When educated parents won't queue up for immunisations

By Carol Natukunda

 

Line up, lose time and money. That is why the modern working mothers might not be taking their children for immunisation.

 

A new research by the School of Public Health, at Makerere University College of Health Sciences reveals that a lot of educated and working people are missing vaccinations because they cannot wait for more than an hour to be served.

 

 Although most private facilities provide services within 30 minutes of arrival at the facility, the children at public facilities have to wait for up to six hours to be immunised, the research says.

 

‘Instead of you taking 30 minutes you take about 6 hours before you get the services.’ a female caretaker was quoted as saying in the study.

 

“At (the public facility) you can even come back without receiving immunisation. You have to wait a long time, the children will cry (and yet) you have another child at the pre-school and it is coming to noon, and have to come back to pick her from the pre-school. You can come back without immunising the other one.” a mother told a focus group discussion

 

Titled Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda, the research senior public health experts including Dr. Juliet Babirye, a Lecturer in infectious disease (HIV, Malaria) and non-communicable disease control. The report examined health system barriers to childhood immunisation in urban centers of Kampala

 

Of the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years respondents reported waiting for 3–6 hours before receipt of services. Detailed statistics in the show that 43% of survey respondents were only willing to wait for up to an hour before receipt of services; 24% were willing to wait for 1–3 hours.  

 

Only 33% of survey respondents were willing to wait for three or more hours before receipt of services. More of those who had attained secondary education than those who had not completed primary education preferred receiving services within an hour of arrival at the immunisation facility. The duration individuals were willing to wait for services was not associated with the respondent’s marital status, occupation or whether services were received from public or private facilities.

 

The delay in service was found to be more at public facilities. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% of the survey respondents utilised these facilities.

 

Researchers attributed the low participation at private facilities to the rampant informal charges. Charges were found to be between sh600 to sh12, 000 depending on the immunization dose. These charges were more commonly reported at private than at public facilities. According to the health ministry guidelines, an immunization dose is supposed to be free of charge at all health facilities.

 

“This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities,” the report says.

 

However, the report also discovered interment availability of vaccines and transport for immunisation services at both private and public facilities. Poor geographical access to immunisation facilities was reported in this urban setting.

 

The providers and managers revealed that delays were primarily due to the bureaucratic health system. This included delays in vaccine supply or travel time by providers, especially those conducting outreach immunisation services. This delay occurs because some health facilities have no refrigerators to store the vaccines and have to send one of the health workers to the headquarters for vaccines. They delay to return and when they eventually arrive, it is quite late in the morning (past mid-morning),” a respondent is quoted as saying in the report.

 

Lack of time?

However, in the report, one 24-year-old mother disagreed with those whom she perceived as uncommitted to immunization. She emphasized that the level of commitment required for seeking immunization services was comparable to visiting a good hair dresser, which is a protracted event for an urban Ugandan woman.

 

“If you know that a good hair dresser is three kilometers away, even if you found very many people in the queue waiting to be served, you would wait for your turn without any complaint.”

 

The report cites several issues such as few facilities providing immunisation services and few health workers to provide services to the large number of consumers who turn up at the facility. On the other hand, the waiting times at some immunisation facilities in Kampala were long because health workers reported late at the work stations. This was attributed to lack of motivation due to delayed allowances and salaries.

 

Vaccination overview

Uganda has recorded improved coverage in Immunisation.  In 1986 – it was only six diseases that were being immunized. Today there are vaccines against eight diseases including, Polio, Diphtheria, Whooping cough, Tetanus, Hepatitis B, Haemophilus influenza, Measles and meningitis. More vaccines are in the pipeline.

 

“In October, this year HPV vaccine against cancer of cervix will be rolled to whole country. By 2016, we may introduce Rota virus vaccine against diarrhoea in children. When malaria vaccine finally gets endorsed by WHO to be used in malaria endemic countries, Uganda may introduce it around 2018,” says the Uganda National Expanded Immunisation Programme (UNEPI) director. Dr. Robert Mayanja.

 

According to the 2011 Uganda Demographic Health Survey, the vaccination coverage in Uganda had improved over the previous past ten years. The percentage of children age 12-23 months fully vaccinated by 12 months of age has increased from 29 percent in 2000-01 to 36 percent in 2006 and 40 percent in 2011

 

However, coverage estimates alone do not constitute a sufficient criterion for determining the achievement of certain performance levels by an immunisation programme. Overall, only 4 in 10 children are fully vaccinated by 12 months, according to the survey.

 

For instance, Dr. Mayanja says measles coverage for infants in 2014, was reported at 96%.  However, he also points out that there about 62,000 children less than one c who were not reached with measles vaccine, based on measles coverage that we achieved in 2014. Measles is a highly contagious respiratory disease caused by a virus; symptoms include rash, fever, runny nose and cough. Because of successful vaccination efforts, measles had virtually disappears from Uganda. In recent months, however, measles out breaks have been reported throughout the country. Could it because the caretakers are not participating in the immunisation?

 

Mbarara district Health Officer Dr. Amooti Kaguna said recently that three cases in Mbarara had turned positive.

 

“Some parents think that because some of the illnesses for which kids get immunized are extremely rare these days, there is little reason to vaccinate. But here is the reality. These diseases do exist and we are already seeing some of them make come back,” says Dr. Kaguna stated.

 

Government’s stand

Asked to comment on the caretakers are missing vaccinations because of limited time to line up, Dr. Mayanja saying the government has put in place mechanisms to ensure there are no queues.  He reveals that the government has procured 100 fridges to store vaccines in the private hospitals and clinics in Kampala

 

“This will improve the quality of immunization services in private sector, access by all categories of people and reduce waiting time at immunization service points,” he says.

 

“Vaccines and supplies are provided to private clinics by government free of charge. The private clinics may charge management fee to clients so as to run their system but vaccines are given to them free of charge. This approach reduces the long lines for clients coming for immunisation,” says Dr. Mayanja.

 

He is also quick to stress that the dangers of skipping immunization routines are enormous. “Your child never develops lifelong immunity against immunisable diseases and thus they are prone to getting those infections in future. We encourage parents to complete the immunization schedule for their infants to get lifelong protection,” he says.

 

Other challenges

The long queues sometimes stem from the fact that some health centers lack vaccines. The immunization vaccines are distributed from National Medical Stores to districts every month. However, about 12% of facilities report a stock out of at least one vaccine in a period of three months because of challenges of distribution from the districts to some facilities, Sunday Vision has established.

 

“For instance in rainy season some facilities become inaccessible. Like in Bukwo district, sometimes some facilities do not have stand by gas cylinders to run the vaccine storage fridge when the one running gets finished. They just transfer vaccines to a neighbouring facility until they get replenished with more gas to run the fridge. Vaccines must be kept in a cold environment of +2 to +8 degrees Centigrade,” stresses Dr. Mayanja.

 

He further explains that the primary health care health funds sent to facilities are not enough for all activities. There is inadequate transport for conducting supervision by districts and also inadequate transport to do outreaches.

 

Way forward

With support from GAVI , the immunisation programme has procured  64 double cabins for 64 districts, over 600 motorcycles for HCIIIs and 1500 bicycles for HCIIs are arriving before August, 2015 to help in delivering vaccines from the districts to health facilities in time. 

 

Still under GAVI , the programme is to procure  over 800 fridges.

 

“The fridges will be in the country before July, 2015. We also need to invest in gas cylinders for the health facilities. Gas runs fridges to keep vaccines in the recommended cold temperatures,” he says.