The compliance paradox in immunisation microplanning: a concurrent mixed-methods study of reported uptake and gaps in form completion and use in four provinces of Nepal

Immunisation microplanning helps health services identify underserved populations, plan sessions and vaccine requirements, and use local data to correct gaps. Evidence remains limited on whether facilities complete and use each component of Nepal’s national microplanning package. We assessed reported microplanning practices, item-level completion and demonstrated use of national forms in a purposively selected subsample, and barriers and facilitators described by participants. We conducted a cross-sectional concurrent mixed-methods implementation study in four selected provinces from 4 to 30 November 2025. The structured survey covered 230 health facilities, and 96 key informant interviews were conducted across facility, municipal, district, provincial, and federal levels. Trained researchers also reviewed the catchment section and ten national forms with responsible health workers in 52 purposively selected facilities from 26 local governments. This subsample included facilities with stronger and weaker microplanning. Quantitative results are descriptive; qualitative analysis used the Consolidated Framework for Implementation Research and NVivo. Annual preparation or updating was reported by 224/230 facilities (97.4%). In the separate purposive review, vaccine and logistics items were documented in 39–47 of 52 facilities, and session planning in 39. Counts were lower for social mapping (23), centre-level dropout analysis (23), problem categorisation (18), documented resource alignment (19), demonstrated vulnerable-group planning (19), and annual implementation review (22). Participants described complex forms, uneven form-specific training, staff turnover, limited technical supervision, delayed budgets, mismatched data sources, and limited community participation. In the assessed settings, high reported annual preparation coexisted with uneven completion and demonstrated use of selected components in a purposively chosen subsample, suggesting a possible compliance paradox. Prospective studies should test form-specific training, technical supervision, data reconciliation, community participation, and closer links between planning and budgets.