Practical example of Root Cause Analysis (RCA): Getting ready for the Immunization Collaborative

# Practical example of Root Cause Analysis

## Asking “why” five times: Uncovering the real causes of recurring malaria in children

Using a practical example of a child repeatedly treated for malaria, the Collaborative demonstrates the root cause analysis approach.

Instead of settling for quick fixes, participants are encouraged to ask “why” five times to uncover the underlying issues:
1. Why does this child keep getting malaria?
2. Why are so many children in your village getting malaria?
3. Why are there so many mosquitoes near your homes?
4. Why is there stagnant water around the village?
5. Why are the drainage systems blocked and broken?

“Once you’ve asked why five times, what you find is very different from where you started out, regardless of how much or how little you know about malaria and the context of that particular community.”

This showcases how the Collaborative will approach immunization challenges during the peer learning exercise.

[FunmilayoDavid-rj]

My major immunization challenge is low coverage of less than 80% in all antigens in my LGA
1. Why low coverage in the LGA?
Answer: Lack of access to immunization service in far and hard to reach places.
2. Why is there lack of access?
Answer: Inadequate outreach and vaccination campaigns
3. Why are there inadequate outreach and campaigns?
Answer: Limited resources
4. Why are the resources limited?
Answer: Insufficient funding or prioritization
5. Why the funding not sufficient?
Answer: Lack of political or community will to support immunization programme.

[queenagundu]

1. My biggest challenge was language translation.

2. Why the challenge?
(1) It is necessary for communities to know what immunization is.

(2) New born mothers can immunize their new born babies.

(4)To create awareness for people to know there are levels and months for children and adults to be immunized.

(4) so that mothers can go for repeat dosage of the Immunization to finish.

(5) To prevent both kids and adults from getting infected from certain diseases.

3. Yes my Root cause is the same as initially thought

[IkyaanEdmund]

My biggest immunization challenge and its root cause analysis in my location is.

1) Immunization Challenge: Low vaccination coverage in a specific community.
2) Why? Because there is a lack of access to vaccination services in the community.
3) Why? Because there are limited healthcare facilities and resources available in the area.
4) Why? Because of inadequate funding for healthcare infrastructure and immunization programs.
5) Why? Because of competing budget priorities and resource allocation at the government level.

Here, the root cause of low vaccination coverage is identified as inadequate funding for healthcare infrastructure and immunization programs, which may not have been the initial perception of the problem.

[ShittuTawakallt]

1) My most significant immunization challenge is the prevalence of inadequate knowledge and misinformation about vaccination among mothers, compounded by vaccine hesitancy and the dissemination of inaccurate information within the community.

2) Write down your answer after you have asked “Why?” 5 times

Why? Because there is a lack of understanding about the benefits and risks of vaccines.

Why? Because accurate information about vaccines is not readily available or accessible to all.

Why? Because there are misinformation and misconceptions about vaccines spread through various channels.

Why? Because some individuals and groups perpetuate false claims and conspiracy theories about vaccines.

Why? Because there is a need for credible sources to provide accurate information and address concerns to combat vaccine hesitancy and misinformation.

3) Is your root cause the same as what you initially thought?
Initially, I thought the root cause was "inadequate knowledge and information about vaccination among mothers and vaccine hesitancy and misinformation in the community".
But after asking "Why?" five times, I drilled down to a deeper root cause: "there is a need for credible sources to provide accurate information and address concerns to combat vaccine hesitancy and misinformation".
So, while my initial thought was close, the true root cause turned out to be more specific and nuanced. It's not just a lack of knowledge, but also a lack of trustworthy sources to provide accurate information and address concerns.

[nancydamulak]

My challenge is Inconsistency of mothers and caregivers to bring children for follow up routines
1. Why?
Because they feel that BCG vaccines are the most important vaccines for their children
2. Why?
Because mothers do not have adequate information about immunization.
3. Why?
Because health care providers do not equip mothers with knowledge enough to know the importance of follow up
4. Why?
Because health care providers are often overwhelmed with work
5. Why?
Because of shortfall in staff strength.

[AbdullahiAquatic-ix]

My challenges is un immunized at hard to reach area and zero dose children/settlements

[attahirmustapha]

My major challenge is poor uptake of HPV vaccine among remote and underserved commonities
1. why? Lack of information about benefits of the vaccine
2. why? Lack of adequate Community and mass media health education programmes
3. why? Lack of adequate funding for such programs
4. Why? Lack of commitment from government and political will
5. Why? Poor understanding of the importance of immunization
Solution:
1. organise community and mass media based health education program
2. advocacy for more funding and policy changes

[dankauramedia]

My biggest challenge is some of the caregivers are not complying with the immunization.

1. Why
Because they don't know the importance of Immunization.
2. Why
Because the have no awareness
3. Because some of them are not given financial support
4. Why
Because Immunization services need to be improved
5. Why
Because some of the health facility are not operating 24hour