Integration has emerged as a cornerstone strategy in Ethiopia’s efforts to accelerate the reduction of zero-dose (ZD) children—those who have not received a single routine vaccination. According to the World Health Organization (WHO) Integration Resource Guide, integrating health services, such as vaccination programs, significantly enhance resource efficiency and improves overall healthcare delivery. Key benefits include cost efficiency through the pooling of resources, and efforts, minimizing of duplicated efforts, optimized utilization of available funding, and expanded access to healthcare services by leveraging existing infrastructure and networks.
Moreover, the coordination of multiple health services streamlines logistics, facilitates comprehensive data collection and monitoring, strengthens health systems through inter-program collaboration, and fosters greater community trust by offering a holistic approach to healthcare delivery.
Ethiopia has prioritized integration within its immunization program to maximize impact. In 2023, the country developed comprehensive guidelines to incorporate COVID-19 management into its broader health systems, integrating COVID-19 vaccination into routine immunization services. Consequently, regions are now required to request COVID-19 vaccines alongside routine vaccines.
Additionally, as part of the Ethiopia Big Catch-Up (BCU) plan, vaccination modalities have been expanded to include routine catch-up efforts, campaigns, outreach programs, Periodic Intensified Routine Immunization (PIRI) campaigns, and integration with other health services, as outlined in the catch-up vaccination guide. The Ministry of Health (MoH) has engaged partners and donors to map resources and identify activities for integration, thereby leveraging existing immunization resources to address gaps effectively.
Following the introduction of a national catch-up vaccination policy in 2022, the MoH began providing catch-up vaccinations routinely while integrating them with other health opportunities. Through this approach, Ethiopia initiated vaccinations for zero-dose children in 2023, successfully reaching 334,042 zero-dose children using routine vaccine stocks. These efforts preceded the global immunization community’s Big Catch-Up (BCU) initiative, which provided additional vaccines to Ethiopia in 2024.
Integration efforts have been implemented across several thematic areas, including coordination and leadership, service delivery, health worker orientation, monitoring and supervision, and demand-generation activities. High-level leadership engagement plays a critical role in advocating for integration by encouraging immunization programs to collaborate with other health and emergency services. Examples include partnerships with nutrition programs (for nutrition screening, Vitamin A supplementation, and deworming), maternal and child health programs (addressing clubfoot and obstetric fistula), and outbreak response efforts for measles and polio in collaboration with the Ethiopian Public Health Institute (EPHI).
Health worker orientation sessions now encompass a range of topics, including routine immunization, catch-up vaccination, nutrition, and maternal health. Similarly, service delivery has been integrated into various campaigns to cost-effectively reach broader populations. For instance, during the recent round one novel oral polio vaccine type 2 (nOPV2) campaign, integration included interventions targeting zero-dose and under-vaccinated children alongside maternal health initiatives, such as nutrition screening, counseling for children and pregnant women, Vitamin A supplementation, and deworming.
Monitoring and supervision tools have also been adapted to support integration. For example, team supervision tools used during the nOPV2 vaccination campaign in February 2025 incorporated zero-dose indicators. Nationwide supervision conducted from February to March 2025 integrated routine immunization metrics with catch-up vaccination indicators, further enhancing oversight.
Efforts in demand generation and community awareness have also benefited from integration, as messaging now incorporates all relevant health services. Evidence demonstrates that such integration fosters greater community trust, enhances service uptake, and contributes to improved public health outcomes.
The integration of health services, particularly vaccination programs, has proven to be an indispensable strategy in Ethiopia’s efforts to reduce the number of zero-dose children. By combining resources, optimizing funding, and leveraging existing healthcare infrastructure, Ethiopia is enhancing resource efficiency and overall healthcare delivery. This holistic approach to healthcare not only increases service uptake but also improves public health outcomes, advancing Ethiopia’s immunization goals and broader healthcare delivery objectives.
Distributed by APO Group on behalf of World Health Organization (WHO) – Ethiopia.
