How simple outreach transformed immunization in Turkana

In the vast, arid expanse of Turkana, northern Kenya, where communities are scattered and health facilities are few and far between, a quiet but impactful revolution is taking place—one that is giving children their first shot at life-saving vaccines. This is the story of how local ingenuity, community trust, and minimal resources came together to reach the most overlooked group in immunization efforts: zero-dose children.

Zero-dose (ZD) children are those who have not received even the first dose of DPT (diphtheria, pertussis, tetanus). These children often fall outside the health system entirely, especially those born at home and far from health facilities.

In Turkana, about 53 percent of caregivers deliver at home, according to Kenya's 2022 demographic and health survey, due to long distances (up to 40 kilometers) from the nearest facility and no affordable transport options.

While immunization registers and facility data offer some insights, they miss a large segment of the population, particularly in nomadic, pastoralist communities. As one health records officer learned, reviewing children's names who have missed vaccinations from facility records often fails: many children received some vaccines during previous mobile outreaches or at different health posts. The only way to truly identify ZD children was to go where the data couldn’t: door to door in the community.

PATH’s Living Labs and local health teams embraced a community-led approach. They started by engaging Community Health Assistants (CHAs), who supervise Community Health Promoters (CHPs), each assigned up to 100 households. Additionally, they engaged several caregivers of ZD children through interviews, which provided valuable insights for outreach efforts to reduce the travel burden for vaccination services.

Focus groups revealed a practical idea: organize dedicated outreach events that brought health services closer to caregivers, minimizing the burden of travel and increasing access to vaccination.

The mobilization was swift and efficient. CHAs alerted CHPs, who spread the word across five villages. When time was tight, phone calls and community leaders filled the communication gaps. Chiefs, village administrators, and health committees worked together to ensure caregivers knew when and where to show up.

Two days later, nearly 80 caregivers and their children arrived.

The outreach setup was modest: an existing tent from UNICEF, paper records, and a nurse with a motorbike. Yet it was enough. CHAs reviewed mother-child booklets to identify ZD children. One child, 11 months old, had only received the BCG vaccine at birth. Dozens of others were in a similar situation—completely missed by the system.

In total, 47 out of 80 children were identified as zero-dose. Caregivers were asked to stay after the documentation process for follow-up counseling. Many shared their challenges: long, hot walks of 1–1.5 hours to health facilities, often starting at dawn to avoid long queues, and waiting until sundown to return. The child wasn’t sick, so the trip felt less urgent.

But hesitancy wasn’t the issue, knowledge gaps and difficulty of access were. Caregivers had never received education about the purpose of multiple vaccine doses or the diseases they prevent.

The outreach uncovered two key caregiver categories:

1. Long-distance caregivers: Those living over 10 kilometers from a facility, for whom regular outreaches are essential.
2. Nearby caregivers: Within walking distance (1–2 hours) but with limited knowledge about vaccines.

For the second group, PATH is now piloting an intervention that trains CHPs, nurses, and community champions to provide targeted education through home visits and community meetings. The goal: bridge the knowledge gap and empower caregivers to follow the immunization schedule.

For long-distance caregivers, the outreach model is being refined for sustainability, leveraging motorbikes instead of four-wheel drive vehicles, minimizing personnel, and replicating it across other underserved villages.

What made this outreach different was its simplicity. No large vehicles. No massive funding. Just a nurse, a motorbike, and the power of community mobilization.

• Cost-effective: Traditional outreaches can cost over $700 a day. This model slashes costs while reaching high-need populations.
• Locally informed: CHAs and CHPs, with their community insights, identified gaps that facility data missed.
• Behavioral insight: Most caregivers were not unwilling, they were uninformed or unsupported.

This experience in Turkana illustrates that identifying and reaching ZD children requires more than data. It requires proximity, trust, and listening to caregivers themselves. Outreach efforts like this are not just catch-up campaigns; they are lifesaving interventions that reveal the power of local knowledge and human connection.

With consistent support and replication, this approach could be the key to closing the immunization gap, not just in Turkana, but in underserved, hard-to-reach communities everywhere.