Complete Basic Immunization Coverage Before and After the COVID-19 Pandemic Based on Districts’ Geographical Differences in Central Java Province

Department of Health Policy and Administration, Faculty of Public Health, Universitas Diponegoro, Semarang, Central Java, Indonesia, 50275

^* Corresponding ayunsriatmi@gmail.com

Abstract

Immunization is a cost-effective strategy for preventing child mortality. After the COVID-19 pandemic, complete basic immunization coverage, including per antigen vaccine, tends to decrease. This descriptive study employed quantitative and qualitative approaches. The quantitative approach used secondary data of Complete Basic Immunization (CBI) coverage 2016-2023, focusing on the characteristic differences of geographical areas (mountainous and coastal). The second stage, employing qualitative approach, aimed to explore immunization coverage before and after COVID-19 pandemic. The research locus was 14 selected districts in Central Java, including 8 districts in mountainous areas and 6 districts in coastal areas. The research subjects were key persons in charge of immunization at HMO. Qualitative data were collected through in-depth interviews. Quantitative data were analysed descriptively to see the comparison and trend patterns. The average of CBI coverage fluctuates annually, although the pattern of fluctuation varied. The CBI coverage pattern of mountainous areas tends to slope compared to coastal areas, which form a sharper pattern. After COVID-19 pandemic, the pattern of CBI coverage fluctuations was sharper in both geographical areas, which continued to fall in 2023 and did not reach the 95% target. Relatively similar conditions also occur in the average coverage per vaccine antigen, except MR immunization. Differences in target numbers between “Pusdatin” data and actual data, frequent vaccine stockouts, and public rejection to immunization are the main causes of low immunization coverage, including technical obstacles in using the “ASIK” digital application for recording immunization data. A recording system for immunization reporting is needed to ensure accuracy of target numbers and coverage calculations, including strengthening commitment through development of appropriate regulations, effective socialization, as well as guidance and supervision mechanisms for health workers in immunization programs.