IMMUNIZATION IN URBAN AREAS - ISSUES AND STRATEGIES

In the past, immunization programmes have focused primarily on rural a reas. However, with the recognition of the increasing numbers of urban poor, it is timely to review urban immunization activities. This upda te addresses two questions: Is there any need to be concerned about ur ban immunization and, if so, is more of the same kind of rural EPI act ivity needed or are there specific urban issues that need specific urb an strategies? Vaccine-preventable diseases have specific urban patter ns that require efficacious vaccines for younger children, higher targ et coverage levels, and particular focus to ensure national and global eradication of poliomyelitis. Although aggregate coverage levels are higher in urban than rural areas, gaps are masked since capital cities are better covered than other urban areas and the coverage in the poo rest slum and periurban areas within cities is as bad as or worse than that in rural areas. Difficult access to immunization services in ter ms of distance, costs, and time can still be the main barrier in some parts of the city. Mobilization and motivation strategies in urban are as should make use of the mass media and workplace networks as well as the traditional word-of-mouth strategies. Use of community health wor kers has been successful in some urban settings. Management issues con cern integration of the needs of the poor into a coherent city health plan, coordination of different health providers, and clear lines of r esponsibility for addressing the needs of new, urbanizing areas.