Immunization coverage in Mozambique: from concepts to decision-making.

Immunization is an effective strategy to reduce morbidity and mortality among children. This recognition has led many countries to concentrate efforts in establishing desirable achievements in the form of immunization coverage figures. However, less focus has been placed on effort made by different countries to attain high immunization coverage. During August 2002, 14 district health directors in a remote province of Mozambique (Niassa) were interviewed. The objective was to ascertain the construction of immunization coverage and how they implement the desired program strategies in order to improve the health status of the region. We found that most managers regarded the immunization coverage as data and thus high coverage as an end in itself, rather than as a reflection of the reality. We also found that there are uncertainties in population data which makes it difficult to plan activities bellow the level of a district. We argue further that the innovative distinction between the views proposed on the immunization coverage, provided us with an insight of the different challenges that district health directors face as leaders of the district health management team in Niassa. Clues on the implications of certain views of immunization coverage for policy and local decision-making in the national and global pursuit of immunization targets are provided.