Despite substantial progress in expanding routine immunization services in Ethiopia, a considerable number of children continue to miss or delay scheduled vaccinations, particularly between completion of the primary infant vaccination series and the nine-month measles-containing vaccine (MCV1) vaccination visit. Immunization dropout remains a critical challenge that contributes to persistent gaps in vaccination coverage and leaves children vulnerable to vaccine-preventable diseases.

The Implementation Research to Reduce Immunization Dropout in Ethiopia project aims to generate evidence, develop contextually appropriate interventions, and strengthen implementation approaches to improve routine immunization uptake and reduce missed opportunities for vaccination. The research focuses on understanding why children drop out of vaccination services, how these factors differ from those contributing to zero-dose status, and how tailored interventions can improve continuity of care and timely vaccination.

The project is jointly implemented by John Snow, Inc. (JSI) and the Center for Digital Health and Implementation Science (CDHI) at the University of Gondar (UoG), in close collaboration with the Ministry of Health (MoH) and Regional Health Bureaus (RHBs). The research is being conducted in three diverse implementation contexts: Gelealo woreda in Afar Region, Gondar Zuria woreda in Amhara Region, and Didessa woreda in Oromia Region. These settings represent different service delivery challenges and population contexts, including pastoralist, conflict-affected, and agrarian communities.

The project applies an implementation research approach to identify barriers and enabling factors influencing vaccination continuity, co-design and test evidence-informed interventions, and generate lessons for sustainable scale-up within Ethiopia’s immunization system. The research also examines the relationship between immunization services and other maternal, newborn, and child health (MNCH) services, including postnatal care and child nutrition platforms, to identify opportunities for improving integrated service delivery.

CDHI-UoG serves as the scientific lead for the research components under the leadership of JSI. CDHI is responsible for conducting formative assessments, supporting baseline and endline evaluations, contributing to adaptive learning processes, analyzing research findings, and disseminating evidence through peer-reviewed publications, policy briefs, and scientific conferences.

Through collaboration with national and regional health authorities, health system actors, and communities, the project seeks to generate practical evidence to strengthen routine immunization delivery, improve retention of children in vaccination services, and support Ethiopia’s efforts to ensure that every child receives timely and complete immunization.

Implementation Research to Reduce Immunization Dropout in Ethiopia

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