Vaccination status among users of private health care in Eastern Indonesia Público
Wardle, Melissa (2015)
Abstract
Background: In 2012, Indonesia ranked third in the world for having the most unvaccinated and partially vaccinated children. Over the past two decades the country's private health sector has undergone substantial growth, which may result in changes to the national health system. Collecting vaccine information to characterize the extent to which caretakers use private providers, the contribution of private providers to immunization coverage, and the private sector's capacity to provide immunization services within Indonesia is critical for understanding, and eventually improving, vaccine delivery services.
Objectives: This study was conducted to characterize public and private outpatient health facility visits and to compare vaccination status between children who visited private health facilities to children who visited public health facilities in Eastern Indonesia.
Methods: A secondary data analysis using household data from the 2012 Indonesian Family Life Survey, East (IFLS, E) was used to compare vaccination status among children 9-35 months of age based on type of outpatient health facility visited.
Results: Among 591 children between the ages of 9-35 months, 59% visited some type of health facility in the previous month; 47% had visited public health facilities only, 5% visited private health facilities only, and 7% of children visited both public and private health facilities. Children who exclusively visited private health facilities were significantly less likely to be vaccinated with three doses of diphtheria-tetanus-pertussis-hepatitis B (DTP-HepB) vaccination compared to children who only visited public health facilities (aOR: 0.29; 95% CI: 0.12, 0.69). Measles vaccination (MCV1) status and fully vaccinated status were also lower among children who only visited private health facilities albeit non-significant.
Conclusions: Children in Eastern Indonesia who exclusively visited private health facilities one month prior to the survey were vaccinated less than those who visited public health facilities. Private health facilities may be a source of missed opportunities to immunize children. More information is needed about immunization practices in the private sector in order to develop strategies and effective interventions used to improve immunization service delivery and to reduce the number of children who are not being vaccinated during health care visits.
Table of Contents
1. BACKGROUND AND LITERATURE REVIEW 1
1.1 INTRODUCTION 1
1.2 INDONESIA'S HEALTH CARE SYSTEM 1
1.2.1 History 1
1.2.2 Health Service Delivery 2
1.2.3 Medical Workforce 4
1.2.4 Public and Private Health Sector 4
1.3 ROUTINE IMMUNIZATION SYSTEMS 6
1.4 2012 INDONESIAN FAMILY LIFE SURVEY, EAST 10
2. MANUSCRIPT 10
2.1 INTRODUCTION 11
2.2 DATA AND METHODS 12
2.3 RESULTS 17
2.4 DISCUSSION 20
3. PUBLIC HEALTH IMPLICATIONS 24
TABLES 24
REFERENCES 32
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