This paper has attempted to bring together, in concise form, all the main aspects of immunization administration related to the prevention of avoidable childhood diseases in developing countries. It will answer many questions and, it is hoped, inspire others.
The information presented here serves three purposes: a) to offer a summary of the components of immunization activities; b) to help managerial personnel make more informed decisions about immunization administration; and c) to contribute to the planning of immunization administration services through Community-Based Distribution projects.
Field experience forms the basis of much of this work, which has been written to highlight important problem areas that arise in immunization administration. If some issues are treated in a simplified manner, this is due to limitations of space and not to a lack of appreciation of the many difficulties and frustrations inherent in field activities.
Immunization as a Component of Primary Healthcare
The term primary healthcare covers a broad range of basic health services related to preventive, curative and health-promotion action. As explained by the World Health Organization (WHO), primary healthcare is fundamentally care made accessible to all individuals and families in the community, through means acceptable to them, with their full participation and at a cost that the community and the country can afford.
Primary care, while constituting the core of the national health system, forms part of the broader economic and social development of the community. The meeting on Primary Healthcare, held in Alma-Ata, USSR, in 1978, adopted the slogan “Health for All by the Year 2000.” This concept pursues the fundamental objective of providing all peoples of the world with adequate health services by the end of this century.
These health services include both preventive and curative activities. The various essential elements needed to achieve health for all are: a) adequate food and housing; b) protection of homes against insects and rodents; c) suitable water for cleaning and safe drinking water; d) proper disposal of waste; e) prenatal, childbirth and postnatal care services, including family planning; f) childcare services at all stages, including nutritional assistance; g) immunization against the major infectious diseases of childhood; and h) prevention and control of local endemic diseases.
The 30th World Health Assembly further emphasized the importance of immunization by adopting a resolution aimed at ensuring that, by 1990, all children in the world would have access to immunization services, marking a major step toward health for all by the year 2000.
Since experience has shown that episodic large-scale campaigns are not effective, the 27th World Health Assembly approved, in 1974, the permanent establishment of an Expanded Program on Immunization, or EPI, as an integral part of primary healthcare services.
The long-term objectives of the Expanded Program on Immunization are:
· To reduce morbidity and mortality from diphtheria, whooping cough, tetanus, measles, poliomyelitis and tuberculosis by providing immunization services against these diseases to all children in the world by 1990. Other selected diseases may be included when and where appropriate.
· To promote self-sufficiency among countries in the provision of immunization services within the framework of general health services.
· To promote regional self-sufficiency in vaccine production and quality control.
The EPI requires a lasting commitment to the continuity of immunization activities and must be integrated into existing healthcare services as an integral part of primary healthcare.
In most cases, the provision of immunization services is the entry point to primary healthcare, especially for those living in remote communities, though not only for them. Other primary healthcare services can be added to the immunization component after a program of systematic visits and logistics has been developed.
These services may include control of diarrheal diseases, health education, nutrition education and also, or instead, assessment, treatment of minor conditions, and prenatal, childbirth and postnatal care.
“In achieving its objective, the EPI seeks to establish permanent immunization services that reach a high proportion of newborns and pregnant women, since these target populations are constantly being renewed. These services are provided more economically and reasonably as a component of broader preventive and curative services, such as maternal and child health services.
In turn, the addition of immunization services strengthens the other services. Moreover, immunization coverage can be easily measured and is directly related to the reduction of morbidity and mortality. It serves as an important index of health-service performance.
As one of the simplest and least costly components of health, immunization can also serve as an instrument for expanding the delivery of primary healthcare services to communities that are still unserved.
In this way, immunization coverage can provide a clearer index of the success of health-sector activities in the field of primary healthcare than programs such as environmental sanitation, safe drinking water and nutrition, which require activities from several other sectors.
All these factors make the results of the Expanded Program on Immunization, or EPI, an important indicator of nations’ progress in their efforts to achieve health for all by the year 2000.”
