This preprint is under consideration at Health Research Policy and Systems. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
BMC Supplements Reviewed
Thewodros Zewde Shay
MERQ Consulting P.L.C
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8696-5089
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Losing children to follow-up is one of the major barriers identified in Ethiopia’s immunization program. In many urban slum areas like Lideta sub-city, Addis Ababa, several demand- and supply-side factors affect the follow-up visits for routine immunization services, so this study aimed to explore the influence of linkages, a feedback mechanism, and caregivers' mobility on immunization follow-up visits.
Methods
The study team employed a qualitative method and conducted 30 in-depth interviews with caregivers, 26 interviews with key informants, and five focus group discussions with health officials and decision-makers. A deductive content and thematic analysis was carried out by importing the transcripts into OpenCodes, applying the a priori codes, and identifying new codes and themes.
Results
The linkages among health facilities included those from hospitals to health centers, from hospitals to hospitals, and from health centers to health centers within and outside of the sub-city. Using these linkages, most vaccinators transfer caregivers without providing multi-dose vial (MDV) vaccines, mainly BCG and MCV, ‘to minimize wastage’ and thus successfully reduce vaccine wastage rates; yet most caregivers wasted their time, energy, and money traveling from one health facility to another. Despite some efforts to transfer caregivers using ‘transferal slips’ and informal phone calls to vaccinators’ friends, unfortunately, there was no formally established system for getting feedback about the arrival of caregivers and continuation of the follow-up visits. Overall, the transfer process lacked uniformity, used various approaches, and was not systematic.
Conclusions
Transferal of caregivers for the sake of minimizing wastage of MDV vaccines without checking the vaccination schedules of the receiving health facilities, using various informal types of tools and approaches, along with a poor follow-up and feedback system were major identified challenges, which cost caregivers extra money, energy, and time in getting timely immunization services. Therefore, the Federal Ministry of Health should strengthen the linkages among facilities, ensure the establishment of formal communications by developing guidelines and standardized tools—transferal slips and approaches—and initiate a fast feedback provision system using SMS text messages.
Keywords
linkages, feedback mechanism, follow-up, transferal process, mobility, transferred out
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Posted 05 Feb, 2021
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On 01 Feb, 2021
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Health Economics & Outcomes Research
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This preprint is under consideration at Health Research Policy and Systems. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
BMC Supplements Reviewed
Thewodros Zewde Shay
MERQ Consulting P.L.C
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8696-5089
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Feb, 2021
No community comments so far
Editor assigned
On 01 Feb, 2021
Submission checks complete
On 01 Feb, 2021
Editor invited
On 01 Feb, 2021
First submitted
On 27 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Losing children to follow-up is one of the major barriers identified in Ethiopia’s immunization program. In many urban slum areas like Lideta sub-city, Addis Ababa, several demand- and supply-side factors affect the follow-up visits for routine immunization services, so this study aimed to explore the influence of linkages, a feedback mechanism, and caregivers' mobility on immunization follow-up visits.
Methods
The study team employed a qualitative method and conducted 30 in-depth interviews with caregivers, 26 interviews with key informants, and five focus group discussions with health officials and decision-makers. A deductive content and thematic analysis was carried out by importing the transcripts into OpenCodes, applying the a priori codes, and identifying new codes and themes.
Results
The linkages among health facilities included those from hospitals to health centers, from hospitals to hospitals, and from health centers to health centers within and outside of the sub-city. Using these linkages, most vaccinators transfer caregivers without providing multi-dose vial (MDV) vaccines, mainly BCG and MCV, ‘to minimize wastage’ and thus successfully reduce vaccine wastage rates; yet most caregivers wasted their time, energy, and money traveling from one health facility to another. Despite some efforts to transfer caregivers using ‘transferal slips’ and informal phone calls to vaccinators’ friends, unfortunately, there was no formally established system for getting feedback about the arrival of caregivers and continuation of the follow-up visits. Overall, the transfer process lacked uniformity, used various approaches, and was not systematic.
Conclusions
Transferal of caregivers for the sake of minimizing wastage of MDV vaccines without checking the vaccination schedules of the receiving health facilities, using various informal types of tools and approaches, along with a poor follow-up and feedback system were major identified challenges, which cost caregivers extra money, energy, and time in getting timely immunization services. Therefore, the Federal Ministry of Health should strengthen the linkages among facilities, ensure the establishment of formal communications by developing guidelines and standardized tools—transferal slips and approaches—and initiate a fast feedback provision system using SMS text messages.
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