Ikechukwu Udo Ogbuanu

"When health workers and local communities take ownership and responsibility for reducing missed opportunities, the impact on the number of children vaccinated is augmented."

A missed opportunity for vaccination (MOV) refers to any contact with health services by an individual of any age who is eligible for vaccination (e.g., unvaccinated or partially vaccinated and free of contraindications to vaccination), which does not result in the person receiving one or more of the vaccine doses for which he or she is eligible. One of the common reasons why opportunities for vaccination are missed in health facilities is parental or community resistance to immunisations.

The World Health Organization (WHO)'s MOV strategy involves an assessment to demonstrate the magnitude and identify causes of missed opportunities, followed by tailored health system interventions to reduce these missed opportunities, potentially resulting in an increase in vaccination coverage and equity and an improvement in timeliness of vaccination. It includes 10 steps:

  1. Plan for an MOV assessment and intervention.
  2. Prepare for the assessment and secure commitment for follow-up interventions.
  3. Conduct field work for the rapid assessment of MOV.
  4. Analyse preliminary data and identify key themes.
  5. Brainstorm on proposed interventions and develop an action plan for the interventions.
  6. Debrief with Ministry of Health (MOH) leadership and immunisation partners on proposed next steps (e.g., plans for social mobilisation and development of communication materials).
  7. Implement the interventions.
  8. Provide supportive supervision and monitor progress.
  9. Conduct rapid field evaluation of outcomes/impact of interventions (6-12 months later).
  10. Incorporate into long-term plans to ensure gains are sustainable.

The MOV strategy is based on a bottom-up approach that obtains information on the reasons for MOV from service providers and the users of health services, at the health facility level. The strategy uses a participatory research approach to obtain the commitment, and leverage the knowledge and experience, of the local staff and users to resolve identified issues.

This suite of documents on MOV from WHO is meant to enhance the toolbox of a programme manager at the national or subnational level. Using a participatory mixed-methods approach, the resources provide step-by-step guidance on how to conduct a root-cause analysis of bottlenecks in the immunisation programme and to design relevant strategies to address them. Designed to be used together, the resources include:

  • Planning Guide to Reduce Missed Opportunities for Vaccination - English and French, 60 pages, published October 2017 - provides an overview of the entire MOV strategy through: (i) background information; (ii) the steps to plan and conduct an assessment of missed opportunities and how to analyse and report on the results of an MOV assessment; (iii) guidance on how to use the findings of an MOV assessment to design and implement interventions to reduce missed opportunities for vaccination.
  • Methodology for the Assessment of Missed Opportunities for Vaccination - English and French, 72 pages, published October 2017 - provides the detailed instructions, standardised methodology, and tools for conducting field work (including sample health facility exit interviews and health worker knowledge, attitude, and practices (KAP) questionnaires), and detailed guidance for conducting in-depth interviews and focus group discussions. The major outcome of the assessment component is to build a strong case for reducing MOV by convening multiple in-country immunisation partners to identify the underlying causes and address these problems. The brainstorming sessions following the field work are intended to achieve this outcome.
  • Intervention Guidebook to Reduce Missed Opportunities for Vaccination (coming soon): This manual provides practical guidance for translating the findings of the MOV assessments into actionable work plans. It includes: a list of frequent reasons for MOV, an overview of potential interventions to reduce MOV, examples of job aids and other materials for use at the health facility level, and guidance for activities and processes to explore and design locally tailored interventions to reduce MOV.

The MOV strategy has been implemented in a number of countries, with additional assessments planned.


English; French

Number of Pages: 

60 (Planning Guide); 72 (Methodology)


WHO website, March 19 2018.

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