Implementation of reaching every child immunization strategy in Ghana: a qualitative exploration of the perspectives of the district health management team

Background: Achieving immunization coverage and access rate of at least 80% in all districts in Ghana has been challenging. Evidence has shown considerable disparities in access to care, immunization coverage among mobile populations, hard-to-reach communities, and underserved communities. The objective of this study was to explore the effectiveness of the implementation of the REC immunization strategy among health workers in ten health facilities in the Greater Accra Region of Ghana. Methods: A qualitative study using in-depth interviews was conducted among 60 members of the District Health Management team in 10 health facilities in the Accra Metropolis. Purposive sampling was used to select eligible participants. Topic guides were used to facilitate face-to-face in-depth interviews. All the interviews and discussions were digitally audio-recorded. All transcripts and field notes were thematically analyzed. Results: Overall, 60 participants were recruited for this study. Five components of the REC immunization strategy [Planning and management of resources, reaching all eligible population, community participation, supportive supervision, and monitoring and the use of data for action] were assessed for their effectiveness in the implementation. Three of the components of the REC immunization strategy (community participation, supportive supervision, and monitoring and the use of data for action) were found to be highly implemented. The other two components (planning and management of resources and reaching all eligible populations) were moderately implemented. Conclusion: This study noted that two of the REC components (planning and management of resources and reaching all eligible populations) were moderately implemented in some of the facilities. Therefore, attention should be given to planning and management of resources at the facility level to identify communities that are still disadvantaged and establish more clinics at various market centers to ensure that all eligible populations are reached. Future research on regional comparison is needed.