Immunization in urban areas: issues and strategies

Abstract

In the past, immunization programmes have focused primarily on rural areas. However, with the recognition of the increasing numbers of urban poor, it is timely to review urban immunization activities. This update addresses two questions: Is there any need to be concerned about urban immunization and, if so, is more of the same kind of rural EPI activity needed or are there specific urban issues that need specific urban strategies? Vaccine-preventable diseases have specific urban patterns that require efficacious vaccines for younger children, higher target coverage levels, and particular focus to ensure national and global eradication of poliomyelitis. Although aggregate coverage levels are higher in urban than rural areas, gaps are masked since capital cities are better covered than other urban areas and the coverage in the poorest slum and periurban areas within cities is as bad as or worse than that in rural areas. Difficult access to immunization services in terms of distance, costs, and time can still be the main barrier in some parts of the city. Mobilization and motivation strategies in urban areas should make use of the mass media and workplace networks as well as the traditional word-of-mouth strategies. Use of community health workers has been successful in some urban settings. Management issues concern integration of the needs of the poor into a coherent city health plan, coordination of different health providers, and clear lines of responsibility for addressing the needs of new, urbanizing areas.

PIP: The Expanded Program on Immunization has tended to direct its efforts toward rural areas. There are increasing numbers of urban poor, however, who also need to be vaccinated against preventable diseases. Urban patterns of vaccine-preventable diseases are unlike those found in rural areas. Urban-specific immunization strategies are therefore called for. Urban patterns require strong and effective vaccines for young children, higher target coverage levels than in rural areas, and particular focus with regard to the national and global eradication of poliomyelitis. Although aggregate immunization coverage levels are higher in urban than in rural areas, coverage in urban areas is not uniformly high. Overall coverage is better in capital cities compared to other urban areas and the coverage in the poorest slum and periurban areas within cities is as bad as or worse than that in rural areas. Difficult access to immunization services in terms of distance, costs, and time can also be the main barriers to securing immunization in some parts of cities. The use of community health workers has been successful in some urban settings. It is recommended that mobilization and motivation strategies in urban areas use mass media and workplace networks as well as word-of-mouth strategies. Management issues concern integration of the needs of the poor into a coherent city health plan, coordination of different health providers, and clear lines of responsibility for addressing the needs of new, urbanizing areas.