The Borno State Immunization Accountability Scorecard 2024, developed by the Africa Health Budget Network and the African Field Epidemiology Network under Gavi’s Zero-Dose Learning Hub, provides a critical assessment of the state's progress in routine immunization financing and service delivery. Using a traffic-light scoring system, the report highlights a significant positive trend in health sector investment, with the approved health budget allocation rising from 8.52 percent in 2023 to 14.4 percent in 2024. However, the scorecard reveals deep-seated challenges in vaccine retention and financial sustainability. A critical dropout rate of nearly 50 percent between Penta 1 and Penta 3 vaccines underscores a major gap in service completion. Additionally, despite budget increases, actual quarterly releases for primary healthcare activities remained low at 21.7 percent. The report calls for urgent action from state level civil society organizations and the Community of Practice to advocate for a minimum 75 percent budget release to ensure every zero-dose child in Borno’s security-compromised areas is protected.