Assessment of the Implementation of Expanded Program on Immunization in

Barangay Maranding, Lala, Lanao del Norte from 2014-2018

Historical Background

Over the years, the child mortality level in the world is a growing challenge to

the global arena. One of the primary targets of the United Nation Millennium

Development Goals is to reduce child mortality. It is significant to lessen the child

death rates of certain country because it is a basic measure of a country's

advancement. Most deaths in the third world countries are disregarded because

social class level was mere priority (UNDP, 2003).

In the UNICEF survey, The Philippines ranked 83rd out of 169 in the global

ranking based on child death rates (UNICEF, 2012). The current rate of the child

deaths in the Philippines has improved with the help of the health programs. These

programs are the key in order to reach the 4th MDG. One of which is the Expanded

Program on Immunization (EPI). It has been implemented by the Philippine

government as a policy in 1976, and was revised in 1986.

The Program is under the Republic Act No. 10152 that is known as the

“Mandatory Basic Immunization Services for Infants and Children LawPhil (2011).

There are eight vaccine-preventable diseases that were included such as

tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, hepatitis B and influenza.

All Barangays in the Philippines must intend to implement this immunization program

to prevent children below five from such diseases. This immunization program is

given by every Health Center for free. Both government and nongovernment

organizations such as Department of Health and LGUs are responsible for the

distribution of materials for immunization that is needed for every barangay health

center. They will be the one conducting training programs and procedures for the

health personnel for the immunization for children and they also have to be informed
about the Republic Act No. 10152 so that they could advise the parents of guardians

of the children about the free immunization to help prevent the diseases of the

children.

The World Health Organization (WHO) and the UNICEF presented to the

Philippine Department of Health the Expanded Program on immunization to protect

children against vaccine preventable diseases. With the support of international

Organization, the DOH supported the expanded program on immunization in

distributing the vaccines in the regions of the Philippines. The Department of Health

hoped to reach 95% vaccination coverage with the help of local government units

especially the local chief executives. The National Capital Region compared to other

island cluster has the lowest 55% measles vaccination coverage. Mindanao has the

highest (68%) followed by Visayas (64%) and Luzon (62%). With the help of

Expanded Program on immunization presented by WHO, the DOH in Northern

Mindanao assured that more people will be immunized as the agency’s program is

on-going.

The eligible population of infants below one year is the greatest concern of the

EPI because this is the population with the greatest risk. The program covers

Philippines local governments including Barangay Maranding in the Municipality of

Lala, Province of Lanao del Norte, the center of commerce in the entire municipality.

This study will determine the effectiveness of the implementation of Expanded

Program on Immunization of the Department of Health by the Health Center in

Barangay Maranding from 2014-2018; evaluate the knowledge of mothers about the

EPI vaccinations; and identify the strategies and activities conducted in relation to

EPI. Moreover, this study aims to raise awareness concerning the effectiveness of

the Expanded Program on Immunization in Barangay Maranding. It is equally

essential for the people to be well-informed and knowledgeable enough with regards

to this particular issue to prolong the life of the children.

Presentation of Data and Results

The primary goal of this research is to assess the effectiveness of Expanded

Program on Immunization in Brgy. Maranding, Lala, Lanao del Norte from the year

2014-2018 by determining the number of fully immunized children and evaluating the

performance of the barangay health workers. The study also provides the strategies

and activities conducted in relation with the EPI. Table 4.1 summarizes the percent

FIC during these periods.

