The Project

The REACH-OUT project’s first goal is to find out exactly who, where and how many zero-dose communities exist, and why these groups have been missed by current vaccination efforts. To tackle this, the project will look at both demand- and supply-sides barriers.

On the demand side, it will investigate what determine vaccine behaviors by children caregivers examining issues like cultural beliefs, misinformation and lack of awareness.

On the supply side, it will explore challenges such as poor access to healthcare, logistical problems, and inefficient planning.

Researchers will collect new survey data and conduct in-depth interviews with caregivers and health workers, using validated frameworks and approaches like Root Cause Analysis and the COM- B Behavioral framework.

They will also use advanced statistical and mapping techniques to combine various data sources, creating detailed maps that show where zero- dose communities are and the risk of infections in those areas.

By developing a Zero Dose Vulnerability Index, the project aims to help policymakers better target resources and improve vaccination coverage where it is needed most.

Building on the evidence generated within the project (SO1), the project team will create tailored vaccine delivery solutions in Kenya, Nigeria and Rwanda based on robust participatory approaches. We will work closely with local and national stakeholders to co-design intervention bundles that target the “last mile” challenges in reaching zero-dose communities.

First, during the Initial Exploration phase, we will review best practices and gather feedback from experts and community members. This phase will help us identify gaps and opportunities in current vaccination efforts.

Next, in the Discovery phase, we will hold in-person co- design workshops in each country. Stakeholders will contribute ideas to develop locally adapted solutions that address both supply and demand barriers.

Finally, in the Prototyping and Testing phase, we will pilot the intervention bundles in selected sites and collect feedback from healthcare workers and community members to refine our approach.

In addition, we will improve micro-planning by creating digital maps, calculating travel times, and setting up a tracking system to monitor immunization efforts. We will also develop a digital decision-support and budgeting platform that will integrate geospatial data to help plan, budget and monitor vaccination efforts.

Once the intervention bundles to improve vaccine delivery among underserved communities have been defined, the project team will implement and evaluate them.

Evaluation will be done using a hybrid trial design that measures both the overall impact and the processes behind the interventions, focusing on reach, effectiveness, adoption, implementation, and maintenance while considering each setting's unique context. Data will be collected in multiple stages through surveys, interviews, and health facility assessments using a stepped-wedge approach.

This method will allow the project team to gradually introduce the interventions and compare outcomes over time. In addition, the project team will perform a distributional cost- effectiveness analysis.

This analysis will not only assess the overall value for money but will also examine how the benefits and costs are distributed across different population groups. By doing so, the team will also determine who gains from the interventions and the existence of any equity/efficiency trade offs.

The findings will guide refinements to the intervention bundles and inform future policy decisions, ultimately aiming to develop sustainable, effective, and equitable vaccine delivery strategies that ensure every child receives the immunizations they need.

This objective is dedicated to ensuring that research findings are effectively translated into practice. The project team will use an Integrated Knowledge Translation approach, engaging policymakers, health workers and community representatives from the outset. This collaboration will help shape project activities in a way that addresses real-world challenges and ensures that research outcomes are both relevant and useful.

The team will develop tailored communication and dissemination plans, along with training materials refined based on stakeholder feedback. They will also build a strategic scale-up plan in each country using the WHO ExpandNet framework to guide the expansion of successful pilot interventions to broader regions.

Additionally, the team will assess the transferability of these interventions to other settings through the PIET- T approach, ensuring they can be adapted to different contexts. By focusing on capacity building and creating clear strategies for implementation and scale-up, the project team will work to ensure that research evidence is effectively integrated into national and international policy guidelines, ultimately improving vaccine delivery and health outcomes for underserved communities.