News @ JSI

Rethinking Immunization Strategies for the Urban Poor

May 11, 2017

Almost one-third of the world’s urban population—about 1 billion people—live in poverty. This is likely to increase over the next 40 years, with 90 percent of urban growth occurring in low- and middle-income African and Asian countries. Rapid urbanization is outpacing the public sector’s ability to build essential infrastructure and systems to provide basic health care and social services, leaving these cities with myriad interrelated challenges, including over-extended resources, sub-standard services, poor coordination, and increased possibility of social unrest.

Building on recent urban immunization work with WHO, UNICEF, Gavi, the Vaccine Alliance, and Bill & Melinda Gates Foundation, JSI recently hosted a webinar to raise the profile of an often neglected issue: immunizing the urban poor.

The panelists discussed the primary barriers for the urban poor to access and use vaccination services, how these barriers can be overcome (with examples from country-specific contexts), and the need to build better evidence to help advocacy efforts. Key takeaways from the event included:

  • Urbanization will increase: There are now more unimmunized children living in urban settings than rural, a contrast to when the EPI program was began and has been designed over the last 40 years. This trend in urbanization will increase over time and will require more and better advocacy to reach the urban poor.
  • Evidence, data, and best practices are needed to guide planning and implementation efforts.This is challenging due to low priority and the unique aspects of denominators, migration, tracking data, and service mapping in urban areas.
  • Collaboration, coordination, and partnership are all required: Better collaboration, coordination, and partnerships between different programs and sectors (especially MNCH, nutrition, and WASH) and government, municipalities, NGOs, civil society, private sector, and UN. Unfortunately this is the biggest challenge and we should look for opportunities to build upon coordination mechanisms that work well and not separate the technical, financial, and political aspects of 'getting things done.'
  • Communities need to be engaged: New delivery models need to take into consideration the needs of different communities, rather than just looking at geographic differences. Communities need to be engaged with social behavior change strategies to increase the demand for vaccines and other health services.
  • New models of delivery that address social distances, not only the geographical and physical barriers that prevent service access and use: EPI models are based on rural settings. New models for service delivery, monitoring, and demand generation are urgently needed to protect urban unimmunized people.
Read "Rethinking immunization strategies to reach the urban poor" for insight on immunizing the urban poor.