To support Ethiopia’s Ministry of Health in informing and improving its strategies to reduce zero-dose prevalence, Fenot Associates and ThinkWell are generating evidence on the cost and programmatic barriers of key strategies aimed at reaching zero-dose children. This report captures the qualitative findings of the study. The qualitative analysis aims to shed light on the barriers that health centers and woredas face in implementing key initiatives aimed at reducing zero-dose prevalence and helps to contextualize cost findings once these become available.
The study focused on two key strategies implemented in Afar and Somali regions: period intensification of routine immunization (PIRI), and mobile health and nutrition teams. MHNTs are teams with a dedicated van with which they travel daily into communities, offering various primary care services, including immunization, nutrition, and others. PIRI are immunization campaigns that are conducted 3 to 4 times per year.
Key findings
- MHNT and PIRI strategies effectively tackled operational challenges by providing transportation and funds, hiring more staff, and actively reaching communities, thus overcoming logistical, financial, and staffing issues, as well as barriers posed by poor roads and distance.
- Both MHNT and PIRI strategies boosted vaccine equity and coverage by reaching previously missed children in remote areas. However, MHNT was perceived as more effective as it delivers a package of essential services in an integrated manner, and improved community participation and turnout.
Key lessons learned
- The focus on zero-dose has helped to change perceptions among health workers and communities about the importance of proactively catching up older children.
- Strategies that integrate immunization with other services like nutrition proved particularly effective compared with standalone immunization delivery, and it increases the turnout rate.
- Simultaneous MHNT and PIRI in the same area could lead to resource duplication, and a reduction in the effectiveness of both strategies, suggesting a need for careful planning and potentially prioritizing one strategy based on the context.
- Infrequent PIRI campaigns may lead to higher dropout rates, as parents wait for the campaign as opposed to going for regular immunization visits, and because families are sometimes not adequately informed about the importance of follow-up vaccinations following PIRI.
- Continuous training, particularly for MHNT staff, on immunization was crucial to meet the demands in hard-to-reach communities.
- Strong collaboration and information sharing among district coordinators, health facility staff, MHNT teams, development partners (for logistics and funding), and community volunteers were vital for the success of zero-dose vaccination strategies.
