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 the 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 Nepal. Immunization against vaccine-preventable diseases is a top priority of Nepal’s public health and National Immunization Program (NIP) program, and key to reducing child morbidity, mortality, and associated disabilities. Nepal enacted legislation to recognize immunization as a right of all children through the
Immunization Act 2072, which was signed into law in 2016. However, providing all clients with a quality immunization service experience remains a challenge due to issues related to governance, facility preparedness, and health worker training.

To understand if and how the global and regional findings resonate in the country (and efforts underway in Nepal to address the immunization service experience), in April and May 2020, JSI carried out key informant
interviews (KIIs) on the immunization service experience with 21 participants. These informants were from federal and local government, academia, professional societies, United Nations agencies, international and local nongovernmental organizations, and the private sector. Conducted with coordination support from the Family Welfare Division, the interviews were primarily virtual due to COVID-19 restrictions. The interviews were recorded and analyzed to extract common themes. The findings were supplemented by information from the Immunization Act 2072 and the comprehensive Multi-Year Immunization Plan. 

This case study examines the immunization service experience in Nepal, identifies successes and challenges, and provides recommendations for improvement.