This report evaluates strategies implemented between March 2024 and August 2025 to reach zero-dose (ZD) children in Uganda’s Wakiso, Kasese, and Mubende districts. While the general ZD burden in study communities dropped from 12.7% to 6.5%, progress was primarily driven by routine immunization rather than targeted campaigns. Key findings include:

• Persistent Barriers: Vaccine stockouts, long wait times, poor data quality, and geographic isolation hinder identification and vaccination.
• Social Drivers: Restrictive gender norms, poverty, and religious beliefs continue to disconnect families from available services.
• Effectiveness: Only 9.3% of baseline ZD children were reached during the intervention period. However, interpersonal communication, home visits, and spousal support showed significant promise in building trust.
• Costing: Identifying a ZD child averages US$3.07, while vaccinating one costs approximately US$14, with costs rising in hard-to-reach areas.

Meaningful progress requires shifting from uniform, centrally designed approaches to strategies grounded in community realities. Future success depends on stronger governance, improved data systems, and active community engagement at every stage of service delivery.