Immunisation is a highly cost-effective public health intervention. But immunisation rates are stagnant or falling in most sub-Saharan African countries. The standard approaches of health education and improved vaccine supply may not stop this decline. What other factors shape immunisation delivery and acceptance?

Coverage depends on how vaccine supply and delivery interact with demand for these services. A working paper from the Institute of Development Studies, UK takes an anthropological approach to consider influences on vaccine demand, supply and coverage in the Republic of Guinea. The researchers carried out 1,550 detailed narrative interviews and child health biographies, plus a review of documents, participant observations, group discussions and interviews with health care workers and users in urban and rural settings in Kissidougou and Dinguiraye prefectures.

Immunisation coverage has declined overall since peaking in the mid-1990s. Health centre staff and mobile teams give routine vaccinations. National Vaccination Days deliver polio vaccine. Children who have missed vaccinations may ‘catch up’ when they visit health workers for treatment or through home visits by health workers.

The authors report that:

• Vaccination is formally free. But inflation, falling revenues and competition from the private sector have cut the capacity of health centres to deliver vaccinations. Unofficial charges are common.
• The majority of parents value vaccination highly. Many mothers believe that vaccines help health in a general rather than a disease-specific way and that they protect against multiple illnesses, including some for which there is no vaccine.
• Missing or delaying vaccination is less linked to socio-economic characteristics and more due to practical problems, such as geography, transport, workload or family demands, or social relations and gender roles that affect decision-making.
• The economic downturn also plays a role. Willingness aside, some parents cannot pay or fear overcharging or fines for previous default.
• Vaccine delivery problems relating to the organisation and financing of multiple service providers can lead to difficult interactions between mothers and health workers which can discourage even those who really want vaccination.
• Several forms of community organisation support vaccination. But social pressures can also inhibit attendance.

Improved immunisation rates are essential to efforts to meet the health-related Millennium Development Goals. The authors make several recommendations for policymakers hoping to achieve this:

• develop more dialogue-based approaches to health promotion, which work with and build on local concepts of health and disease
• revise communication strategies to help mothers understand vaccination schedules
• improve communication between health providers and communities so that health workers better understand parents’ demand for vaccination plus the factors that can lead to non-attendance
• develop more transparent and accountable governance mechanisms which enable frontline health workers to highlight and solve funding difficulties
• improve integration between National Vaccination Days and routine immunisations, to enhance public understanding of their links
• discuss the potential role of the private sector in partnerships to deliver vaccination.

Source(s):
‘The social dynamics of infant immunisation in Africa: perspective from the Republic of Guinea’, Institute of Development Studies (IDS) Working Paper 262, by Dominique Millimouno, Alpha Ahmadou Diallo, James Fairhead and Melissa Leach, 2006 Full document.
'Making vaccine technologies work for the poor', IDS Policy Briefing Issue 31, May 2006 (PDF)
Also see further papers by the IDS KNOTS Team on immunisation Full document.

Funded by: UK Department for International Development (DFID)

id21 Research Highlight: 29 September 2006

Further Information:
Melissa Leach
KNOTS Team
Institute of Development Studies
University of Sussex
Brighton BN1 9RE
UK

Contact the contributor: M.Leach@ids.ac.uk

Knowledge, Technology and Society (KNOTS) Team, Institute of Development Studies, UK

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