Peer-reviewed article

Health worker practices and challenges surrounding routine immunisation service delivery of measles-containing vaccine: a cross-sectional assessment of health facilities in Oromia region, Ethiopia - 2021.

Gelmessa TD, Woyessa AB, Shah MP, Matanock AM, Nkengasong S et al. · 21 May 2026

Abstract

Background Ethiopia's routine immunisation schedule has included the first dose of measles-containing vaccine (MCV1) since 1980, and MCV2 was introduced in 2019. However, challenges with MCV service delivery and frontline health worker (HW) practices persist. Methods A cross-sectional assessment was conducted between February and March 2021 among HWs (n=72) and Expanded Program on Immunization (EPI) focal persons (n=29) from 18 randomly selected districts and 36 health facilities that provide vaccination in Oromia, Ethiopia. Participants were interviewed about their practices during vaccination sessions, the availability of updated reporting tools for MCV2, the cold-chain system, immunisation programme operations and vaccine supply monitoring. Data management and descriptive analyses were carried out using R. Results Among HWs, 76% and 40% reported offering MCV at every static and outreach vaccination session, respectively, 72% needed at least five children to open a 10-dose MCV vial, 13% reported recent (past 12 months) cancellation of MCV sessions due to vaccine stock-outs and 29% regularly discussed with the performance monitoring team. The availability of updated reporting tools varied; 36% had updated immunisation registers, 40% had updated tally sheets, 63% had updated vaccination cards and 76% had updated monthly reporting forms. District EPI focal persons reported inconsistent power supply (68%) and at least one recent vaccine stock-out (17%). Conclusions Inconsistent delivery of MCV at all vaccination sessions and the reluctance of HWs to open the measles vaccine vial could lead to missed opportunities for measles vaccination. MCV coverage could be improved by switching to a five-dose MCV vial, re-enforcing HW training in open vial policies and session management, ensuring availability of updated monitoring tools and monitoring vaccine stock.