Community-Based Strategies for Increasing Childhood Vaccination Coverage:A Secondary Analysis of WHO/UNICEF and MICS Data(Pakistan)

Abstract

Background: Pakistan continues to face gaps in routine immunization coverage and persistent sub national inequities. Community-based strategies (community health worker outreach, religious/traditional leader engagement, mobile outreach, and reminder systems) are widely promoted but require contextual evidence to guide scale-up. We used publicly available national estimates and MICS/DHS/provincial MICS reports to describe vaccination coverage, equity patterns, and synthesize evidence on community strategies in Pakistan.

Methods: We performed a secondary analysis of WHO/UNICEF national immunization coverage estimates (WUENIC) and published Pakistan MICS/DHS/provincial MICS reports (2017–2021). Primary outcomes: national and provincial coverage for BCG, DTP/Penta1–3, Polio1–3, MCV1 and full basic immunization (BCG + DTP/Penta1–3 + Polio1–3 + MCV1) among children aged 12–23 months as reported in those sources. We extracted national trends (WUENIC) and dis-aggregated tables (MICS/DHS). Because only aggregated published tables were used, the analysis is descriptive; intervention effectiveness is synthesized from peer-reviewed and program literature.

Results: WUENIC (2023 summary) reports Pakistan DTP1 ≈ 94% and DTP3 ≈ 86% (2023), with an estimated ~396,000 zero-dose children in 2023 (i.e., missing DTP1). Provincial and survey reports show marked heterogeneity: Punjab and Khyber Pakhtunkhwa report substantially higher full-immunization proportions (Punjab often >80–90% in provincial MICS snapshots) while Balochistan and parts of Sindh show much lower coverage (Balochistan reported as low as ~38% fully immunized in some assessments). Socioeconomic gradients are consistent: lower maternal education and poorest wealth quin tiles have the lowest coverage. Evidence synthesis shows CHW outreach (including Pakistan’s Lady Health Worker model), community mobilization with religious/traditional leaders, and targeted outreach sessions are among the most promising community strategies to increase uptake when combined with reliable supply and data systems.

Conclusions: Pakistan’s published national and sub national data show strong overall progress but persistent pockets of under-coverage and inequity. Scaling community-based strategies — CHW outreach, faith/traditional leader engagement, targeted mobile outreach, and context-appropriate reminders — in high-burden districts should be central to national immunization recovery and equity strategies. For causal evaluation and quantification of effect sizes, analysis of microdata (MICS/DHS child files) or implementation trial data is recommended.