A survey of the Expanded Programme on Immunisation in eastern Zimbabwe showed a low valid coverage rate of only 51.4% by one year of age despite a high crude coverage rate of 86.8%. Health workers had assumed that ignorance, distance and religious beliefs were obstacles to the immunisation programme, but the survey revealed that the problem lay in the poor quality of EPI services rendered by health staff (specifically due to invalid vaccination doses and missed opportunities). Focus group discussions with mothers confirmed this. Mothers were well informed, highly motivated and had many suggestions how service could be improved, but were rarely given the opportunity to discuss them with health workers.

Recommendations (resulting from the study):

• Regularly assess service quality of EPI programme
• Interview mothers about service quality
• Revise EPI manuals
• (Re-)train service providers

• All recommendations were implemented
• After training of health staff, proportion of invalid measles vaccine doses reduced from 25% to 10.4%
• Research results published in booklet: "Improving Service Quality through Action Research" and distributed throughout the Southern African Region
• Findings published by Razum O.: Mothers voice their opinion on immunization services. World Health Forum, 1993; 14 (3):282-6