Why do some parents prefer private vaccine providers in urban area?

Dear Editor,

The government has ensured an elaborate mechanism to immunize all children under national immunization program in India.[1] The vaccines are not only given free but delivered near to the community through the peripheral health workers, auxiliary nurse midwife/village health nurses.[1] In spite of this, a section of the community prefer to take their children for vaccination with private providers; either private doctors or private hospitals, more so in the urban areas. The present study aims at estimating the proportion of children taken to private service providers for routine immunization within Kancheepuram municipality area and the reasons for this preference if any.

A 30 by 7 cluster sampling method, as suggested by WHO for estimating coverage evaluation of routine immunization, was adopted.[2] A selection of household was done by following multistage sampling (two-stage). In the first stage, 30 wards were selected from the 51 wards by simple random sampling. Then in each selected ward, one street was selected in a similar manner. Survey was started from one end of the street and continued till seven children in the age group of 12-23 months were surveyed. If the number fell short, the next street was taken up. The information was collected after verbal consent from the parents/guardians. A predesigned questionnaire was employed to collect the information. The interview was conducted by the first and third investigators, during the months of June and July 2014. The study was approved by the Institutional Ethics Committee. Statistical analysis was performed using Epi Info™ 7 (CDC, Atlanta, USA).

All the vaccines had 100% coverage except measles which had the coverage of 99.5%. Most the vaccines were given at government immunization center. The proportions of these vaccines given at private centers are Bacillus Calmette–Guerin (BCG) (26.7%), oral polio vaccine 1 (22.4%) and rest all vaccines (20%).

Around 1/5th (20–26.7%) of the parents in this study prefer to vaccinate their children at the private centers. The findings from this study was consistent with the Coverage Evaluation Survey - 2009, undertaken by United Nations International Children's Emergency Fund, which showed that 8.7% children were taken to private health care providers for routine immunization in general and in urban area this figure was 21.1%.[3] A majority of these parents, in the present study, prefer private service providers due to a convenient place (42–55%) and time (21–26%). The preference of service provider (whether government or private) is significantly associated with the gender of the child (except in the case of BCG), and educational status of parents [Table 1].

Table 1

Association of choice of service provider with different variables

Vaccination at the private centers are not only costly, but there is also a concern with the quality of vaccine and vaccination process.[45] More educated parents are taking their children to private centers, especially the boy child. If the timing of vaccination at the government centers can be rescheduled to evening hours, many of these parents who are working during the day time can bring their children for immunization. By little modification in the ambience of the vaccination site, making it cleaner and organized, a large chunk of these parents can be brought back to the government immunization system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.