Strategies to revitalize immunization service provision in urban settings of Ethiopia

AbstractBackground: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopi

Assessing the Impacts of Climate Variability on Rural Households in Agricultural Land Through the Application of Livelihood Vulnerability Index

Climate variability adversely affects rural households in Ethiopia as they depend on rain-fed agriculture, which is highly vulnerable to climate fluctuations and severe events such as drought and pests. In view of this, we have assessed the impacts of climate variability on rural household's livelihoods in agricultural land in Tarchazuria district of Dawuro Zone. A total of 270 samples of household heads were selected using a multistage sampling technique with sample size allocation procedures of the simple random sampling method. Simple linear regression, the standard precipitation index, the coefficient of variance, and descriptive statistics were used to analyze climatic data such as rainfall and temperature. Two livelihood vulnerability analysis approaches, such as composite index and Livelihood Vulnerability Index-Intergovernmental Panel on Climate Change (LVI-IPCC) approaches, were used to analyze indices for socioeconomic and biophysical indicators. The study revealed that the variability patterns of rainfall and increasing temperatures had been detrimental effects on rural households' livelihoods. The result showed households of overall standardized, average scores of Wara Gesa (0.60) had high livelihood vulnerability with dominant major components of natural, physical, social capital, and livelihood strategies to climate-induced natural hazards than Mela Gelda (0.56). The LVI-IPCC analysis results also revealed that the rural households in Mela Gelda were more exposed to climate variability than Wara Gesa and slightly sensitive to climate variability, considering the health and knowledge and skills, natural capitals, and financial capitals of the households. Therefore, interventions including road infrastructure construction, integrated with watershed management, early warning information system, providing training, livelihood diversification, and SWC measures' practices should be a better response to climate variability-induced natural hazards. Keywords: Households;  Livelihood Vulnerability Index; climate variability; Tarchazuria District   Copyright (c) 2021 Geosfera Indonesia and Department of Geography Education, University of Jember This work is licensed under a Creative Commons Attribution-Share A like 4.0 International Licens