Expanded Programme on Immunization: study of the feasibility coverage and cost of maintenance immunization for children by district mobile teams in Kenya

ABSTRACT : The general of objectives of the study conducted in Kenya under the authority of the director of the Division of Communicable Disease Control and with the participation of the University of Nairobi and the Medical Research Center in Nairobi were: to attempt to improve routine immunization coverage of childred by means of a system of half-yearly rounds by mobile immunization teams; to test the operational feasibility of the system with respect to cost and coverage in 3 zones of different population density; and to compare the coverage results with those achieved in comparable zones in which immunization is carried out by the fixed health units alone. The strategy of operations was based on a few simple principles and schedules: use of vaccination scars (BCG and smallpox) to verify that the other associated vaccines had been administered; acquisition of a knowledge of the structure of the the community concerned in order to improve community participation; use of school children as to disseminate information; and immunization schedules based on visits at 6-month intervals. Four 6-monthly immunization rounds were considered necessary. By the end of it 3 groups of young children had been fully immunized. 2 different teams visited each school within a period of less than a week. Each team consisted of 2 vaccinators and 1 driver. A minimum amount of equipment was used: sterilized nylon syringes a portable gas cooker a small gas refrigerator and vacuum flasks. The base camps were set up at health centers which provided 1 or 2 rooms for the teams use. The results of the study may be summed up under the headings of operational problems coverage and costs. The introduction of this new approach met with some resistance from health staff who were not always convinced of the value of the operation. Frequent vehicle breakdowns interfered with the timing of the rounds and the system of supervision did not work out as planned. In the 3 zones of different population density the operations considerably improved coverage. In the zone of greatest population density coverage rose from 54% to 82%. In the zone with lowest population density coverage increased from 25% to 57%. The cost of the complete set of vaccines was estimated at $0.75 per fully immunized child. Operational costs varied from $0.92 to 0.75 depending on whether on a cross-country or ordinary passenger vehicle was used. The cost could be brought down to $0.40 per child if resources were cut to the minimum (1 team and 1 ordinary passenger vehicle only instead of 2).