Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study.

There is substantial variability in immunization coverage trends across the globe which can be attributed to a number of factors such as demographic profile, socioeconomic characteristics and political environment. Vaccine preventable diseases contribute to severe disease burden when coverage is low, particularly, in slums. Present qualitative study explored barriers, opportunities, and key facilitators of childhood immunization. This was a community based cross-sectional study conducted in the slum areas of Mumbai, India. Data from the observations of immunization sessions and interviews of end users, healthcare service providers, and influencers were collected and analyzed. Lack of time, poor awareness, fear of adverse event, loss of daily income, and migrant population were some of the major reasons to not get immunized. Also, lack of good behavior of staff was another crucial factor perceived by caretakers as barrier in the immunization. Stakeholders agreed that immunization is a shared responsibility involving community, service providers, and policy makers. There was general consensus that immunization practices have improved over the last few years. However, its positive impact is yet to be fully seen in populations that belong to lower socioeconomic strata, thus warranting additional efforts to improve the immunization coverage in slums. Effective communication, process improvement at various levels, active involvement of communities in the immunization activities, building trust and accountability, and constructive feedback are some of the essential elements to strengthen the immunization program. Strategies to improve immunization services in such settings should be based on interactions with stakeholders and understanding their perspectives.