Sometimes these challenges are exacerbated by negative interactions with health workers, making caregivers feel powerless in advocating for immunisations for their child.

For example, Esselina was familiar with the immunisation schedule from her older children, but when she brought her twins to the health facility for their vaccines, they never received them. Esselina was hesitant to speak up or complain to the health workers for fear of being humiliated in front of other patients at the health facility. Instead, she and her children returned home with no vaccines.

“For a few months I went to the hospital, and they just weighed the children and returned the [vaccination] card to me without saying anything, but as I was afraid to ask, I was silent without knowing if it was a lack of vaccines that the hospital did not have or bad luck for me,” said Esselina. Her experience illustrates how a breakdown in communication between caregivers and health workers can create confusion around the reason for a missed vaccination – for example whether it’s due to vaccine stock issues or an erroneous entry on a vaccination card.