The article addresses the problems of immunization coverage and current policies aimed to expand immunization among adolescents. The authors state that many groups of children are at risk because they do not receive immunization and related services. The study shows that it is possible to improve immunization coverage of adolescents using the same strategies as for 2-year-old children. These strategies are cooperation with and support from local communities, relations with suppliers and after service provision.
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The article shows that immunization programs are centrally controlled and administered in a top-down fashion. Thus they run contrary to the fundamental principles of community-based primary health care. The child survival interventions really are selective. The strength of the article is that it objectively identifies weaknesses and challenges of immunizations campaigns. “Success” of immunization is usually based on numbers of programs started and rates of coverage achieved rather than on fives saved. Many agencies have a tendency to describe their achievements in terms of inputs, effort expended, but these should not be confused with outputs, the health results achieved. The scientific approach measures success in terms of aggregate numbers of services delivered, and tends to be insensitive to the articulation of satisfaction or dissatisfaction in local communities. These concerns related to specific child survival programs fit squarely into the debate between those who advocate comprehensive and those who advocate selective primary health care. The main weakness is that the authors limit their research to statistical results only paying no attention to risk and threats of low immunizations rates. Also, the research does not address alternatives viewpoints on the problem of immunization and its impact on children. Factors such as education, income, and occupation do vary from household to household, but it is important to appreciate that they are largely determined by the social contexts in which people are embedded.
To improve the articles, the authors could conduct a comparative research based on two sample groups: (1) low and (2) high coverage of immunization, and its impact on the community health. Also, they could address risks and threats of immunization. Healthcare staff and parents should be cautious about placing too much faith in immunization programs. Extensive investment in immunization campaigns may draw resources away from other important health and development programs.
This article is relevant for community health nursing practice because it unveils problems and challenges faced by community health nurses. The research emphasis in health is on finding technological means for overcoming diseases at the clinical level. There are many technical issues in survival and development of adolescents. The article answers the following questions: what interventions work, under what conditions, how well, for how long, with what side effect? Individuals and organizations develop vested interests in particular sorts of analyses and particular sorts of remedies. Sometimes, instead of choosing among alternatives, the solution is simply to let different approaches coexist: they confront one another only when they must draw from the same pool of resources. The article demonstrates that immunization programs still fall far short of the targeted levels of coverage; other sorts of programs, most of which have not been pushed nearly as vigorously as immunization, reach few people and their scope of coverage grows slowly.
Sharon D. Horner, Linda Murphy. (1999). Creating Alternative Immunization Clinics to Maintain and Improve Community Immunization Rates. Journal of Community Health Nursing, 16 (2), 121-132.