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Improving childhood immunisation in Indonesia: challenges and solutions

Increasing immunisation coverage in Indonesia faces challenges requiring government and community collaboration. Immunisation is recognised globally as one of the most effective public health interventions for preventing infectious diseases. Indonesia has strived to achieve basic immunisation coverage of 88% by 2020, as recorded by the Ministry of Health.1 However, challenges remain, especially in remote and rural areas with limited access to health services. The 2017 Indonesian Demographic and Health Survey indicated that vaccine-preventable diseases such as measles are still common in Eastern Indonesia, where immunisation rates are below the national average. This suggests the need for continued efforts to ensure that all children in Indonesia receive the necessary vaccinations.1

One of the main challenges in increasing immunisation rates is raising public awareness of the importance of vaccinations. Syiroj et al2 noted that low levels of education correlate with a lower understanding of the benefits of immunisation. Individuals with higher education are generally more aware of the importance of vaccination and more receptive to accurate health information. On the other hand, those with lower education levels are more susceptible to misinformation, including myths circulating on social media. For example, research by Herliana and Douiri shows that approximately 30% of parents mistakenly believe that vaccines can cause autism, even though there is no scientific evidence to support this.3 This misconception contributes to vaccination refusal and low immunisation coverage in some areas.

The spread of misinformation through social media also affects parents’ vaccination decisions. In the digital era, health information is often accessed online; however, not all information on social media is accurate. Herliana and Douiri showed that many parents are exposed to misinformation about immunisation on these platforms, leading to vaccine refusal. Therefore, using social media to disseminate valid vaccination information is essential. Effective digital campaigns can significantly increase public understanding of immunisation.3

Challenges in awareness, education and access to health services are obstacles to increasing immunisation coverage in Indonesia. Many rural areas have minimal access to the health facilities that provide immunisation. Arifin et al noted that approximately 20% of Indonesia’s population lacks adequate healthcare. This limited access significantly contributes to the low immunisation rate in these areas.4 WHO found that immunisation coverage in rural areas is often only 70%, whereas in urban areas, it is more than 90%.1 This highlights the importance of access to health services in determining immunisation coverage. Collaboration among the government, health workers and local communities is essential to address this issue.

Community-based immunisation programmes are effective in increasing vaccination rates in hard-to-reach areas. Involving community leaders, religious leaders and local figures in health education allows accurate vaccine information and reduces stigma. Oyo-Ita et al show that involving local community leaders in immunisation efforts can increase parental participation. Additionally, mobile immunisation programmes in schools and places of worship have successfully increased vaccination rates in remote areas.5 These findings underscore that appropriate strategies can increase immunisation coverage in more challenging areas.

Other challenges include a shortage of trained healthcare workers and inconsistent policies that confuse communities. Indonesia has a lower ratio of health workers than other ASEAN (Association of Southeast Asian Nations) countries, which can hamper efforts to increase immunisation coverage.1 In addition, frequent policy changes can confuse parents regarding immunisation schedules and different types of vaccines, creating a fear of vaccinating their children. Therefore, the government must provide clear and consistent information about immunisation programmes so the public can understand and trust the vaccination.

Addressing this problem requires a comprehensive, sustainable approach. Improving education, health and counselling to the community, especially by involving communication figures such as religious leaders and local figures, can effectively disseminate accurate information about the benefits of immunisation. Additionally, the government needs to improve access to health services, especially in remote areas, by building better health facilities and ensuring the availability of sufficient health workers to vaccinate all children.

Technology can also serve as an effective tool to increase public health awareness. Mobile applications that offer information about immunisation and the location of health facilities can help parents make informed vaccination decisions. In addition, social media campaigns that emphasise the benefits of vaccination while debunking myths can diversify public perception. Oyo-Ita et al showed that well-executed digital campaigns can increase public knowledge about immunisation by up to 40%.5 Thus, the appropriate use of information technology can significantly improve public awareness of the importance of vaccination.

Collaboration between the government, non-governmental organisations and the private sector is essential for increasing immunisation coverage in Indonesia. Initiatives that involve various stakeholders can improve the effectiveness and reach of immunisation programmes. For example, partnerships between the Ministry of Health and international organisations, such as the WHO and UNICEF, have successfully increased immunisation coverage in several regions of Indonesia.1 The data show that areas that receive support from international organisations have higher immunisation rates than regions that do not. Therefore, strengthening the collaboration between the government and various organisations is essential for the success of immunisation programmes.

Regular evaluation and monitoring are essential. Arifin et al showed that regions that routinely evaluate immunisation programmes tend to have higher coverage rates. A systematic evaluation provides an opportunity for the government to identify problems and implement corrective measures, thereby continuously improving the programme to meet the community’s needs.4

Overall, increasing immunisation coverage in Indonesia is a complex challenge that requires a comprehensive approach involving education, counselling, information technology, multistakeholder collaboration and ongoing evaluation. Although significant challenges include gaps in coverage, negative stigma and access to health services, various solutions can be implemented to increase community awareness and participation in immunisation programmes. Thus, immunisation coverage in Indonesia is expected to increase, ultimately strengthening public health.

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