Peer-reviewed article
Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations
Stuti Tripathi, Monica Jain, Avantika Bagai, Kirthi V. Rao ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This paper synthesises findings from six formative evaluations of community engagement strategies to increase childhood vaccination coverage in Ethiopia, Myanmar, Nigeria, and Pakistan. The research identified that low caregiver knowledge about vaccine schedules and timing, rather than vaccine hesitancy, was the main barrier to immunisation across all settings. Successful interventions involved frontline health workers and community leaders in monitoring and advocacy. The study found that while these approaches were acceptable and feasible, important questions remain about whether health systems can scale them up affordably.
Key points
- Low knowledge about vaccine schedules and importance of timely vaccination was a consistent barrier across all four countries, while vaccine hesitancy was not a major barrier despite variability in measurement
- Frontline health workers played a critical role in community engagement approaches to increase vaccination
- Successful interventions obtained community buy-in by involving community members and leaders in monitoring and placing immunisation on community agendas
- Interventions required substantial research team assistance when implemented through existing health systems
- Limited cost data was available, and scalability questions remain regarding both cost and health system capacity
Limitations
This synthesis of formative evaluations does not provide robust outcome data on intervention effectiveness or cost-effectiveness. The findings are based on formative work designed to inform intervention design rather than rigorous impact evaluation, and scalability and sustainability questions cannot be fully answered from these evaluations.
Abstract
INTRODUCTION: As global child vaccination coverage has plateaued, understanding how to increase routine child vaccination rates further is key to avoiding preventable disease and death. To analyse how community engagement strategies can increase child vaccination, we synthesise the results from formative evaluations of interventions that aimed to increase vaccination coverage in Ethiopia, Myanmar, Nigeria, and Pakistan. METHODS: This paper uses an inductive qualitative approach to synthesise the results from the six evaluations, gathering lessons for designing context appropriate interventions that are feasible to implement and acceptable to providers, communities, and caregivers. RESULTS: Assessing contextual, caregiver-level and provider-level barriers to vaccination is key to identifying appropriate engagement strategies. Across all contexts, low knowledge about the schedule of vaccines and the importance of timeliness represented a barrier to child immunisation. Despite the variability in how studies measured and reported caregiver attitudes, vaccine hesitancy was not found to represent an important barrier to immunisation. Frontline health workers played a critical role in community engagement approaches to increase vaccination. Interventions successfully obtained community buy-in by centre-staging community members, especially leaders, ensuring their participation in monitoring, and making immunisation an agenda item on community platforms. Interventions were implemented through existing health systems with substantial assistance from research teams. Limited data was available about intervention costs. CONCLUSIONS: Interventions designed around community engagement strategies can be appropriate, acceptable, and feasible approaches to overcome barriers to vaccination in a variety of low- and middle-income country contexts. However, questions remain about the ability of health systems to implement interventions at scale, both from a cost perspective and a capacity perspective.