Table 4.1 Changes in Immunization Coverage from year 2014-2018

YEAR Fully Immunized Child Total Live birth % FIC based on TLB

2014 371 432 85

2015 318 370 85.9

2016 411 429 95.8

2017 401 409 98

2018 529 534 99.1

FORMULA USED: FIC/TLB×100

 600

500

400

300 Fully Immunized Child

Total Live Birth

200

100

0
2014 2015 2016 2017 2018

% FIC based on TLB

100

95

90

% FIC based on TLB

85

80

75
2014 2015 2016 2017 2018

From the data above, it can be gleaned that every year the percentage of

Fully Immunized Child is increasing. In fact, in 2018, almost a 100% is recorded for

the number of Fully Immunized Child over the Total Live Birth.
Performance of the Health Workers

One of the best measures of a health personnel’s performance is the

feedback of the recipients of the service, the mothers. Table 4.2 presents the results

of the interview of 24 mothers regarding the approach and performance of the health

workers. The findings show that the health workers were very accommodating and

courteous by immediately attending to the needs of the clients and answering their

questions in a simple manner regarding their child’s condition. They were also very

efficient in the information dissemination regarding changes in schedule, and the

schedule of the next immunization. However, an area of improvement is on the

dependability of schedules. Some mothers and health workers verbalized that

changes in the schedule resulted in discouragement of the mothers to return, and

increased transportation costs and inconvenience for them. Where rescheduling is

inevitable, house to house visitations were supposed to be done to ensure that all

the children are immunized. During the course of the interview of the mothers, it was

found out that the health workers were not able to conduct regular house visits to do

vaccine mop-up. The health workers have attributed it to several reasons such as

the volume of workload, the large area to cover compared to the few health workers

who do the legwork, and the lack of incentive to perform an excellent job.

Table 4.2 Results of Interview of Mothers regarding Health Worker Approach and

Performance

Questions YES (%) NO (%)

1. Gi-atiman ba dayon mo sa inyong gikinahanglan sa pag- 100 0

adto nimo sa health center?

2. Aduna bay panahon nga na usab ang schedule sa pag 63 37

bakuna?

3. Na pahibalo ba ikaw deretso sa pag usab sa schedule? 92 8

4. Gina pahibalo ba ka nila sa adlaw sa sunod na pag 100 0

bakuna sa imong anak?

5. Na tubag ba nila imung pangutana sa simple ug dali 100 0

masabtan na pamaagi?

6. Gi na adto ba ka sainyong balay para magbakuna or ma 42 58

pahibalo sa schedule sa bakuna?

7. Naa bay panahon na gikasab-an ka or gi-insulto? 29 71

8. Aduna bay panahon nga nangolekta sila nimo ug kwarta 58 42

para sa serbesyo na ilang gihatag?

Table 4.3 Strategies and Priority Activities

Strategies Priority Activities

Implement or reinforce Reaching - Strengthen outreach services

Every Barangay (REB) approach in where most likely needed

all puroks of Barangay Maranding - Provide incentives to health

workers and community health

workers
Measles Supplemental immunization - Implement measles follow-up

activities campaigns

Polio eradication activities - Implement the preventive polio

campaign in case of wild polio virus

is detected

Training and reference materials - Train Barangay health center level

dissemination in vaccine management

Analysis of Data

With results and data presented above, vaccination of children with the EPI

vaccines is a highly effective to the public health community. Overall, vaccination has

significant effect on reducing mortality from childhood diseases and will be a priority

intervention for achieving the child health Millennium Development Goals.

The researchers concluded that the implementation of Expanded Program on

Immunization is highly effective. The immunization coverage has been increasing

and has been maintained from 85% and above. However, it was found out that there

were insufficient numbers of nurses for the Barangay’s population of 12,114 (2015

Census). Some of the respondents said that there were some inaccessible areas in

Maranding that were difficult to be informed for health free vaccines program. In the

Philippines, it is mandatory for a family to comply with the complete immunization of

the children. For this reason, every health center is obliged to give a free vaccination

to their community especially to those mothers who have their first born child.

Moreover, dissemination of the Expanded Program in Immunization in Maranding

Health Center lacks advertising in their program to the people according to the

respondents. Thus, this factor blocks the distribution of information of the benefit of

vaccination to the people of Maranding. However, in spite of the mentioned barrier,

the vaccination implementation in Maranding is still effective, but there is a need to

intensify the effectiveness of the program to achieve a 100% fully immunized

community.

