This study from the Bangladesh Country Learning Hub evaluates innovative strategies to identify and reach children in missed communities—including hard-to-reach coastal, hilly, and urban slum areas. Using a quasi-experimental design, researchers from icddr,b, Jhpiego, and partners provide a roadmap for scaling high-impact, cost-effective immunization services within existing health systems.

Key Insights from the Research

• Tailored Interventions Work: Strategies such as evening sessions for working mothers in urban slums and "crash programs" in remote island and char communities reached children who were previously invisible to the health system.
• Cost-Effective: The program averted 566 DALYs (Disability-Adjusted Life Years) with an incremental cost-effectiveness ratio (ICER) of only $442 USD per DALY averted, making it a viable investment for national scale-up.
• Proven Impact: The interventions resulted in a net reduction in the prevalence of zero-dose and under-immunized children, specifically increasing Penta-3 coverage in intervention areas.
• Scalability: By leveraging existing health structures and human resources, the IRMMA framework demonstrated strong potential for sustainable integration into the national EPI platform.

Explore the detailed evaluation of area-specific strategies, barriers to coverage (such as vaccine and human resource shortages), and qualitative process evaluation results in the implementation research report. 

Access the findings from the economic evaluation to review the activity-based micro-costing analysis, area-specific cost variations (ranging from $24 to $398 per child reached), and the full cost-effectiveness data supporting strategic investment decisions.