An interesting subject and findings above.
As the then State MCH Officer, we in Delhi ( India) mainly urban city state with a very high proportion of floating ( migrating) population believed occurrence of missing opportunities at health facilities especially the public sector hospitals ( nearly 36 at that time offering immunization services daily ) was high where infants & young children would be visiting for minor ailments with no contraindication to receiving vaccine at that particular visit.It was in early 2000-2001 when Information technology was in its infancy.
We introduced few innovative tools to plug the deficiencies ( remove or reduce the missed opportunities): Sensitizing the first contact ( staff nurse who would be registering), stamping the card with all UIP/EPI Vaccines and the frst contact would tick all those received, and then the first doctor ( paeds at OPDs) would prescribe the particular age specific vaccine to that child if he/she was eligible and otherwise medically not unfit to receive on that visit due to the current illness ( high fever, sick looking, convulsion history etc). We did notice from data of the immunization clinics after 6 months of introduction there was a significantly higher number of vaccines ( each antigen) being given as compared to prior to this strategic introduction .
In a Nutshell: Sensitizing first contact staff and Resident Doctors in paediatrics settings of hospitals can make a significant reduction in improving immunization coverage as well as reduce the drop out rates.
Dr D K Dewan
CHIFA profile: Dharmendra Kumar Dewan is Director Family Welfare, Directorate of Family Welfare, Government of Delhi, India. Professional interests: Public Health issues on Maternal & Child Health: Neonatal care strengthening, Improving institutional deliveries & quality care, Childhood immunization, Gender Ratio imbalance & role of regulations & Acts. dharmdewan22 AT yahoo.co.in