Background: In Mukono District, Uganda, the issue of zero-dose childrenâthose who have notreceived any routine vaccinationsâarises from discrepancies, for instance, in populationdenominator data, delayed reporting through the Health Management Information System (HMIS),underreporting by private health facilities, and inconsistencies between field records and districtreports, obscuring the actual number of zero-dose children in official statistics, which complicatesefforts to meet immunization targets. Recent estimates indicated that approximately 650 children inMukono did not receive the DPT1 vaccine last quarter. This could be attributed to high urbanizationrates leading to increased reliance on private health facilities that often do not report to the HMIS,resulting in incomplete vaccination data. Also, children born in community settings frequently missvaccinations due to inadequate follow-up and documentation. Additionally, geographic mobilitycomplicates data accuracy as mothers may seek vaccinations in neighboring districts, and transportchallenges exacerbate the problem. This necessitates enhancing vaccination data capture andreporting processes to improve data collection and cross-verification methods and ensure thatvaccination information from all sources is accurately recorded to facilitate better-targetedinterventions to address the zero-dose problem in Mukono District.Findings: To address these challenges, the district has to work together with partners and the Ministryof Health to enable tracking of children who receive vaccinations, especially from different healthfacilities, and to incentivise private health facilities to report routine immunisation data to thenational health management information system. Integrating community health workers, innovativetracking technologies, and improved information sharing between health facilities are crucialstrategies for increasing immunization coverage and reducing missed opportunities, particularly inlow-resource settings. While some methods may face challenges in scalability and cost, targetedinterventions in hard-to-reach areas and the adoption of advanced systems like the DHIS2 trackermodule can help in the reconciliation of immunisation records to understand the true picture ofcoverage.On the other hand, private health facilities greatly contribute to immunization coverage, particularlyin urban areas. However, challenges such as interoperability issues, lack of staff training, high staffturnover and lack of reporting hinder their contribution to national immunization data. To overcomethese issues, strategies like comprehensive staff training, improved reporting systems, and private-public partnerships are essential. Enhancing collaboration with private facilities, especially inurbanizing areas like Mukono District, can improve immunization data reporting and help reconcilerecords, including addressing "false defaulters."Conclusion: Addressing the challenge of zero-dose children in Mukono District, necessitates amultifaceted approach that enhances the capture and reporting of immunization data. Engagingcommunity health workers, leveraging innovative technologies, and improving information sharingamong health facilities can improve data accuracy and ensure that all children are accounted for inimmunization efforts. Additionally, incentivizing private health facilities to participate in the nationalHMIS through training and resources will further reconcile discrepancies in reporting. Implementingthese strategies not only aims to increase immunization coverage but also plays a crucial role inachieving Uganda's broader immunization goals, ultimately contributing to better health outcomesfor children in the region.
