After rising for more than two decades, routine immunization coverage rates began to stagnate in 2010, with an estimated 19.4 million children under the age of one not receiving basic vaccines in 2018. While immunization services have historically focused on supply and delivery functions, inequities have highlighted the significance of demand generation—and the need for a people-centered model that incorporates health worker and client perspectives for a more positive immunization service experience.
Partners in the Vaccination Demand Hub Service Experience Workstream are collaborating to inform a new direction in people-centered quality immunization service delivery and re-orient immunization services to include caregiver, client and health worker perspectives and needs. In support of this effort, John Snow Research & Training Institute, Inc. (JSI), in collaboration with Gavi, the Vaccine Alliance, consolidated existing knowledge and conducted rapid learning around immunization service experience at global and regional levels through desk reviews and key informant interviews (KIIs). Results from these KIIs were organized
into nine main components. These components formed the basis for additional insight gathering in four countries, including Ghana. The Ghana Health Service (GHS) mainstreamed quality health services approximately two decades ago with the adoption of several policies and programs, including the creation of a Quality Assurance Strategy, new protocols and guidelines, and the five-year National Healthcare Quality Strategy (NHQS) adopted in 2016. However, these frameworks do not provide guidance on how to improve the quality of immunization services or the service experience for clients, communities, and
service providers.
To understand if and how the global and regional findings resonate in country (and efforts underway in Ghana to address the immunization service experience), in June and July 2020, JSI conducted a review of the grey and peer-reviewed literature to gather the following information:

• The experience of clients and caregivers in the healthcare system
• Health system and facility factors that affect the immunization service experience
• Health worker and client factors and perceptions that impact service delivery and experience
• Community contributions to service design and delivery

The published and grey literature were identified through a web-based search and suggestions gathered from key stakeholders. The search, which yielded over 46 documents, focused on immunization issues as
well as maternal, newborn and child health, HIV/AIDS, family planning, and antenatal care. Additional information was obtained from 13 key informants representing the Ghana health sector. Following analysis
of the literature review and interviews, the GHS EPI team also met to provide input and build consensus on the recommendations.
This case study shares findings from the literature review and KIIs and offers practical recommendations to improve the immunization service experience for clients, caregivers, and health workers in Ghana.

Demand Hub

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Immunization Service Experience

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