An analysis of the impact of strategies used to mitigate child mortality: Case of the Zimbabwe expanded programme on immunisation.

Abstract

The Zimbabwe Expanded Programme on Immunisation (ZEPI) is one of the most cost effective and powerful child survival interventions against the vaccine –preventable six killer diseases among the children under the age of five years. This study makes an analysis of the impact of the ZEPI in mitigating child mortality in Ward 46 of Tafara district in Harare East Constituency from 2010 – 2014. This will be done in line with the ZEPI’s broad objectives of protecting children with safe vaccines, reduction of child morbidity and mortality through vaccine utilization, strengthening advocacy and communication as well as integrating ZEPI with other interventions. The researcher adopted the mixed methods approach in data collection, presentation and analysis. Purposive in-depth interviews with eight key informants were conducted with officials from both the Ministry of Health and Child Care and Harare City Health Department. Information obtained from key informants was collaborated with data obtained from administered survey interviews conducted from 98 household families in Ward 46 of Tafara District in Harare. Systematic sampling method was used to select respondents for the survey questionnaires. The researcher targeted mothers from Ward 46 who received ZEPI at Tafara clinic and these were drawn from different demographic characteristics such as age, educational, religious and employment background. The research study then triangulated the data collected from key informants, survey methods and desk review to get comprehensive analysis of information on the impact of ZEPI in reducing child morbidity and mortality in the district. Data was presented in the form of tables and a descriptive analysis was done through the use of line and bar graphs. The research study concluded that the ZEPI has not reduced child morbidity and mortality in Ward 46 of Tafara district in Harare East Constituency between 2010- 2014. It was established that more than 80% of the respondents agree that ZEPI has low impact in reducing child mortality rates in the district despite the community having adequate knowledge on the existence and importance of this child health care intervention. It was established that religion has a strongest bearing on immunisation uptake as revelations concluded that followers of the Jowane Marange Apostolic church had the lowest immunisation uptake in Ward 46 of Tafara District. Other church denominations have above average to high ZEPI uptake with Roman Catholic Church having the highest uptake. From the study, maternal knowledge of the ZEPI has no bearing on child immunisation uptake as revealed in this study that ill mothers in the district are aware of the significance of having their children immunised even from the followers of the Jowane Marange church who are objectors of the ZEPI. Respondents in this study revealed that no ZEPI outreach programmes were observed in the district between 2010 and 2014. The implementation of ZEPI in the district was facing numerous challenges, chief amongst them relating to transport problems to cover the whole district, religious objectors, inefficient communication channels and the general failure by the health professionals to effectively reach out to the population. The study noted that there is low participation of the community in ZEPI programmes in the district. The study therefore recommends active participation of all concerned stakeholders including religious leaders at community level, availing of more vehicles for ZEPI to the Tafara clinic for extensive reaching out to the hard to reach population, tracking of dropouts, the inclusion of private players and in particular the donor community in the health service delivery can help ameliorate financially related problems. High levels of result-based monitoring and outcome evaluation are also required as key to implementation of the ZEPI in the district.