Assessment of Delivery of Routine Immunization in Kashmir: A Qualitative Study

Introduction:Immunization is one of the splendid public health interventions that remarkably reduced child morbidity, mortality, and disability. Despite attaining substantial immunization coverage in Kashmir, assessment of the immunization system is quintessential for sustaining the gains and exploring the gaps. Objective: To assess the gaps in the delivery of routine immunization services in Kashmir Valley. Method: In-depth face-to-face interviews were conducted with thirty-two (32) important stakeholders, who were purposively selected as they play an active role in the planning and implementation of the Immunization Program and devise strategies at different levels of healthcare delivery. At the state level, SEPIO and SMO were interviewed at the District level, DIO/Deputy CMO was interviewed in all ten (10) districts of Kashmir Valley. From all ten Districts, two Medical-Blocks were selected from each District, and one Block Medical Officer and one Medical Officer were interviewed alternatively from each Medical-Block. Results: The thematic qualitative analysis approach was used and the analysis process generated five themes. Each of these themes included many sub-themes. 1. Factors facilitating the implementation of Routine Immunization (RI), 2. Limitations and deficits related to knowledge, attitude, monitoring, 3. Constraints encountered in the implementation of (RI) program, 4. Difficulties in the implementation of RI revealed by respondents, 5. Transformational steps to bridge gaps in the delivery of Immunization (RI) Conclusion: There were visible deficits related to knowledge, attitude, and monitoring among health professionals. Certain constraints encountered in the implementation of the program were financial constraints in the training of health care professionals and human resources constraints. The study showed the need for transformational steps to bridge gaps in the delivery of the Immunization (RI), which included regular monitoring and review meetings, teamwork and peer learning, training, and improvement in cold chain maintenance.