A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh

This report assesses the quality of service inputs,service professes and se rvice outcomes (with the exception of coverage and effectiveness) for immun ization services in Zone 3 of Dhaka City The results indicate that in gener al,the providers of immunization services are knowledgeable, friendly and g ive technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toroid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opport unities for the promotion or provision of immunizations; uneven distributio n and utilization of immunization sites,and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductiv e age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numers of deaths and ill nesses-from vaccine-preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.