JAFAD COLLEGE OF NURSING
SCIENCE
ORU-IJEBU, OGUN STATE
PRESENTED BY
1. ODUSINA TEMILOLUWA FAVOUR JCONS/STD/ND.24/001
2. OLOWOFOYEKU AJIBOLA MARY JCONS/STD/ND.24/002
3. MARTINS OYINKASOLA JCONS/STD/ND.24/003
4. THOMAS RACHEAL EBIERE JCONS/STD/ND.24/004
5. SOWUNMI ANUOLUWAPO JCONS/STD/ND.24/005
6. OLATUNJI BUSAYO JCONS/STD/ND.24/006
7. SHITTU MARIAM OLAMIDE JCONS/STD/ND.24/007
8. THOMAS JOSEPHINE JCONS/STD/ND.24/008
9. MAJEKODUNMI BLESSING JCONS/STD/ND.24/009
10. ABUKA BLESSING JCONS/STD/ND.24/010
COURSE TITLE: PRIMARY HEALTHCARE
DEPARTMENT: NURSING SCIENCE
QUESTION
DISCUSS THE FOLLOWING:
- Administration of immunization Coverage
- Follow up of defaulters
- Evaluation of immunization services
LECTURER IN CHARGED
MRS ARULOGUN
TABLE OF CONTENTS
1. Introduction
2. Administration of Immunization Coverage in Primary Health Care
3. Follow-Up of Defaulters in Immunization Services
4. Evaluation of Immunization Services in Primary Health Care
5. Conclusion
6. References
TITLE
ADMINISTRATION, FOLLOW-UP AND EVALUATION OF IMMUNIZATION
SERVICES IN PRIMARY HEALTH CARE
INTRODUCTION
Immunization is a core component of Primary Health Care (PHC) and remains one of
the most successful, impactful, and cost-effective public health interventions in modern
medicine. It plays a vital role in the prevention and control of infectious diseases,
contributing significantly to the global reduction of childhood mortality and the
eradication or near-elimination of diseases such as smallpox, polio, measles, and
neonatal tetanus. By boosting the body’s immunity against specific pathogens, vaccines
help individuals develop long-term protection, which not only benefits the vaccinated
individual but also contributes to broader community protection through the
development of herd immunity. Immunization, therefore, serves not only as a personal
health strategy but also as a critical instrument for achieving population-wide disease
prevention and sustainable public health outcomes.
In PHC, immunization is more than just the administration of vaccines; it embodies a
comprehensive approach that includes planning, logistics, education, community
involvement, and continuous evaluation. This report focuses on three fundamental
pillars of immunization within PHC: the administration of immunization coverage,
follow-up of defaulters, and the evaluation of immunization services. Each of these
components plays a crucial role in determining the overall effectiveness of
immunization programs and their ability to reach target populations, particularly
vulnerable groups such as children under five, pregnant women, and
immunocompromised individuals. These three components shall be explored to provide
understanding of how immunization is operationalized within PHC settings and how its
effective delivery contributes to the broader goals of disease prevention and the
achievement of Sustainable Development Goals (SDGs).
ADMINISTRATION OF IMMUNIZATION COVERAGE IN PRIMARY
HEALTH CARE
Immunization remains a cornerstone of preventive health care within the Primary
Health Care (PHC) framework, particularly in low- and middle-income countries. In
PHC settings, the administration of immunization coverage entails delivering vaccines
to specific target groups—mainly infants, children under five, pregnant women, and at-
risk adults—to protect them from vaccine-preventable diseases (VPDs). The
effectiveness of this system relies heavily on the efficient organization of services,
trained personnel, robust logistics, and strong community involvement.
Immunization coverage refers to the percentage of the eligible population that has
received the recommended doses of vaccines within a given timeframe. It is a key
performance indicator used to measure the success of immunization programs and the
overall efficiency of PHC services. In most developing countries, routine immunization
schedules are designed by national programs based on World Health Organization
(WHO) guidelines. For instance, Nigeria’s National Programme on Immunization (NPI)
outlines a schedule that includes BCG and OPV0 at birth, DPT-HepB-Hib
(Pentavalent), OPV, and PCV at 6, 10, and 14 weeks, and measles and yellow fever
vaccines at 9 months.
The administration process must follow appropriate guidelines, including correct
dosing, reconstitution techniques, and observation of aseptic procedures. One vital
component that determines the success of immunization coverage is the cold chain
system. Vaccines are sensitive to temperature fluctuations and require storage within
the 2°C to 8°C range. PHC centers are therefore equipped with refrigerators, vaccine
carriers, and temperature monitoring tools to ensure vaccine potency is maintained from
the point of receipt to administration.
Accurate record-keeping forms the backbone of immunization coverage monitoring.
