Developing appropriate strategies for EPI: a case study from Mozambique

Abstract

In 1985 a ‘pulse immunization’ project was begun in southern Mozambique, to overcome the difficulties of delivering immunization services in rural areas. The project was closely monitored in order to determine whether this strategy would be appropriate on a national level. Major inputs were in training of both health workers and volunteers, and the development of a system for communications and defaulter tracing via Mozambique's network of grassroots organizations. By 1987 the project had achieved 60% coverage of fully immunized children in safe rural areas of the province, having reduced dropout rates between first and third doses of DPT/OPV from 49% to 11%. This paper describes the process of project development through situation analysis, project design, implementation, monitoring and evaluation. Conclusions are drawn which may be relevant to other programmes in their attempts to accelerate immunization coverage in a sustainable way.