Demand and Supply Side Barriers in Access to Childhood Immunization Services: A Case Study of Murshidabad, West Bengal
To elucidate the independent role of various demand side and supply side factors as barriers to access childhood immunization and how their impact change when both these sides are taken together, in the Murshidabad district of West Bengal, India. We used multinomial logistic regression method to analyze the primary data collected through a household survey and a survey on frontline health workers-ANM (Auxiliary Nurse and Midwife) in Murshidabad in February 2008. A total of 2114 households with 2142 children aged 12-35 months and 50 ANM-s were included in the analysis. In Murshidabad 61.3 percent children were fully immunized. Demand side factors that significantly influence full immunization up take included mother’s education, mother’s knowledge, her health care utilization pattern, religion and caste. Significant factors from the supply side were ANM’s household visit during pregnancy and after child birth, village infrastructure, number of monthly meeting attended by ANM, ANM’s perception about difficulties in provisioning the immunization service and population per sub centers. When both the demand and supply side factors were taken together mother’s employment, distance to be covered for outreach by ANM and immunization infrastructure came out as significant factors additionally. Village infrastructure and number of monthly meeting attended by ANM no more acted as significant contributor in the combined model. Both demand side and supply side play important role in accessing the child immunization services. Murshidabad is still far behind from attaining the goal of universal immunization. Efforts should be made to increase the access to immunization services by removing demand as well as supply side barriers simultaneously. More focus should be given on outreach services and mother’s knowledge.
Future Health Systems Working Paper II, India Series, 16 pp.