Published in PLOS One on 2026-08-21, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Nardos Gelana, Finina Abebe, Menen Tsegaw, Yordanos Tadesse, Melkamu Ayalew Kokebie, Tseganesh Gedlu, Hanna Alemayehu, Tesfaye Bikes, Yeshiwork Eshetu, Mesfin Kassaye, Adugna Endale, Rachana Sharma, Hiwot Getachew, Hnin Su Mon, Tolasa Yadate
Source: PLOS One • DOI 10.1371/journal.pone.0356253
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite global progress, significant disparities persist in routine childhood vaccination coverage, commonly in low- and middle-income countries, including Ethiopia. Ethiopia has made considerable progress in extending immunization services through the national Expanded Program on Immunization. However, still significant coverage gaps remain, particularly among the vulnerable population such as urban slums and pastoralist areas. This study seeks to capture the perspectives of healthcare professionals and program managers to understand the challenges, best practices, and opportunities for strengthening immunization service delivery in these marginalized settings.
An exploratory qualitative study was conducted in urban slum and pastoralist areas of Ethiopian regions from November to December, 2023. Purposive sampling technique was used to select 39 key informants, including healthcare providers, health extension workers, maternal and child health directors, Woreda Immunization officers, and focal persons. The interview guides were developed with Human-Centered Designand the World Health Organization’s behavioral and social drivers frameworks. Open Code software version 4.03 was used to perform thematic analysis, employing both deductive and inductive coding approaches. Inter-coder reliability and daily debriefing were used to ensure the trustworthiness of the study.
Key barriers affecting the routine childhood immunization service included inconsistent vaccine supply, limited cold-chain capacity, low financing, high workloads, and challenges in reaching these populations. However, best practices such as community engagement, involvement of local community structures, mobile teams and the inclusion of the private sector demonstrated notable successes. Healthcare professionals recommended improving supply chains, enhancing healthcare providers training and supervision, and increasing community awareness as crucial strategies to reach under-immunized groups.
This study identified that persistent health system challenges remain in delivery of routine childhood vaccination, while there is best practices in some areas. Strengthening health system capacity in terms of human power and necessary, combined with active community engagement, is essential to achieving equitable vaccine coverage among under-immunized populations.
Introduction
Immunization remains one of the most productive and cost-effective public health interventions, globally preventing more than 30 life-threatening diseases and infections and an estimated 3.5 to 5 million deaths annually from vaccine-preventable diseases [1,2]. Despite global progress, significant disparities persist in routine childhood vaccination coverage, commonly in low- and middle-income countries (LMICs), including Ethiopia. Geographic, socioeconomic, and systemic challenges continue to hinder equitable access to immunization services, especially among those living in urban slums and pastoralist regions [3,4].
Ethiopia has made considerable progresses in extending immunization services through the national Expanded Program on Immunization (EPI). However, still significant coverage gaps remain, particularly among the vulnerable populations. The 2019 Ethiopian Mini Demographic and Health Survey revealed regional differences in immunization rates, with children in remote and marginalized areas being under-vaccinated [5]. This inequity is worsened by unique challenges to these contexts, including high mobility in pastoralist community, poor infrastructure, limited health workforce capacity, and socio-cultural barriers such as low health literacy and vaccine hesitancy [4,6,7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Nardos Gelana, Finina Abebe, Menen Tsegaw, Yordanos Tadesse, Melkamu Ayalew Kokebie, Tseganesh Gedlu, Hanna Alemayehu, Tesfaye Bikes, Yeshiwork Eshetu, Mesfin Kassaye, Adugna Endale, Rachana Sharma, Hiwot Getachew, Hnin Su Mon, Tolasa Yadate. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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