Recommendation

The researchers recommend the following for the improvement of the program:

1. Training and seminar for the health workers, actively participating the program,

should be done on a continual basis.

2. Strict implementation of the mop up of immunization in addition to the regular

immunization schedule will ensure large coverage of FIC. There is no better way to

ensure complete FIC.

3. The LGU should support the health workers in performing their responsibilities by

providing for the resources needed in the program such as transportation allowance.

4. Barangay Council of Maranding should provide other means of communication by

giving flyers/leaflets to the residents.

5. Poster must be posted in the health center and in the different zones in the

community.

6. All purok leaders should cooperate with the health workers in disseminating the

information to the community.

7. Media should be utilized as another means of dissemination of information about

the program.

8. In order to carry out the effective implementation of the program, the media should

be used to disseminate the information.

9. For further encouragement, conducting seminars are helpful for the residents to

have knowledge about the importance of vaccination.

REVIEW OF RELATED LITERATURE

This area presents the related literature and studies after the thorough and in-

depth search done by the researchers that are taken from books, ebooks and

journals.

The importance of an assessment was emphasized in the country of

Mozambique where the Expanded Program on Immunization underwent an

evaluation from 1985 to 1987. The results were used to modify immunization

strategies. Due to the evaluation the major determinants of low vaccination coverage

were perceived. These included provision of vaccination services at health centers

on less than 3 days per week; missed opportunities; and vaccinating too early or with

too short an interval between doses. Evaluation led to changes in EPI policy in

Mozambique (e.g., adoption of a uniform national vaccination schedule and

discontinuation of the use of expired vaccine) and strategies (elaboration of different

strategies for urban areas, rural areas, and displaced people). Also, performance

was improved by involving program managers and implementers in evaluation, and

by providing timely and widespread feedback of results to policy-makers, peripheral

health workers, and the community. (CUTTS, F. et al.,1990)

In addition to, a program evaluation was conducted in Pakistan from January

to June 2011, by a group of independent local and international experts. The

assessment gives recommendations to enhance the program performance in the

short and medium terms within the context of the newly devolved health sector.

Through the study, Amendment 18 is passed in which responsibility is transferred to

provinces for the implementation of EPI, the provincial immunization programs need

to develop strategic directions for the districts and provide guidance to them on how

strategies should be carried out. ( Masud, T. et al., 2012)

 Community based cross-sectional study has been conducted in Arba Minch

town and Arba Minch Zuria district, Gamo Gofa Zone, Southern Ethiopia in March

2013. This study has measured the EPI coverage within 630 children age 12 – 23

months residing in 15 districts of Arba Minch Town and Arba Minch Zuria districts.

This study has revealed the immunization coverage at the area is better than the

national and regional coverage. Nearly three fourth (73.2%) of children in the study

area were fully immunized; 90.0% and 77.6% had taken one doses of each BCG and

Measles, 89.8% and 86.3% had taken three doses of each Pentavalant and Polio

and vaccines respectively. Only 6.5% did not take any vaccine at all. The percentage

of not immunized children is significantly lower than the figures of nationwide (15%)

and Ambo district (23.7%). (Animaw, W. et al., 2014)

It is also essential to assess the vaccines used for the immunization programs

according to World Health Organization 2000 in their study entitled “ASSESSING

NEW VACCINES FOR NATIONAL IMMUNIZATION PROGRAMMES A framework

to assist decision makers.” Vaccines should be thoroughly examined if whether it

could be a great help to the effectivity of immunization programs or not. Moreover,

the decision to add a new vaccine to an immunization program is often influenced by

social values, perceptions, and political concerns and is not just a technical one.

In the Philippines, a study regarding the status of DOH immunization program

in Badjao Community was conducted. It focuses on the facilitating and different

challenging factors in the delivery of immunization program, the difficulties encounter

in the implementation and the strategies that can do to improve and sustain the

program among the Badjao community.

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