This case study describes JSI's approach to addressing inequity in immunization programming by working at the facility, district, and regional levels to implement quality improvement strategies. The three key strategies used included: 1) engaging community health programming to identify, target, and reach all children; 2) operationalize health system management processes by enhancing health workers' use and management of data to improve the reach and quality of immunization services; and 3) build health workforce capacity to plan, implement, and monitor immunization services. In addition to describing these strategies, this case study provides recommendations to strengthen the health system and primary healthcare workforce to identify, target, and reach the hardest-to-reach children.