Fragile Health System: Issues and Challenges in Pakistan – Harnessing Opportunities

Universal immunization of children against major vaccine-preventable diseases is one of the most cost-effective means of reducing infant and child morbidity and mortality. However in Pakistan, there has been a slow improvement... [ view full abstract ]

Universal immunization of children against major vaccine-preventable diseases is one of the most cost-effective means of reducing infant and child morbidity and mortality. However in Pakistan, there has been a slow improvement in the percentage of fully immunized children age 12-23 months, from 47 percent in Pakistan Demographic and Health Survey 2006-07 to 54 percent in 2012-13. Moreover, there is a large dropout of 14 percent and 7 percent, respectively, between the first and third dose of the DPT and polio vaccines. A lot still needs to be done in this regard.

The study intends to examine the barriers and facilitators to obtaining vaccination for their children in Pakistan besides exploring provincial and rural/urban differences using PDHS 2012-13. A model is developed to improve understanding of the barriers and facilitators which impact vaccination uptake at household level, adherence and completion. The constructs in the model have been shown to be important predictors of immunization which include woman empowerment, woman’s own reproductive health seeking behavior, mother-child relationship and other parental factors. Indicators chosen for woman empowerment include decision-making, mobility and domestic violence. The variables of woman’s own reproductive health seeking behavior consist of antenatal and postnatal care, place and assistance during delivery, TT vaccination and use of family planning. The variables for measuring mother-child relationship indirectly include gender, parity and wanted status of child. Other parental factors include age, education and occupation of both parents.

Limited decision practices, controlling behavior by husband and domestic violence are identified as key barriers to obtaining vaccines for children.