Urban EPI [expanded program on immunization]

Because urban health issues have been largely unaddressed to date, priorities now need to be directed toward this end. Although defining what constitutes an urban area is still an unresolved issue, there are some concrete elements of megalopolises that can be addressed so that health services can be effectively implemented. Such characteristics, which are reviewed in this report, include: population density and overcrowding, water and sanitation, infant and child mortality, transportation and pollution, and social stratification. An intriguing aspect of urban health is the control of vaccine-preventable diseases and how different an urban Expanded Program on Immunization (EPI) must be from a rural EPI model. This issue of specificity of EPI in urban settings pertains to several operational areas: disease transmission, targeting specific groups, communication channels, channels of delivery, and monitoring and surveillance. These areas are also briefly described in this paper. The Resources for Child Health (REACH) Project became involved in urban EPI in 9/86, first in Bangladesh, then in the Philippines, and later in Indonesia. In working to bring immunization to neglected urban areas in these and other countries, REACH has learned valuable lessons that the present document attempts to explain. These lessons are capsulized as follows. (1) The delivery of immunization in urban settings is a formidable and not yet adequately addressed challenge to the national and international health community. (2) Data related to urban EPI are usually unavailable or unreliable. (3) The cultural and social heterogeneity of different parts of a city require approaches that are tailored to their specific profiles. (4) Epidemiology should shape the strategies used in urban EPI- preventable disease control. (5) Campaigns and pulse activities have an important role to play in urban settings. (6) Collaboration with municipal services, which are legally and technically responsible for the delivery of immunization services, is a new and important challenge for EPI. (7) Physical accessibility to services is not an issue for most urban dwellers; however, the dropout rate remains an important problem. (8) The use of physicians as a role model in the delivery of urban immunizations is crucial. (9) NGO"s are essential partners in the promotion of urban immunization services. (10) Communication strategies can be cost-effective in urban settings, providing that messages and their timing are carefully directed to appropriate segments of the population. (Author abstract)