| Issue/Objective |
Pastoralist communities in Ethiopia continue to face persistent immunization inequities driven by mobility, weak microplanning, and limited last-mile accountability. Zero-dose children remain concentrated in areas least served by conventional fixed-site delivery. This study evaluated whether a community-led immunization model could reduce zero-dose prevalence and improve continuity of vaccination in pastoralist settings, while strengthening locally led PHC delivery. |
| Methodology/Approach |
A stepped-wedge cluster design was implemented across 24 health-centre catchment areas in Afar and Somali Regions over 18 months. The intervention combined community immunization agents, monthly name-based defaulter tracking, mobile phone appointment reminders, outreach scheduling aligned to seasonal mobility, and joint review meetings involving health extension workers, facility staff, and district managers. Household enumeration identified 18,642 children aged 0-23 months. Primary outcomes were zero-dose prevalence and pentavalent-1 uptake; secondary outcomes included pentavalent-3 completion, dropout, timeliness, and missed opportunities for vaccination. Mixed-effects logistic regression was used with adjustment for cluster and period effects. |
| Results |
Zero-dose prevalence declined from 23.4% at baseline to 11.2% at endline, corresponding to an adjusted odds ratio of 0.41 (95% CI 0.34-0.50). Pentavalent-1 coverage increased by 19.6 percentage points, while pentavalent-1 to pentavalent-3 dropout fell from 31.8% to 14.7%. Outreach sessions conducted as planned increased from 58% to 83%, and missed opportunities for vaccination during child health contacts fell by 37%. Gains were greatest in clusters where community agents were retained for at least 12 consecutive months and monthly microplans were jointly reviewed. |
| Discussion/Conclusion |
These findings show that reaching zero-dose children in pastoralist areas is not primarily a technology problem but a local systems problem. Equity gains were strongest where communities helped identify children, district teams used simple operational data, and outreach adapted to lived mobility patterns. Ethiopia's experience demonstrates that resilient, community-led PHC strategies are essential to restoring commitment to action for those most often left behind. |
| Presenters and Affiliations |
Helina Siyoum EPIC Health Systems |
