Routine Immunization Service Delivery Through the Basic Package of Health Services Program in Afghanistan: Gaps, Challenges, and Opportunities

Abstract

Background.The Basic Package of Health Services (BPHS) program has increased access to immunization services for children living in rural Afghanistan. However, multiple surveys have indicated persistent immunization coverage gaps. Hence, to identify gaps in implementation, an assessment of the BPHS program was undertaken, with specific focus on the routine immunization (RI) component.Methods.A cross-sectional survey was conducted in 2014 on a representative sample drawn from a sampling frame of 1858 BPHS health facilities. Basic descriptive analysis was performed, capturing general characteristics of survey respondents and assessing specific RI components, and χ2 tests were used to evaluate possible differences in service delivery by type of health facility.Results.Of 447 survey respondents, 27% were health subcenters (HSCs), 30% were basic health centers, 32% were comprehensive health centers, and 12% were district hospitals. Eighty-seven percent of all respondents offered RI services, though only 61% of HSCs did so. Compared with other facility types, HSCs were less likely to have adequate stock of vaccines, essential cold-chain equipment, or proper documentation of vaccination activities.Conclusions.There is an urgent need to address manpower and infrastructural deficits in RI service delivery through the BPHS program, especially at the HSC level.

The Effect of Solar Direct Derive Cold Chain Equipment on the Performance of Immunization Services in Health Facilities of Ethiopia

“…However, static immunization services are still below 50% though there is an improvement from the baseline data (FMOH, 2015). The static immunization service finding is similar to the findings in Afghanistan in which static immunization services were used by 40% of the health facilities (Mbaeyi et al, 2017). This is further similar to the findings in Cameron which account that 69.0% of health facilities were organizing one vaccination session per month (Akoh et al, 2016).…”

“…The functionality of the refrigerators were even better than a study conducted in Afghanistan in which only 90% of the health facilities reported having a refrigerator in working condition. This functionality was lower because the power sources were kerosene, electricity and solar power for 68%, 13% and 9% of the refrigerators respectively (Mbaeyi et al, 2017).…”

Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan

“…20 Our narrative of Afghanistan's resilience in the wake of ongoing insecurity and skilled worker and infrastructure shortages is similar to that of previous literature in Afghanistan and other conflict-affected settings. 9,[18][19][20][21][22][23][24][25][26][27][28][46][47][48][49] With the government's establishment of a basic package of services and delivery through NGO-contracting mechanisms (contracting out as well as contracting in), Afghanistan was able to scale up a combination of primary and secondary care services addressing maternal, newborn, and child health and communicable diseases. 9 These choices were made early on, given the unique challenges and shortages of human resources in most areas.…”

“…17 Several studies of population and health systems resilience in the wake of ongoing conflict in Afghanistan have been performed. Although cross-sectional and analytical studies exist, 14,15,[18][19][20][21][22][23][24][25][26][27][28][29][30] they have had limited scope, and few assessed the continuum of reproductive, maternal, and child health. We undertook a longitudinal assessment of Afghanistan's entire redevelopment period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)) using individual-level data sets from robust national survey data to further explore these gaps.…”

A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region

“…The political crisis and wars in the region caused coverage of the Diphtheria, Tetanus, and Pertussis (DTP3) vaccine and third dose of oral polio vaccine (OPV3) to drop from 86% in 2010 to 80% in 2015, with wide inter- and intracountry differences. The quality of storage and cold-chain management, suboptimal compliance with recommended microplanning activities [6,7], insufficient funding, lack of transportation, and insecurity were the main challenges to the routine immunization programs in the region [8].…”