For immunization to be effective in the long run as a major global disease control intervention it is important to provide good quality vaccination services. Studies carried out in three countries in Asia (Bangladesh, India, and the Philippines) and two countries in Africa (Ethiopia and Malawi), and reported on in this article, document the fact that parents are willing to invest considerable effort in having their children vaccinated; however, there are a number of serious shortcomings in the quality of the routine vaccination services and strains are apparent at the interface between the vaccination providers and the users. These shortcomings are detracting from the sustainability of routine vaccination programmes and are promoting the growth of pools of nonimmunized and partially immunized children. To safeguard the continued operation and to enhance the coverage of routine vaccination programmes it is crucial that these difficulties be addressed.
PIP: This article summarizes the results of a comparative research project, which was initiated in Africa and Asia in 1994. The purpose of the project was to improve the coverage and sustainability of vaccination programs through a better understanding of their social and cultural aspects. The Asian countries included were Bangladesh, India, and Philippines; while in Africa, the countries included were Ethiopia and Malawi. 3 transnational investigations were conducted: 1) immunization and the state; 2) global programming and technology development; and 3) social demand for vaccinations in relation to the quality of vaccination services. The results of the studies in Africa and Asia indicated that the quality of vaccination services still leaves so much to be desired. Even if parents are willing to invest considerable effort in having children vaccinated, there are a number of shortcomings in the quality of the routine vaccination services. These shortcomings and strains at the interface of providers and users detract from sustainability and promote the growth of pools of unvaccinated and partially vaccinated children. Therefore, it is high time to pay more attention to both quality and sustainability, and introduce appropriate improvements and solutions.