Routine immunisation in East New Britain is shaped by access, trust, and service reliability
Routine childhood vaccination in East New Britain Province sits at the intersection of family resources, service availability, and community support. In 2023, 40% of children in the province were classified as zero-dose, meaning they had not received DTP1, and 55% were under-immunised, missing DTP3. Those figures framed a qualitative study that explored why some families reached immunisation services while others did not, especially in areas where coverage for DTP1, DTP3, and the first dose of measles-rubella vaccine varied widely.
The interviews captured a straightforward but difficult reality: immunisation uptake is not driven by a single obstacle. Caregivers, healthcare professionals, community leaders, and the service environment all shape whether a child receives vaccines on schedule. In practice, the pathway to vaccination could be supported by family encouragement, community-based services, and relationships with health workers, or it could be disrupted by distance, cost, stockouts, non-functioning aid posts, and uncertainty about where to go next.
Caregiver barriers were practical, social, and financial
Thirty-three caregivers of children aged 9 to 23 months took part in face-to-face interviews in Gazelle and Kokopo districts, alongside 28 healthcare professionals. Their accounts pointed to several recurring barriers. Limited immunisation knowledge stood out early. Some caregivers did not have a clear understanding of the vaccine schedule or the purpose of each dose, which can leave a child vulnerable even when a family is willing to engage with services.
Travel and transport expenses also mattered. Reaching a clinic was not always simple, and the cost of getting there could compete with other household priorities. When services were located far from home or when travel required cash that families did not have, vaccination became easier to postpone. Limited availability of healthcare professionals added another layer of difficulty. Even when caregivers made the effort to attend, staff shortages could reduce confidence that the trip would end with a completed vaccination visit.
Support from family members and community-based services worked in the opposite direction. When relatives helped caregivers manage travel, decision-making, or childcare, vaccination became more feasible. Community support did not appear as a vague social benefit; it operated as a practical enabler that could determine whether a child actually reached an immunisation session.
One sentence captures the core problem: a vaccine schedule cannot function smoothly when the trip to the clinic is uncertain, expensive, or repeatedly unsuccessful.
Service disruption weakened confidence in routine delivery
Healthcare professionals described a system strained by operational limitations. Increased operational funds helped services function, especially when they supported routine outreach or day-to-day delivery. Working with community leaders also improved the reach of immunisation efforts, likely because trusted local figures could help explain the value of vaccination and bring families into contact with services.
The barriers were more concrete and often more severe. Costs within the service environment, non-functioning aid posts, and vaccine stockouts all interrupted delivery. These problems do more than delay a dose. They can erode trust, reduce attendance at later sessions, and make caregivers less confident that the system will be ready when they arrive. In rural and semi-rural settings, one missed appointment or one empty clinic can quickly become a reason to stop returning.
The study’s structure, mapped across the six UNICEF Journey to Health and Immunisation framework stages, helps explain why these issues accumulate. A child may first need a caregiver to recognise that vaccination is important, then need a nearby and functioning service, then need staff, supplies, and follow-up. If any step fails, uptake falters. The interviews made clear that the path from intention to completion is fragile at several points at once.
Community leaders and tailored communication emerged as practical levers
Participants did not stop at describing barriers. They also suggested ways to strengthen uptake. Tailored immunisation communication materials were among the most direct recommendations. Generic messaging is often too blunt for settings where caregivers have different levels of literacy, different concerns, and different access to health information. Materials adapted to the local context could help explain the schedule, the need for repeat doses, and the importance of staying engaged even after earlier doses are received.
Engaging community members in routine immunisation promotion was another proposed strategy. This approach reflects a simple operational truth: in places where formal services are stretched, local networks can extend the reach of public health messaging. Community and religious leaders can help normalize vaccination, answer questions, and reinforce the idea that immunisation is a shared responsibility rather than a remote clinic-only task.
Better coordination between communities and healthcare professionals also stood out. The study points toward bidirectional communication rather than one-way instruction. Health workers need to hear what prevents attendance, and communities need clear, consistent information about when and where services are available. Without that exchange, service gaps remain invisible until coverage data show the shortfall long after the missed visit.
Reaching zero-dose children remains the hardest research and programmatic task
The study also exposes a methodological challenge that matters for program design. Identifying and including zero-dose children and their caregivers in research is difficult, which means the families most disconnected from services are often the hardest to hear from directly. Even so, the interviews provided useful contextual guidance for improving routine immunisation delivery in East New Britain.
The findings support a practical focus on three linked areas: stronger communication between healthcare professionals and community leaders, better immunisation knowledge among caregivers, and more reliable community-based delivery systems. These are not abstract goals. They map directly onto the failures described by participants: unclear information, unreliable access, and fragile service delivery.
A child who misses DTP1 does not need a slogan; the child needs a service that is open, stocked, staffed, understood, and reachable. The interviews from Gazelle and Kokopo show how easily that chain breaks, and how much depends on restoring it before the next visit is missed.