Journey to immunization service: identifying barriers and enablers to routine immunization service uptake among communities residing in urban slum areas of Addis Ababa, Ethiopia, 2023

Despite the acknowledgment of the effectiveness of immunization in reducing the spread of vaccine-preventable diseases, many children around the world face challenges in getting their initial essential childhood vaccines due to a range of behavioral and structural obstacles. Therefore, this study aimed to explore the context-specific barriers and enablers to routine immunization service uptake in Addis Ababa, Ethiopia, using the journey to immunization framework. To assess the barriers and enablers to routine immunization service uptake among communities residing in urban slum areas of Addis Ababa, Ethiopia. The journey to immunization mapping exercise took place in Addis Ababa from October 24 to 30, 2023. Ten caregivers of under-five children and fourteen stakeholders were involved in the study. We analyzed the data using notes taken during the interviews. Individual level factors (limited awareness about vaccines schedule, mistrust and negative attitudes towards vaccines, time constraints to vaccinate their children, financial difficulties for transportation, fear of side effects), health system barriers (challenges with vaccine supply, proximity to health facilities or outreach sites, loss of vaccination cards, shortages of health workers and skill gaps), and service related (long waiting times, inadequate counseling and client-provider interaction) were the major barriers identified in this study. Maternal factors (increased maternal knowledge of vaccination, and high women’s decision-making power) and social system (neighborhood support) were all identified as enablers of routine vaccinations for children. The journey mapping approach provides a valuable framework for developing methodological and strategic approaches to enhance childhood immunization services. It fosters a comprehensive understanding of the caregiver’s and health care provider’s journey.