Urban Immunization: A Tool Kit for Those Planning to Address Inequitable Immunization Coverage in the Urban Context

The Urban Immunization Working Group was constituted in January 2017 to coordinate efforts of immunisation partners to create awareness about inequities in urban areas and support development of strategies aimed at improving immunisation outcomes in those areas, especially slum environments. The group has developed a toolkit to complement existing immunisation guidelines during planning, implementation, and monitoring of immunisation services in urban areas, targeting economically poor communities. Guiding principles include:

• The equity-focused models that have been built for rural village structures must be adapted to urban realities.
• There is a need to strengthen cross-sector collaborations, particularly with education and water, sanitation, and hygiene (WASH), which have worked with an urban focus for many years.
• Policymakers must be engaged to develop policies that prioritise the needs of disadvantaged populations in urban areas.
• Key actors, including those in the private sector, civil society organisations (CSOs), and municipal authorities, have influence on urban health projects.

Designed for all stakeholders involved in immunisation programming, including community members, the toolkit is based on the following pillars:

• Planning, political will, and coordination and management of resources
• Reaching all eligible populations
• Engaging with communities
• Monitoring and using data for action
• Supportive supervision
• Planning, coordination, and management of resources

Organised according to the 5 components of the Reaching Every District (RED) strategy, the document features brief sections outlining the tools and methods available to adapt other approaches to the urban disadvantaged setting, with links throughout to annexes or websites that provide more detailed instructions to those interested. There are also annexes for how to incorporate parts of this into training programmes, Expanded Programme on Immunization (EPI) reviews, or other standardised activities. Users are encouraged to browse the toolkit, using those portions that are applicable to their situation and their setting.

Members of the Urban Immunization Working Group include: the United Nations Children's Fund (UNICEF) and Gavi alongside the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), the Bill and Melinda Gates Foundation (BMGF), John Snow, Inc. (JSI), the International Federation of Red Cross and Red Crescent Societies (IFRC), Save the Children, and the London School of Hygiene and Tropical Medicine.