# Caregiver and healthcare professional perspectives on drivers of routine immunisation uptake in East New Britain, Papua New Guinea: a qualitative study

## TL;DR

This study explores why some children in East New Britain, Papua New Guinea, miss routine vaccines by examining the views of caregivers and healthcare workers.

## Contribution

The study provides new insights into local barriers and enablers of immunisation through qualitative analysis in a region with low vaccine coverage.

## Key findings

- Caregiver enablers included family support and community services, while barriers included lack of knowledge and financial challenges.
- Healthcare professionals suggested strategies like better communication and coordination with communities to improve vaccine uptake.
- The study emphasizes the need for tailored strategies to address vaccine coverage gaps in the region.

## Abstract

Immunisation coverage varies across Papua New Guinea (PNG), with 40% of children in East New Britain Province (ENBP) classified as zero-dose (children missing diphtheria-tetanus-pertussis vaccine first dose (DTP1)) and 55% as under-immunised (missing DTP3) in 2023. This study aimed to understand routine childhood immunisation enablers and barriers in areas of ENBP reported to have highly variable DTP1, DTP3 and measles-rubella first-dose (MR1) coverage.

Qualitative in-depth semi-structured interviews were conducted face-to-face with caregivers of children aged 9–23 months and healthcare professionals in Gazelle and Kokopo districts. Local research officers conducted interviews in Tok Pisin and English. Data were thematically analysed and mapped across the six UNICEF Journey to Health and Immunisation framework stages.

33 caregivers and 28 healthcare professionals were interviewed. Despite finding that a high proportion of caregivers’ children had received DTP, DTP3 and MR1, participants identified a myriad of contextual caregiver and healthcare professional enablers and barriers to routine immunisation. Caregiver enablers included support provided by families and community-based services; barriers included limited immunisation knowledge, financial and travel challenges, and limited availability of healthcare professionals. Healthcare professional enablers included increased operational funds and working with community leaders, while barriers were focused on service delivery including costs, non-functioning aid posts and vaccine stockouts. Strategies suggested by participants for improving vaccine uptake included developing tailored immunisation communication materials, engaging community members to support routine immunisation promotion activities, and strengthening coordination between communities and healthcare professionals.

This study highlights the challenge of identifying and including zero-dose children and their caregivers in research but still provides useful contextual focus points to enhance and inform tailored strategies to strengthen immunisation service delivery. These include strategies that improve bidirectional coordination and communication between healthcare professionals, community and religious leaders about routine immunisation, increase immunisation knowledge and strengthen community-based services for vaccine delivery.