Ref Number = ASPR0005
Immunization Advocacy in Limited Resource Area : Seram Case Study
Hasriza E Putra
Participants of Pediatrician Compulsory Duty batch VI Ministry of Health of the Republic of Indonesia, East Seram District Placement
E-mail: hasrizaekaputra@gmail.com
The prevention of major threats to children?s health and the control and management of other problems can not be managed solely in the pediatric office. The integration of clinical practice with the public health actions is necessary for disease prevention that involve the child, family and community. Pediatrician are well positioned to advocate on issues that affect children?s health. One of them is immunization endeavors due to poor coverage.1 The measles and rubella (MR) immunization campaign was carried out in August-September 2018 in East Seram District. At the beginning, as had been happened the previous year when these were carried out in Java and Bali, there was rejection  by local people due to some misconceptions regarding vaccine halality, benefits and side effects of vaccines. The education provided by individuals or community groups didn?t have significantly effect. The coverage was only 66.24% at the end of the initial period. When the implementation period was extended for one month, an evaluation was conducted to assess the cause of the slow progress of the achievement. In addition to misconceptions, obstacles included funding, transportation and the quantity of human resources in each region. Types and materials of advocacy were carried out in accordance with the assessment. The approach to the District Ulema Council and local religious leaders resulted in the issuance of a recommendation stating the ability to give MR vaccine to children in the local district. This became the clear basis for local residents, who followed the views of local ulemas more strongly rather than  Fatwa and recommendation letters issued by Central and Province Ulema Counsil, and as material to strengthen public education. Collaboration with the officials of the district ministry of religion opened the way again for vaccination to be carried out in madrassas and Islamic boarding schools which had previously refused vaccination. Together with the United Nations Children's Fund (UNICEF) communication was carried out to the district government in accelerating the achievement of targets within the time limit. The district government, through the health department, provided bailouts to each community health center (CHC) as a breakthrough way to overcome the administrative obstacles in disbursing health operational fund to finance the MR vaccination campaign including transportation costs in visiting vaccination subjects in areas that are difficult to reach by land and islands separated by seas. The advocacy steps taken took up to two weeks. In that time span there was only an increase of 3.1% resulting in 69.5% coverage. The next strategy was to determine the number of daily targets in the remaining two weeks in each CHC working area that had not yet reached the coverage target. It was also appointed and sent officials and staff of the health department to directly supervise the implementation of the results of advocacy that had been carried out (educational material, vaccination logistics, cost constraints and transportation), making a massive movement that was not only the responsibility the prevention and control of disease filed but includes all human resources of the health department in various fields. It also provided a solution to the constraints to the quantity of implementing staff. Optimization of the implementation of the above concept led to the achievement of a coverage target of 97.28% at the end of the MR vaccination campaign extension period (31 October 2018). Low immunization coverage in an area has a broad spectrum of causes. Achieving target coverage requires an analysis of the potential obstacles and planning to overcome them. These should be done before the vaccination campaign is started by the working group involving officials in the regional government and cross-sectoral community leaders. Advocacy meetings need to be held to garner commitment, concrete support and participation from all stakeholders in the community towards the implementation of the MR vaccination campaign.2 In addition, interpersonal communication using all available means continues to be carried out to get massive community mobilization.3 Pediatricians have the responsibility to prevent disease by promoting immunization. The individual approach taken in the child's examination room will have optimal results in if it is equipped with a community-based approach. Communication, collaboration and partnership between pediatricians and the public health sector have the potential to achieve these goals in order to improve the health level of children at the individual and community level through the achievement of immunization coverage targets in the community. ASPR0005 - 1  ASPR0005 - 2
Keywords: Vaccination Policy; Barrier and opportunity to Immunization; Vaccine Hesitancy; Determinants
Acknowledgement: The authors are immensely grateful to East Seram District Government, Health Department and the entire community for their support in achieving the MR vaccination coverage target.
1. Kuo AA, Thomas PA, Chilton LA, Mascola L. Pediatricians and public health: optimizing the health and well-being of the Nation?s children. Pediatrics 2018;141:1-9.
2. Singh S, Sahu D, Agrawal A, Vashi MD. Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative studi. Preventive Medicine Report 2019;14:
3. Waisbord S, Larson HJ. Why invest in communication for immunization: evidense and lessons learned. New York: A join piblication of the health communication partnership based at John Hopkins Bloomberg School of Public Health/Center for Communication Program (Baltimore) and the United Nations Children?s Fund; 2005.   
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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