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Title page 1

Contents 4

Acknowledgements 6

Abbreviations 7

Executive summary 9

1. Introduction 14

1.1. Country case studies 17

1.2. Purpose and structure of the global report 19

2. Case study approach 20

2.1. Individual case study design 20

2.2. Cross-country synthesis 25

2.3. Strengths and limitations 25

3. What factors contribute to children not being immunized on time? 26

3.1. Caregiver and household socioeconomic characteristics 29

3.2. Geographic and time barriers 30

3.3. Service delivery gaps 31

3.4. Provider-related factors 32

4. How was the Big Catch-Up planned, implemented and monitored? 33

4.1. BCU planning 34

4.2. Implementation approaches 36

4.3. Resources 44

4.4. Health worker training and incentives 46

4.5. Data systems 47

4.6. Adaptive management 49

5. What were the Big Catch-Up's achievements? 51

5.1. Systems and practice changes 51

5.2. Progress in catch-up vaccination 53

6. What are country plans for institutionalizing catch-up? 55

6.1. Policies and politics 60

6.2. Structures and inputs 61

6.3. Funding 61

6.4. Communities 62

7. Conclusion 64

References 67

Annex 1 - Further research details 68

Annex 2 - Individual catch-up schedules for each case study country 70

Tables 5

Table 1. Summary methods used in case study design, by country 21

Table 2. Summary of KII respondents, by country 22

Table 3. Summary of FGD respondents, by country 22

Table 4. Summary of health worker questionnaires, by country 23

Table 5. Summary of caregiver questionnaires, by country 24

Table 6. Factors associated with ZD and underimmunization, by case study site 27

Table 7. BCU country plans approved for global support, by case study site 34

Table 8. Operational modalities for the BCU, by case study site 39

Table 9. Strengths and weaknesses of different operational modalities for the BCU 40

Table 10. Catch-up institutionalization plans, by case study site 56

Table 11. Analysis tools used by type of data, by country 69

Figures 5

Figure 1. The Big Catch-Up theory of change 15

Figure 2. Coverage of key childhood vaccines from WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), 2024 revision... 18

Figure 3. Timeline of BCU implementation, by case study country 37

Boxes 5

Box 1. Changes to operational targets for on-time vaccination in the United Republic of Tanzania 35

Box 2. Integration and intensification of services in Cameroon 43

Box 3. BCU implementation conditions in conflict-affected area - lessons from Yemen 44

Box 4. Vaccinator teams in Pakistan 45

Box 5. Delayed community funds in Cameroon 45

Box 6. Progress in catching up children aged 12-59 months previously missed, by country 53

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