Title: Analysis of access and utilisation problems
Course: Immunization - Ethiopia (Full)

Analysis of access and utilisation problems

The commonly used immunization coverage and dropout rate indicators, and what they may indicate, are summarised in Table 10.2.

Indicator (%) | What it may indicate
Penta1 coverage | Availability of, access to, and initial use of immunization services by parents or caregivers
Penta3 coverage | Continuity of use by parents or caregivers
Measles coverage | Protection against a disease of major public health importance
Penta1 to Penta3 dropout | Access to the service by parents or caregivers, and quality of communication by health workers — this is an international dropout indicator
Penta1 to measles dropout | Utilisation of health services by parents or caregivers, and the perceived quality of the service in the community — this is an international dropout indicator
TT1 coverage during pregnancy | Availability of, access to, and use of immunization services by pregnant women
TT2+ (TT3, TT4 or TT5 coverage) TT2+ (or TT+2 as in Figure 10.6) means the women received more than two doses of TT vaccine. | Continuity of use, client satisfaction and capability of the system to deliver a series of immunizations to women
Fully-immunized children (FIC) | Capability of the system to provide all vaccines in the childhood schedule at the appropriate age, and at the appropriate interval between doses in the first year of life; also measures public demand and perceived quality of services

Table 10.3 shows you how to assess whether low immunization coverage or high dropout rates are due to a problem of access (coming to the immunization services) or to a problem of utilisation (usage of immunization services). You should use the results of your assessment to identify and prioritise problems in your immunization programme, and work out possible solutions, as described in Section 10.4.

Observation at Health Post level | Problems identified
High Penta1 coverage and low dropout rate | No problem
High Penta1 coverage and high dropout rate | Utilisation problem
Low Penta1 coverage and low dropout rate | Access problem
Low Penta1 coverage and high dropout rate | Access and utilisation problems