Report of Profiles of Slums and Underserved Areas of Five Largest Cities of Punjab, Pakistan July 2020 Acknowledgments This study was conducted with the technical support and oversight from UNICEF Immunization team Pakistan, with financial support of Gavi- the vaccine alliance and executed by Civil Society Human and Institutional Development Programme (CHIP) under the leadership of Provincial and Federal EPI programs. The report in hand presents the results of ‘Profiling of Urban Slums/Underserved Areas’ held in 08 largest cities of Pakistan. Our sincere thanks to UNICEF for their technical support throughout the process to achieve the planned results. Our sincere thanks to UNICEF & WHO Country office colleagues, CSOs and expanded partners for their technical support and facilitation to complete this assignment. Special acknowledgement is extended to Federal EPI Programs, Provincial EPI and District Department of Health who extended their leadership and fullest cooperation for the successful execution of the survey. Specific acknowledgement is also extended to all the respondents for participating in this study and adding their valuable input to this discourse. It would not have been possible to present such in-depth, relevant and reliable information without their cooperation. Table of Contents Executive Summary .............................................................................................................................................. 1 Chapter 1: Introduction ................................................................................................................................. 3 1.1 Introduction ............................................................................................................................................ 3 1.2 Initiatives for Slum-Dwellers by the Private Sector ................................................................................ 6 1.3 Objectives .............................................................................................................................................. 6 1.4 Rationale ............................................................................................................................................... 6 Chapter 2: Methodology................................................................................................................................ 8 2.1 Study Design ......................................................................................................................................... 8 2.2 Study Sites ............................................................................................................................................ 8 2.3 Study Duration ....................................................................................................................................... 8 2.4 Study Respondents ............................................................................................................................... 8 2.5 Sampling Procedures and Sample Size ................................................................................................ 9 2.6 Key Variables ...................................................................................................................................... 12 2.7 Data Collection Instruments ................................................................................................................. 12 2.8 Operational Definitions ........................................................................................................................ 12 2.9 Data Analysis Techniques ................................................................................................................... 14 2.10 Monitoring Mechanism......................................................................................................................... 14 2.11 Study Team and Training .................................................................................................................... 15 Chapter 3: Profiling of Slums and Underserved Areas ............................................................................ 17 3.1 Slums and Underserved Areas ............................................................................................................ 17 3.2 Demography ........................................................................................................................................ 19 3.3 Health and Epi Resources ................................................................................................................... 20 3.4 Infrastructure ....................................................................................................................................... 23 3.5 Social Welfare Services ....................................................................................................................... 27 Chapter 4: Health and EPI Resources at Union Council of Punjab ......................................................... 30 4.1 Administrative Layout .......................................................................................................................... 30 4.2 Healthcare Facilities ............................................................................................................................ 31 4.3 EPI Centers ......................................................................................................................................... 31 4.4 Equipment and Supplies ...................................................................................................................... 32 4.5 Human Resources ............................................................................................................................... 32 4.6 Nutrition Services ................................................................................................................................ 33 Chapter 5: EPI Facilities .............................................................................................................................. 36 5.1 Infrastructures ...................................................................................................................................... 36 5.2 System ................................................................................................................................................. 37 5.3 Management and Facilities .................................................................................................................. 37 5.4 Equipment and Supplies ...................................................................................................................... 39 5.5 Waste Management............................................................................................................................. 40 5.6 Human Resources ............................................................................................................................... 41 Chapter 6: Childhood Vaccination ............................................................................................................. 43 6.1 Vaccination Coverage.......................................................................................................................... 44 6.2 Characteristics of the Mothers ............................................................................................................. 49 6.3 Characteristics of the Households ....................................................................................................... 49 6.4 Characteristics Of Fully Immunized Vs. Zero Dose Children ............................................................... 51 Chapter 7: Conclusion ................................................................................................................................ 54 7.1 Conclusion ........................................................................................................................................... 54 7.2 Study Limitations ................................................................................................................................. 54 Chapter 8: Recommendations .................................................................................................................... 57 8.1 Service Delivery ................................................................................................................................... 57 8.2 Demand Generation and Communication............................................................................................ 57 8.3 Health Work Force ............................................................................................................................... 57 8.4 Gender in Immunization ....................................................................................................................... 57 8.5 Practical vs. Strategic Needs ............................................................................................................... 57 8.6 Others .................................................................................................................................................. 58 Annex 1: Questionnaire for Group Interviews in Slums & Underserved Areas ....................................... 59 Annex 2: Questionnaire for Household Coverage Survey ......................................................................... 66 Annex 3: Questionnaire for District or Town