Urban inequity in Atwima Nwabiagya Municipality, Ghana: bridging gaps to reaching every child with vaccination in urban areas and among mobile population
 

Introduction
The goal of public health is to prevent disease. It is much easier and more cost-effective to prevent a disease than to treat it and that is exactly what immunizations aim to do.

Immunizations protect populations from serious diseases and also prevent the spread of those diseases to others. Over the years, immunizations have frustrated epidemics of once common infectious diseases such as measles, mumps, and whooping cough. And because of immunizations we've seen the eradication of others, such as and smallpox.

Like many countries, the Expanded Program on Immunization (EPI) is an integral strategy of Ghana Health Policy aimed at reducing child mortality and morbidity due to vaccine-preventable diseases (VPD) and targeting the attainment of Sustainable Development Goals (SDGs).

Immunization is one of the key components of the Basic Package of Health Services (BPHS) provided mainly by government frontline health workers with support from volunteers and other stakeholders. The target is to achieve and sustain at least 90% reported national coverage for all antigens and at least 80% coverage in every district.

However, the 2018 nation demographic and Health Survey reports huge regional and district variation in immunization coverages, thereby presenting inequality in the routine immunization coverages. In the last decade, Ghana and Atwima Nwabiagya have shown progress in immunization coverages and keeping at lowest levels morbidity and mortalities due to vaccine-preventable diseases. This notwithstanding, the last three Ghana Demographic and Health Surveys (GDHS) have shown stagnation of Immunization coverages around 89%; spanning over one decade (2008 – 2018) of an average 10% of cohort unimmunized children during the period (figure 1 and 2).

Figure1 Figure2

Evidence from surveys and reports suggest that immunization services and coverage in the country are good but stagnated for some time now with regional and district variations. Several factors contribute to the stagnation. These factors include inadequate funds for timely vaccine procurement and operational activities at subnational level; high numbers of unimmunized children in urban and peri-urban areas; inadequate logistics such as cold chain storage facilities, inadequate transport for service delivery and supervision, shortage of some vaccines; and data quality and use

Moreover, issues of urban vaccination strategies (no outreach in cities) and rural vaccination strategies. In urban settings, the issue is further complicated by internal displacement of population by search for jobs in the cities, where a great portion of the rural population has displaced to urban settings, served as urban slums, often not included in the microplanning or requires additional resources for vaccination.

Routine data from DHIMS II (table 1) show that while BCG coverage is doing well from the fact the municipality has been profited with six hospitals, one polyclinic, two health centres, four maternity homes and clinics where delivery of babies and their vaccination happens, there is worsening coverage of antigens as children age and become mobile with parents working in the city.

Table 1: Atwima Nwabiagya routine immunization coverage: year 2016 -2018

This project is therefore designed to improve vaccination services in the urban settings of Atwima Nwabiagya Municipality.