A study to assess the impact of decentralisation on immunization coverage/services

Introduction: Childhood immunization coverage in Uganda has been declining over the last few years thus wiping out a significant part of the initial gains made in the immunization sector. The period of this decline coincides with the decentralisation of the health services in the country. This study s aim was to assess the impact of decentralisation on immunization services/coverage. Previous studies have shown a mixed picture on the performance of immunization services under decentralization. In some countries immunization services have improved while in others they have declined. Methods: A cross-sectional study design utilising both quantitative and qualitative methods of data collection were employed. Quantitative data was collected from various official records and registers at both national and sub-national levels, 114 health workers were interviewed and 23 in-depth interviews were carried out at central, district, health sub-district, sub-county and health unit levels. In addition, an observational checklist was administered at 11 health units. Results: 96.5% of health workers had a regular supervisor and provision of feedback by supervisors was a common practice. Immunization supplies were regularly delivered to all health units with delays being infrequent. 61.4% of health workers attended one or more training sessions over a 12 month period. All health units ran outreach programmes and provided health education to waiting clients. Health workers face some constraints in carrying out immunization activities and the most common ones were found to be transport and financing. In addition health information posters and pamphlets on immunization were found not to be universally available at the health units. Conclusion: Supervision and supplies delivery for immunization services are being done quite well. Training of health workers is not well distributed among the staff. Transport and financing pose the greatest challenges to immunization services