Does support to Private Health Practitioners increase childhood vaccination coverage? Findings from a comparative study in Afghanistan

Introduction: In Afghanistan coverage of childhood vaccinations is very low, especially in remote and insecure areas with a weak public health structure. Private health providers (PHPs) in these areas play an important role in health care provision, some of whom have received (para)medical training. In 2009 HealthNet TPO initiated a Public-Private Partnership program in Uruzgan province, training and equipping 34 PHPs in remote and conflict-affected locations to provide quality childhood vaccination services. We aimed to assess the impact of this program on child vaccination coverage.

Methods: A cross-sectional household survey was performed in three districts of Uruzgan Province from January through April 2013. A stratified cluster sampling approach was used to select villages; in each of the villages 15 households were randomly selected. Vaccination information, based on vaccination cards and mother's recall, was obtained about all children aged 12-23 months in these households.

Results: In total 113 children from 8 PHP villages and 286 children from 18 non-PHP villages were included. A clustered analysis showed that coverage of polio-3, diphtheria-tetanus-pertussis (DTP)-3 and of measles-1 were significantly higher in PHP villages (73.5%, 66.4% and 69.9% respectively) than in non-PHP villages (36.0%, 5.2% and 26.2% respectively; P < 0.0001 for all comparisons). The proportion of children being fully vaccinated (excluding BCG) was 54.9% in the PHP villages and 4.9% in the non-PHP villages (P < 0.0001). Vaccinated children in non-PHP villages were mainly vaccinated during mass vaccination campaigns (92.5%), while in PHP villages this was done by PHPs (47.2%) or a combination of PHPs and mass vaccination campaigns (39.2%).

Conclusion: Our study shows that PHPs in remote and conflict affected locations in Afghanistan can play an important role to increase childhood vaccination coverage. Expanding this program to comparable provinces in Afghanistan and to other countries struggling with insecurity and weak public health systems may save much childhood morbidity and mortality.