Health workers document each child’s vaccination in registers, immunization cards, and
national health information systems. These tools help track progress, identify defaulters,
and plan for outreach sessions. Trained health personnel—including nurses,
Community Health Extension Workers (CHEWs), and immunization officers—are
critical in ensuring that vaccines are administered safely and effectively.
Community mobilization also plays an essential role in increasing immunization
coverage. Local leaders, religious groups, and market associations often support PHC
facilities in mobilizing caregivers and spreading awareness about the importance of
immunization. Public health campaigns, town hall meetings, and the use of community
radios are some of the methods used to educate the public and increase vaccine uptake.
PHC centers also provide outreach and mobile immunization services, especially in
hard-to-reach or underserved communities. These sessions are designed to bridge the
access gap created by distance, difficult terrain, or sociocultural barriers. In such
settings, health workers travel with vaccines in carriers to rural settlements, ensuring
that all eligible children are reached.
Data management systems are increasingly becoming digital, enhancing the capacity
for real-time tracking of immunization coverage. Mobile technology, for example, is
used to send SMS reminders to caregivers, improving adherence to immunization
schedules. Development partners such as WHO, UNICEF, and GAVI also play pivotal
roles by supporting training, logistics, and the procurement of vaccines.
Despite successes, PHC centers still face barriers that affect immunization coverage.
These include stockouts, caregiver misconceptions, vaccine hesitancy, and poor
infrastructure. Addressing these barriers requires a multifaceted approach involving
health system strengthening, policy reform, and continuous community engagement.
In emergency and conflict-affected areas, special immunization interventions are often
designed. These include setting up temporary vaccination posts in Internally Displaced
Persons (IDP) camps and collaborating with security personnel to access insecure
zones. During the COVID-19 pandemic, PHC centers adapted their services by
enforcing safety protocols, maintaining social distancing, and using appointment
systems to continue routine immunization while minimizing the risk of virus
transmission.
Ultimately, the administration of immunization coverage in PHC systems is not just
about delivering vaccines—it is about building a system that can sustain public trust,
reach the unreached, and ensure every eligible child or adult receives timely and
complete vaccination.
FOLLOW-UP OF DEFAULTERS IN IMMUNIZATION SERVICES
Within the PHC context, defaulters in immunization are individuals—mostly children
—who have missed one or more scheduled vaccine doses. The follow-up of defaulters
is an essential strategy aimed at reducing drop-out rates and ensuring complete
immunization, which is vital for personal and herd immunity. This process entails
systematic identification, tracing, and re-engagement of caregivers to complete the
immunization schedule.
The first step in defaulter follow-up is the identification of those who have not returned
for scheduled vaccinations. Health workers use immunization registers, child health
cards, and tally sheets to determine missed doses. For instance, a child who received the
first dose of Pentavalent but did not return for the second dose is identified as a
defaulter.
PHC facilities employ defaulter tracing tools such as community registers and defaulter
tracking books. Some centers also use simple appointment stickers or cards given to
caregivers with the next due date marked. In areas with mobile coverage, text message
reminders or phone calls are used to notify caregivers of missed vaccinations.
Once defaulters are identified, follow-up is often done through home visits. Community
Health Extension Workers (CHEWs), volunteer health mobilizers, or ward development
committees (WDCs) are involved in tracing and counseling caregivers. These
interactions often reveal underlying reasons for defaulting, such as lack of awareness,
travel, fear of side effects, or cultural beliefs. Addressing these concerns empathetically
and professionally increases the likelihood of caregivers returning.
In some regions, community leaders, traditional chiefs, and religious figures are
mobilized to support defaulter tracing. Their involvement lends credibility to health
messages and can overcome social resistance. In Northern Nigeria, for example,
traditional rulers have been instrumental in mobilizing communities during polio
campaigns.
Integration of defaulter follow-up into other PHC services is another effective strategy.
Mothers who bring their children for growth monitoring, nutrition, or malaria treatment
are often screened for missed vaccinations and given catch-up doses when necessary.
This integrated approach increases opportunities for immunization while reducing
missed contacts.
PHC facilities also maintain community-based registers that list all children in the
catchment area, with their vaccination status. These registers are updated regularly and
help in proactive follow-up of children due for immunization. Such localized tracking
strengthens accountability and responsiveness.
Re-vaccination of defaulters follows national guidelines. In some cases, the child
resumes the remaining schedule, while in others, the series may need to be restarted,
especially if the gap has been extensive. This decision is often guided by immunization
protocols and the type of vaccine involved.
Documentation is key in all follow-up activities. Each traced defaulter must be
recorded, and their vaccination status updated once they return. These updates feed into
the health facility’s reporting system and contribute to improved planning and resource
allocation.
