Background: Vaccines don’t just prevent infectious disease and save lives, they are also essential in helping to maintain global security, social cohesion and economic stability. Nearly 90 percent of the world’s children now receiving at least one routine vaccination, no other public health intervention has such a large reach. Expanding this reach would protect more children from infectious disease, and improve surveillance. Most unvaccinated children live countries, with large populations and weak immunization structures. Streamlining vaccine administration and improving immunization rates must rely on evidence based innovations to address the current barriers in difficult-to-reach populations, intimate knowledge of immunizations and ready access to resources that address the nuances.

Objectives: The overall aim of the project is to analysis of quality of child immunization delivery in rural and urban health care settings in Uganda. Specifically the objectives were to:

•  Design short formatted and de-identified video footage for education, communication and research purpose on immunization delivery in low income settings, based on video footage previously collected
• Design and develop a website/web portal to make available video, artifacts, field observation notes and other research data (de-identified data) for non-restricted use and restricted use of raw data to people working in public health, innovators, programmers, policy makers.
• Explore and analyze the quality of child immunization service delivery and compliance with immunization guidelines in rural and urban health care settings, and possible solutions,
• Engaging policy makers in the use of the research findings from the child immunization delivery project for sound development of policies and programs,
• Utilize the ethno videography data for capacity building, communication and charitable global health activities in maternal newborn and child health policy development and program implementation.

Methods/Approach: Recording of 10 different immunization sessions, field notes, interviews and photographs and work artifacts at 10 different health facilities, in four different hard-to reach Ugandan districts were used. The video footage, field notes, and photographs were further analyzed, formatted into short formats for education, communication, advocacy and research. High-quality immunization delivery data and design of educational packages designed in form of short videos are also intended for capacity building for health workers to improve the quality of immunization service. A team of public health specialists, policymakers, medical practitioners, ethnographers, graphic designers, information communication technology and video graphers worked together to

Results: Short videos and accompanying script were developed in four thematic areas:

• Clients’ experience with immunization services;
• Documentation(prior, during and after) immunization;
• Preparing and delivery of immunization service (focusing on lean perspectives)
• Development and delivery of clients education. Developed,  43 short videos of 4-6 minute  and accompanying scripts for research education and communication in areas of child immunization. The essence of the videos is to show non-staged immunization experiences in rural and urban health care settings, describe best practices, lessons, gaps, opportunities and suggestion for improvement to close the know-do gap in immunization service delivery. The videos highlight what can be done to better immunization service delivery, innovations paving way to programming and areas of focus for improvements. Short videos and graphics are enhanced with voiced over in English with subtitles and were validated by national  and international experts.

Designed and disseminated a website https://aqcid.luziibangi.org/  to access non-restricted videos data and restricted data base (footage, artifacts, field notes, interview transcripts) permissible after securing ethics clearance for research and other inventions. Website translates in 4 languages English, Swahili, French, Swedish.

Findings of analysis of the quality of child immunization service delivery show that: The shortage and unequal rural/urban distribution of healthcare providers affects women’s and their children access to quality immunization services. Access to immunization service is inequitable and the quality of care is sometimes poor. A task share of medical and non-medical immunization service elements between skilled and semi-skilled providers, made it possible for rural mother-baby pairs access vaccinations. Multiple injections elicited discomfort, and women’s acceptability is influenced by their past experience. Caregivers preparedness, visual privacy prior to multiple shots was lacking. Interviews with caregivers revealed that immunization hesitancy was  due to community misinformation, myths, cultural/religious interference that seemed to shape discourse in relation to immunization timeliness, completion intentions and decision-making.

Despite the HCP dedication immunization services delivery, their knowledge and skills amidst challenging work environment, infrastructure and logistics limitations affect the provision of good-quality service. Well-organized immunization environment was observed in sites where policies were adhered. Technical vaccine handling, cold chain/quality control, infection control gaps were pronounced in rural sites. Stock-outs, initiation of new vaccines, demand variation, wastage, waiting times, dis-respectful care were shared challenges in static and outreach service points. Variation in infrastructure, skill set of the workforce, inconsistencies in messaging, missed opportunities, poor service organization across rural-urban facilities.