Experience from six states of India: Implementation of “health systems approach” to improve vaccination at birth in institutional deliveries at public health facilities

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Newborn vaccination is an integral part of routine immunization program in India, but program implementation gaps exist. The focus of this article is to identify and describe an implementation strategy which could improve the newborn vaccination at the facility level.

Materials and Methods

A situation analysis was conducted through a mixed-methods approach to identify the lacunae in the health system and develop an implementation strategy to improve newborn vaccination coverage across six priority states in India.


Issues in stewardship and human resources, vaccine-related stock-outs, and poor service delivery were some of the reasons for low facility-level vaccination coverage. After implementation of a health system–based strategy, newborn vaccination improved from 55% to 88% across 10 quarters of program implementation. Factors such as sensitization of stakeholders, vaccination on holidays, rigorous documentation, and supportive supervision of health staff were primary reasons for improvement in service delivery.


Importance of newborn immunization at birth is well established. The results from six states prove that “health systems approach” as an implementation strategy is a viable tool to improve newborn immunization at birth.

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