Ref Number = ASPR0010
Increasing Immunization Coverage: A Lesson from Young Pediatrician of Way Kanan, Lampung Province, Indonesia
Achmad Rafli
Department of Child Health dr.Cipto Mangunkusumo Tertiary General  Hospital in Cooperation with Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
E-mail: achmad.rafli31@alumni.ui.ac.id
Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases especially in children and estimated to avert between 2-3 million deaths each year.1,2 Tremendous progress has been made towards this goal of global equity, yet the health systems in many of the developing countries which have remote areas remain have obstacles of vaccine supply and lack of competent human resources e.g. in Way Kanan, Lampung Province, Indonesia.

Way Kanan is one of remote district from 15 districts in Lampung Province, Indonesia with population 450.109 people in 2019. In Way Kanan, children immunization coverage is particularly very poor. This is due the lack of trained health workers, inefficiency of supply chains, and vaccine hesitancy. During the one year the trained ?fresh graduate? pediatrician worked with the Way Kanan Health Office, basic children immunization (government?s program) coverage increased from 64.8% in January 2017 to an average of 103% in December 2018. As of April 2019 when follow-up data were collected, the immunization coverage rates remained at 100%. Similarly in coverage of Measles Rubella (MR) campaigns phase II with target 120.323 children increased from 40% in January 2018 to 97.1% in December 2018.3 

According to District Health Officials, this coverage increase is attributed to the on-the-job training provided by the ?fresh graduate? who set up immunization program working with local government officials and health department to train around 858 health workers (nurses, midwives, and general practitioners) in Way Kanan district as well as support to the District Health Office team around reporting and data management, Indonesian Ulema Council (Majelis Ulama Indonesia) delegation for Way Kanan, and also role of Indonesian Pediatric Society who facilitated and trained new pediatrician in immunization advocacy training called immunization champion.
Way Kanan received award from Indonesian Ministry of Health and also appreciation from Indonesian Pediatrics Society and American Academy of Pediatrics for expert role in the successful 2018 MR campaigns (also more than 95% of immunization MR coverage) at national and sub-national levels, achieved 103% immunization rate for basis vaccines (increase 60%) and 97.1% MR immunization rate (increase from 40%) in Way Kanan district. 
From this experience, we have learned the importance of a comprehensive approach that engages the government sector, increases health officers capacity, and improves data availability. To deliver the promise of immunization to all children no matter where they live, we must start at the last mile with an understanding of what can be done and then work together to build health systems that will reach every child.
Keywords: Children; Immunization; Coverage; Remote District; Pediatrician; Champion
Acknowledgement: Acknowledgements: the author thanks to Way Kanan Health Office, Indonesian Ministry of Health, Indonesian Pediatric Society, and American Academy of Pediatrics for supporting children immunization program in Way Kanan.
1. World Health Organization. Immunization. Available at: 
https://www.who.int/topics/immunization/en. Accessed August 8, 2019.
2. Center for Disease Control and Prevention. Vaccines and immunizations. Available at: 
https://www.cdc.gov/vaccines/vac-gen/howvpd.htm. Accessed August 8, 2019.
3. Way Kanan District Health Office. Report of children immunization coverage. Available at: http://waykanankab.go.id/dinkes/detailpost/way-kanan-
menerima-kunjungan-american-academy-of-pediatrics-aap-dan-ikatan-dokter-anak-indonesia-idai. Accessed August 8, 2019.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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