<p> Recent years have seen Ghana pursuing extensive reforms of its healthcare delivery system. The delivery of immunization and other outreach services to the people of Bibiani-Anhwianso-Bekwai (BAB) district in Ghana despite the tremendous efforts by the district directorate to extend services to more people has recently been stalled. Faulty case management techniques used by case managers managing the immunization delivery services may be cited for the slow pace at which this process is moving. CDCynergy, a theoretical framework and model developed by the Centers for Disease Control and Prevention (CDC) was used to examine the case management techniques used in the health services departments in and around the Bibiani-Anhwianso-Bekwai (BAB) district in Ghana to deliver immunization and outreach services to the target community. Using a community-based research approach, 27 community health nurse case managers took part in a semi structured interviews to select participants of the focus group deliberations. The focus group members were all community health nurse case managers involved in managing immunization and immunization related outreach programs. The researcher moderated a focus group discussion with nine community health nurse case managers stationed at the BAB district. Additionally, a district vice chair, a director of health services in the region, primary healthcare providers (PCPs) from health centers in the BAB district, and a nurse from one of the Community Health Post (CHPS) compounds in the Bibiani-Anhwianso-Bekwai (BAB) District participated in separate semi structured interviews. The findings identified the following: (a) majority of the community nurse case managers understand that offering immunization and outreach services to the target population constitutes an important part of their job description, (b) improving the case management techniques used by the outreach and the immunization case managers in the BAB district could improve the context of their service delivery, (c) improving the time management component of the case management techniques could tremendously improve the delivery of immunization and outreach services, and (d) developing a training manual to provide case management guidance and tools to the community health case managers, in order to improve their case management skills. Even though the community healthcare posts (CHPS) serve as a model for bringing immunization and outreach services closer to target populations, the idea of community healthcare worker (CHEW) delivery of more services to hard-to-reach communities is a definite public health measure of improving collaboration between healthcare workers, community residents, community leaders, public health administrators, and local politicians. This measure can positively impact the delivery of immunization and outreach services.</p>

<p> A personal belief exemption (PBE) has allowed parents to exempt their children from immunization when they are opposed to it based on their personal beliefs. As the number of PBE increased over the past few years, there was an increase in incidence of vaccine preventable diseases such as measles and pertussis among kindergartens. The current study examined the association between the percentages of PBEs filed by parents of kindergarten and three socio-demographic variables of schools including ethnicity, income level, and religious affiliation. The statistical findings showed that the percentages of PBE were lower among Asian Americans and Hispanics than Caucasians, higher among the religiously affiliated schools than religiously affiliated schools, and higher among south Orange County (OC) schools than north OC schools. The findings can help public health field detect which risk factors correlate the percentage of PBE and develop interventions more effectively and can help limit future outbreaks.</p>