Is Expanded Programme on Immunization doing enough? Viewpoint of health workers and managers in Sindh, Pakistan

To understand health managers' and service providers' views about routine immunization; perceived barriers and practical measures to improve the situation in three districts of rural Sindh and one town of Karachi, Pakistan.

Key informants interviews and focused group discussions were carried out involving district and town health officers, health providers, vaccinators, lady health visitors and lady health workers.

The study result showed that the problems hampering the routine immunization related mainly to lack of incentives and restricted mobility of health workers in the field. Political interference, flaws in monitoring of routine immunization, disinterest of facility based doctors and lack of private sector involvement in the provision of vaccine are other major problems. National immunization days (NIDs) so far had a negative impact on routine immunization coverage.

There is need of policy shift to integrate routine immunization with NIDs for polio which will help in improving routine immunization along with eradication of Polio. More incentives and clear service structure for vaccinators will raise the motivation among the EPI staff. The budgetary constraints must be overcome by involving all stakeholders both foreign and local. Public and private sector must work hand in hand to achieve the goal. Lastly, political will and support is mandatory to sustain the efforts of EPI.