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  • Title: Higher coverage attained through public participation: National Vaccination Days in Bolivia.
    Journal: EPI Newsl; 1985 Feb; 7(1):4-6. PubMed ID: 12268041.
    Abstract:
    Since the inception of the Expanded Program on Immunization (EPI) in 1979, a better understanding of the vaccine-preventable diseases in Bolivian children has been realized by provision of useful epidemiological data on the target EPI diseases. A strength of EPI is that it focuses attention on sociocultural, economic, and political conditions with a view toward the application of new and more realistic tactics for the benefit of vulnerable and neglected population groups. In 1980 and 1981, the coverages achieved by purely fixed health facility delivery tactics did not exceed 25-30% with the 3rd dose of DPT and polio vaccines, or 28% with the single-dose vaccines (BCG and measles) among children under 3 years of age. In 1982 a technical and administrative EPI evaluation was performed and impediments limiting the attainment of epidemiologically significant vaccination coverages were identified. The leading causes were a lack of political commitment, a lack of public participation poor coordination of the program with the general health services, rigid and uniform administrative standards for the entire country, the abstractness of the technical standards, and poor pubic information. From this analysis emerged the strategy of mobilization of the population through the local health committees in order to help improve vaccination coverages. These local committees have been able to substantially improve the coverage of polio vaccination by aiding health staff in the application of that vaccine during the operations carried out on National Vaccination Days organized 3 times a year. The implemention of this strategy in Bolivia since 1983 allows each user of health services to be an active agent for his/her own health rather than a passive recipient of services. The overall achievements of mass mobilization for vaccination include: it has made the country's health condition an object of thought and discussion and helped the country to achieve the highest vaccination coverage in the last few years; it has prompted a revision of vaccination standards for the public; and it has prompted responses to requests for health services from the public. Specific objectives include: it has provided the people with needed health information so that they may become their own agents for health improvements; it has raised the level of institutional participation through analysis and self-criticism; and it has effectively protected the infant population against polio and measles. With implementation of the National Vaccination Days and public participation, polio vaccine coverage reached 90.1% for children 3 years and older. Due to the mass mobilization in 1984, the coverage of measles vaccination among 1-year-olds was 80% greater than it had been in 1983 -- the highest ever achieved in the country for this vaccine.
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