Challenges and enablers in measles vaccination implementation in Ethiopia: Insights from a qualitative study

Even though safe and free vaccines are available, measles vaccination coverage remains low in Ethiopia. There is a paucity of studies on measles vaccination implementation challenges and enablers. Hence, this study aimed to examine implementation challenges and enablers of measles vaccination, both from the perspectives of service providers and caregivers. A case study was conducted in the east Gurage zone of central Ethiopia from December 2023 to May 2024. Fifteen health workers and 16 mothers of children aged 12-23 months who missed the measles vaccination were interviewed. Fifteen service exit interviews and six focus group discussions were also conducted. We analyzed the data manually using an inductive thematic analysis approach and presented the themes and sub-themes with representative quotations. The four basic trustworthiness measures for qualitative research were taken into account. The major measles vaccination implementation challenges for caregivers were inaccessibility, unaware of the next vaccination schedule, unavailability of a daily immunization service, interrupted outreach vaccination sessions, long waiting times, adverse event following immunization, and health workers' impoliteness. Lack of funding, transportation, vaccine refrigerators, space, training, benefit packages, inadequate child screening practices, vaccine stockouts, and fear of vaccine wastage and contraindications were among the major challenges health workers faced when implementing the measles vaccination. Our results suggest that there is an urgent need to improve service availability and accessibility, vaccine and other supply management, basic and refresher training, health workers' benefit packages, and provider-client communications.