Evaluation of quality in child immunization program in Godere woreda - gambella region, 2014

Abstract

Background: In Ethiopia, EPI program have been started in 1980 as routine immunization service. However, in 2012, fully vaccinated children, completing immunizations on time and with appropriate interval between doses were 18.6%. Immunization service provision to be effective for long run it is important that giving attention to quality of vaccination service. The aim of this evaluation was, therefore, to identify the point where quality failure would occur with in process and to determining the quality of program. Method: Case study with qualitative and quantitative methods was used to evaluate the quality in child immunization program. The study population were 189 caregivers, 11 health facilities, 12 health workers, 22 caregiver-provider interactions, immunization registration books and charts. The data were collected by in-depth-interview, document review, observation and survey. The quantitative data was analyzed by using SPSS window version 16. Bivariate (un-adjusted OR) and multivariate (AOR) analysis techniques were used to determine factors that may contribute to caregivers’ satisfaction. Qualitative data was analyzed by using Within-case analysis technique. The overall quality of program was determined based on pre-set judgmental value. Results: The judgmental level of availability dimension was good. Even if it was good, there were shortage of some resources. Health facilities with functional refrigerator 3 (27%), with incinerator were 6 (54.5%) and all of HFs had no water. Compliance dimension was the area that face many constraints. There was no supervision in all health facilities, and immunized children were not monitored in nine health facilities. The average dropout rate of DPT-HipBHib1-3 was 20.8% and DPT-HipB-Hib3 and MCV coverage were 47% and 38% respectively. Very good achievement score recorded in acceptability dimension. The mean caregivers’ satisfaction lie between undecided(3) and satisfied(4). Caregivers satisfaction on overall service provided affected by service available on appointment date and waiting time. Caregivers that receive service based on previous appointment had 3 times probability of being satisfied than not and Caregivers that wait < 30 minutes had 4 times probability of being satisfied than those wait >30 minutes on overall service provided. Conclusion and Recommendations: The quality of child immunization program was good. Even if it was good, the program can achieve more by availing water and making supportive supervision, and monitoring immunized child in each health facilities. Providers should strive to reduce caregivers waiting time and provide service based on previous appointment.