Understanding and Addressing Childhood Immunization Coverage in Urban Slums

This paper, from USAID-Environmental Health Project (EHP), examines issues and suggestions for improving immunisation coverage in urban slums. The urban poor, many residing in slums, make up about one-fourth of India’s 285 million urban population. Although immunisation coverage has increased significantly in recent years, large numbers of slum dwelling children remain incompletely immunised. One of the reasons for this low immunisation rate is the lack of immunisation outreach and coverage in urban areas.

According to the paper, the achievement of universal childhood immunisation by 2010 requires reach of services to urban poor through effective outreach and optimum use of fixed facilities. Six key processes to improve immunisation coverage in urban slums are suggested:

• Process 1: Identify all slums; use mapping and vulnerability assessment of slums as a
  planning tool
• Process 2: “Strengthened” and “Regular” immunisation outreach, particularly for
  areas with poor access
• Process 3: Slum dwellers and Health Provider Linkage
• Process 4: Effective monitoring and tracking mechanisms
• Process 5: Supportive Supervision for immunisation service quality assurance
• Process 6: Convergence of stakeholders for better resource management

Process 2 discusses possible mechanisms for effectively reaching the often-left out urban poor. It is said that mass media immunisation drives, where urban slums have better access to such media, combined with community counseling and peer contact can enhance service utilisation. Communication should be targeted to move caretakers from inertia i.e., fear of vaccine and no fear of disease to action i.e., no fear of vaccine and fear of disease.

The authors note that although debilitating environmental conditions and high population density in slums expedite disease transmission, the crowded living of slums makes larger number of people geographically accessible for outreach activities in lesser time unlike rural areas where population is more dispersed; thus providing more options for communication related outreach and activities.


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