After rising for more than two decades, routine immunization coverage rates began to stagnate in 2010, with an estimated 19.4 million children under the age of one not receiving basic vaccines in 2018. While immunization services have historically focused on supply and delivery functions, inequities have highlighted the significance of demand generation—and the need for a people-centered model that incorporates health worker and client perspectives for a more positive immunization service experience.

Partners in the Vaccination Demand Hub Service Experience Workstream are collaborating to inform a new direction in people-centered quality immunization service delivery and re-orient immunization services to include caregiver, client, and health worker perspectives and needs. In support of this effort, John Snow Research & Training Institute, Inc. (JSI), in collaboration with Gavi, the Vaccine Alliance, consolidated existing knowledge and conducted rapid learning around immunization service experience at global and regional levels through desk reviews and key informant interviews (KIIs). Results from these KIIs were organized into nine main components.

These components formed the basis for additional insight gathering in four countries, including Mozambique. Established shortly after Mozambique’s independence in 1979, the Extended Program on Immunization (EPI) saw a 59 percent increase in national immunization coverage (DPT3) between 1985 and 2019. In the last five years, however, Mozambique has faced several crises, and DPT3 coverage has leveled off at 88 percent, suggesting the need to continue to strengthen services while also investigating what drives clients and caregivers to seek or avoid immunization services.