Factors influencing implementation of immunization programs in primary healthcare facilities in Kakamega county

Abstract

Immunization is not only effective but has been adjudged as one of the most cost-effective interventions for child survival. Immunization prevents approximately 20% of child deaths annually. Despite the benefits of the immunization program, 24 million children are not immunized around the globe, mostly in rural communities. This research investigated factors influencing implementation of immunization programs in primary health care facilities in Kakamega County. The objectives of the study were to examine the extent to which human resource factors, facility-level infrastructure, health data management and client vaccine seeking behavior influence implementation of immunization programs in primary healthcare facilities in Kakamega County. Mixed methods research design was used in this study. This involved a cross sectional descriptive survey and in-depth interviews with key informants. The target population of the study included 125 health facility managers of government owned primary health care facilities in Kakamega County. The sample size of the survey was 94 primary health care facility managers. Simple random sampling technique was used to select study participants to participate in the cross sectional survey. In-depth interviews were conducted with 14 purposively sampled key informants. Majority of the respondents were female (72%) and mostly registered nurses (77%). Most of the managers had more than 10 years work experience suggesting that they understood the subject matter well. The main factor associated with high workload was high patient/client ratio within facilities. Majority of respondents reported that high workload reduces the chances of counseling clients adequately on the importance of vaccination and reduces reliability of vaccinationrelated records. Employing more healthcare workers was seen as the most effective measure to address the workload challenge. Most respondents were not very motivated to implement the immunization program successfully and financial incentive for meeting specified vaccination targets was identified as the most successful measure to improve motivation. Increasing the frequency of immunizationspecific supervisory visits and implementing supervisees’ suggestions were also identified as important measures to improve implementation of immunization programs in primary healthcare facilities. Vaccine stock-outs from the DVI depot was reported as the most important cause of missed vaccination opportunities in the healthcare facilities. Surprisingly, vaccine storage facilities were not identified as a major problem as 77% of respondents reported availability of KEPI-standard fridges in their healthcare facilities. However, challenges with energy source/power to storage facilities were reported by 63% of respondents. Most respondents reported that incidences of under-reporting or over-reporting in their vaccination records were unusual. They mostly reported using their records to plan defaulter tracking and forecasting vaccine needs. However, they rarely had records to determine the tetanus toxoid vaccination status of their clients. Vaccine acceptability by clients was reported to be high, as 82% of clients had not heard of clients declining vaccine in the past 3 months. Funds earmarked for vaccine transport in facilities need to be increased and provision of reliable power source in primary healthcare facilities should be addressed. Data management for tetanus toxoid records need to be re-designed to ensure that clinicians can access TT records in prior pregnancies to determine TT eligibility.