Vaccination session quality and caregiver experience in Ethiopia: findings from a national immunisation program evaluation

Background Ethiopia has expanded immunisation coverage significantly over the past two decades through strengthened primary healthcare services. However, the quality of immunisation services remains a concern, and their overall quality status has not been thoroughly investigated. This study assesses the immunisation service quality using technical aspects, such as pre-, intra-, and post-administration session quality, as well as perceived quality (client satisfaction), in Ethiopia. Methods This study was part of the national immunisation program evaluation survey. Vaccinators’ practices were observed, and exit interviews were conducted with mothers and caregivers. The study was conducted in all regions and city administrations, except for the Tigray region. A total of 2,971 session observations and 2,955 exit interviews were included. A structured checklist assessed vaccinators’ competency, while satisfaction was measured using a Likert scale questionnaire. Results The study revealed sub-optimal immunisation session quality and client dissatisfaction. Only 4% of vaccinators conducted a complete infant assessment, 11% used educational materials, and 7% delivered key immunisation messages. Nearly half of the sessions were handled by a single vaccinator. Incorrect vaccine administration was noted, with 9% and 11% missing the correct route and site for BCG, 8% and 9% for measles, and 7% administering incorrect doses of the Rota vaccine. Only 55% of mothers/caregivers reported satisfaction with the service. Conclusions The study highlights poor communication regarding immunisation, vaccine administration, and post-administration safety practices, as well as caregivers’ dissatisfaction. Strengthening immunisation service quality through standardised guidelines, ongoing capacity-building, and accountability measures is essential to improve immunisation service uptake, quality, and health outcomes.