization campaign (January to June 2019), Rangpur became a model city for urban immunization by involving a large variety of professional categories, influencers, religious and political leaders. All with one goal- reaching every child with the lifesaving vaccines.
“WHO has always supported routine immunization, working with Ministry of Health and Family Welfare and with Local Government Institutions as well as with other health partners to increase the vaccination coverage, making the best use of existing resources. However, when the Mayor decided to allocate extra resources, mobilize entire community and engage large sectors of society, we are in the frontline of supporting health authorities to plan and implement traditional activities as well as new, innovative approaches on a par with the task and the expectations.” Dr Rajendra Bohara, WHO Immunization and Vaccine Development Team Leader.
“From the core stakeholder point of view, EPI has always welcomed and collaborated with ideas of enhancing capabilities of its own. In this new digitalized era of Bangladesh the Expanded Programme on Immunization (EPI), DGHS under the MoHFW is willing to provide the essentials to achieve highest coverage by strengthening the routine EPI, supplementary immunization and integrating new vaccines as well as strong surveillance, supervision & monitoring. We believe the collective efforts of our existing workforce and development partners will enable us to overcome whatever may be the odds are specially in the urban areas of Bangladesh.” Dr Mowla Baksh Chaudhury, Programme Manager, EPI.
Electronic registration
An innovative electronic immunization registration software developed by the Government has been deployed in the field, and armed with this powerful tool, hundreds of health workers and volunteers went from house to house for registering every child of vaccination age. To better track the covered households, stickers have been posted on the already visited houses.
Additional workers
Forty five new health workers were permanently employed and trained for immunization, while a large number of staff has been temporarily reassigned for the information, registration and vaccination activities during the campaign.
Swapping slums
As the slums areas pose one of the greatest challenges for routine immunization, both informal slum leaders and elected city counsellors have been taken on-board for swiping all the 64 slums accommodating over 50 000 people for registration and vaccination. Geographic Information Systems (GIS) have been used for proper mapping the slums and hard to reach areas and identifying sectors uncovered by the routine vaccination. Outreach vaccination teams have been deployed and working hours for the outreach sites (where needed) have been extended.
GIS mapping of hard to reach areas
“The biggest problem we are facing is that people still don’t fully understand the benefits of vaccination. Especially in poor areas, parents think that if they were not vaccinated when they were young and now they are healthy, why should they vaccinate the children. We are also facing the problem that parents forget about the next vaccination dates and therefore the children do not receive the full immunization course.” Dr Kamruzzaman Abne Taz, Chief Health Officer in Rangpur City Corporation.
School teachers and imams oriented
The campaign received support from Islamic Foundation, Government organization under the Ministry of Religious Affairs. Through Islamic Foundation, over 150 local religious leaders have been oriented for better informing children and community members about immunization, and its life saving benefits. School teachers have been also brought on board for disseminating the immunization messages in community, to inform the parents about the importance of vaccination, both for every child and also for the community as a whole.
Phone tracking
To make sure that every child completes the full course of immunization, phone tracking has been put in place. Information collected through the electronic registration involved obtaining the phone numbers of the parents so they got notified on the following vaccination date.
Involvement of community prominent figures
The campaign also benefitted from personal involvement of community’s prominent figures such as Professor Mohamad Abdul Wahed, well known paediatrician in Rangpur and champion for immunization promotion, who conducted regular gatherings with community members to explain the benefits of vaccines.
“Lack of education is in many cases an important cause of immunization gaps. Communities must be educated about vaccination; they should not simply wait for the health workers to come to their homes but rather actively ask for immunization. We must put all efforts in place to create a generation demand for vaccines as a long term solution for protecting communities against vaccine preventable diseases.” Professor Wahed.
Vaccination booth
While the main focus of the campaign was to reach children that have been traditionally under the radar, efforts have been put in place also to improve conditions at the main routine EPI point in Rangpur and to integrate it with Maternal and Child Health services. A newly inaugurated vaccination booth in Nagar Bhabon, the first of its kind in public health facilities in Rangpur City Corporation, allows privacy for parents and their children, has que management system with token numbers and it’s visual appealing through a design that combines stories for children and useful information for parents.
Within three months after the inauguration, the vaccination site has seen an increase of daily clients from around 70 to over 100, being the top choice of immunization places in the entire 1 million population district of Rangpur and a model that can be replicated in other sites.
“It’s more private”, “It looks very colourful”, “You get a token with a number so you know when your turn is” are some of the comments of parents regarding the new booth and also some of the reasons why more and more people prefer it for vaccinating their children.
“WHO has been in the frontline supporting the Rangpur health authorities and all the parties involved in this campaign from planning and implementation to monitoring. We are proud to have been part of one of the most wide and ambitious immunization registration campaigns in a City Corporation in Bangladesh and many good practices from here can be exported to other urban areas for strengthening routine immunization”. Dr Rajendra Bohara, WHO Immunization and Vaccine Development Team Leader.