In some PHC centers, women’s groups, market associations, or school authorities are
engaged to trace and remind defaulters. These groups often have access to caregivers
and can help bridge the gap between the health facility and the community.
Effective follow-up of defaulters significantly reduces immunization dropout rates.
WHO recommends that dropout between the first and third doses of DPT be kept below
10%. Sustaining this requires consistent effort, community ownership, and supportive
supervision of health workers
EVALUATION OF IMMUNIZATION SERVICES IN PRIMARY HEALTH
CARE
Evaluation of immunization services in PHC is an essential component of health system
strengthening. It helps determine whether immunization programs are achieving their
targets, reaching the right populations, and using resources efficiently. Evaluations also
guide improvements in service delivery, planning, and policy formulation.
There are various types of evaluation, including process evaluation (which assesses
how immunization services are being implemented), output evaluation (which looks at
the results of activities, such as the number of children vaccinated), and outcome or
impact evaluation (which determines the long-term effect, such as a reduction in disease
incidence).
One common method of evaluation is the coverage assessment survey, which
independently measures immunization coverage to validate administrative data. The
Lot Quality Assurance Sampling (LQAS) technique is frequently used in Nigeria to
assess immunization coverage at the ward level.
Data Quality Audits (DQAs) are conducted to assess the accuracy, consistency, and
timeliness of immunization data. These audits help identify discrepancies between
actual service delivery and reported figures. Facilities with poor data often suffer from
vaccine misallocation, underperformance, and lack of follow-up.
Evaluation also involves monitoring key performance indicators such as vaccination
coverage rates, dropout rates, timeliness of service, adverse event reporting, and
vaccine wastage rates. These indicators provide a comprehensive view of how well the
immunization program is functioning.
Supportive supervision is another critical tool for evaluating immunization services.
Local government and state immunization officers regularly visit PHC centers with
checklists to assess staff performance, cold chain maintenance, record-keeping, and
session quality. These visits help identify gaps and offer opportunities for mentoring.
Community participation is encouraged in evaluation through participatory scorecards
and public meetings. Communities are asked to rate the quality of services, suggest
improvements, and hold health workers accountable. This bottom-up approach fosters
transparency and responsiveness.
Visual tools such as immunization monitoring charts are used at PHC facilities to
display monthly performance trends. These charts compare the number of children
vaccinated against the expected target and help in early detection of service delivery
gaps.
Cold chain functionality is another area of evaluation. Regular assessments are done to
ensure vaccine refrigerators are working, temperature logs are maintained, and vaccine
potency is not compromised. In some cases, solar-powered fridges are deployed in off-
grid PHC centers.
Health worker competence is also assessed during evaluation. This includes observing
vaccination techniques, client communication, waste management, and knowledge of
immunization protocols. Refresher training is provided where gaps are identified.
Client satisfaction surveys are carried out to understand caregivers’ perceptions about
waiting time, staff attitude, availability of vaccines, and the cleanliness of the
immunization environment. These findings are used to improve client-centered service
delivery.
Evaluations also examine logistics and supply chains, particularly the availability of
vaccines, injection materials, and safety boxes. Poor supply management can lead to
stockouts, interruptions in service, and reduced coverage.
Financial evaluations determine the cost-effectiveness of immunization programs and
help optimize budget allocations. For example, it may be more efficient to invest in
outreach sessions in certain areas rather than increase the number of fixed posts.
Periodic review meetings at the LGA and state levels are platforms where
immunization performance is evaluated and compared across facilities. These meetings
encourage peer learning and promote accountability.
In some instances, operational research is used as part of evaluation. Studies may be
conducted to understand reasons for low uptake, such as vaccine hesitancy, caregiver
education, or cultural practices.
The results of evaluations inform microplanning, reallocation of resources, community
mobilization strategies, and staff training plans. They are crucial in meeting national
and global immunization goals such as the Expanded Programme on Immunization
(EPI) and Sustainable Development Goals (SDGs).
the administration, monitoring, and evaluation of immunization services in PHC
represent an integrated approach to disease prevention. When done effectively, they
contribute significantly to reducing childhood morbidity and mortality, improving
community health, and strengthening the overall health system.
CONCLUSION
Immunization plays an indispensable role in preventing disease and promoting health in
communities. The successful administration, diligent follow-up of defaulters, and
continuous evaluation of immunization services ensure not only individual protection
but also the wider goal of herd immunity. Strengthening these components in PHC
leads to improved health outcomes and supports national and global health objectives.
REFERENCES
World Health Organization (2023). Immunization in the context of Primary Health
Care.
National Primary Health Care Development Agency (NPHCDA), Nigeria. (2022).
Routine Immunization Manual.
UNICEF (2022). Strategies for Improving Immunization Coverage.
GAVI Alliance (2021). Strengthening Immunization Systems in Low-Income
Countries.
