Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic

Area of Science:

• Public Health
• Sociology
• Anthropology

Background:

• Expanded Programme on Immunisation (EPI) vaccination rates are critically low in many regions globally.
• Significant international resources are allocated to vaccination financing and access, yet herd immunity remains elusive.

Purpose of the Study:

• To investigate the barriers to childhood vaccination from a 'customer' perspective in Jimma Zone, Ethiopia.
• To identify service delivery failures and propose innovations to improve vaccination uptake.

Main Methods:

• Ethnographic study involving 83 mothers who had not vaccinated their children.
• Application of service marketing theory, organisational sociology, development anthropology, and cultural consumer research.

Main Results:

• Western public health policies are dominated by administrative logic, obscuring on-the-ground challenges faced by mothers.
• Mothers perceive vaccination as a 'low involvement' good compared to immediate survival needs.
• Poor service quality, including uncaring staff, unpredictable schedules, and long waits, deters mothers from vaccinating.

Conclusions:

• Current vaccination delivery systems fail to address the practical realities and perceived costs for mothers.
• Service design innovations focusing on the mother's perspective are crucial for improving vaccination rates in areas with low uptake.