Skip to main content

Pro-Equity Evidence Map

Photo: FHI 360

Reaching the underserved with immunization: map of pro-equity interventions.

View evidence map

FHI 360, supported by Gavi, the Vaccine Alliance, has reviewed and synthesized relevant evidence for a collection of pro-equity interventions, with a focus on their effectiveness and implementation considerations for reaching zero-dose children and missed communities across the world. Equity is the organizing principle of the Alliance’s 2021-2025 strategy, whose vision is to leave “no one behind with immunization.” A pro-equity intervention is any targeted or tailored strategy designed to reach populations or communities facing vulnerabilities. Zero-dose children are those who have not received any routine vaccine. For operation purposes, Gavi measures zero-dose children as those who have not received their first dose of diphtheria-tetanus-pertussis containing vaccine (DTP1). Missed communities are population groups that face multiple deprivations, including systematic constraints on their access to immunization and other essential health services. These may include socio-economic inequities such as gender-related barriers. Often the presence of zero-dose individuals, populations, or disease outbreaks are signals for missed communities as they are inextricably linked.

Logo for FHI 360

IRMMA Framework

This collection of evidence briefs summarizes the evidence on how effective each pro-equity intervention is at identifying, reaching, monitoring and measuring, or advocating (IRMMA) for missed communities or those facing vulnerabilities and details any available implementation considerations. Each topic falls into a different category of the IRMMA framework (see graphic below). Particular attention was paid to the distinctive considerations required for different equity reference group (ERG) settings (conflict, gender-related barriers, remote rural, and urban poor), as each environment is characterized by unique challenges and opportunities.

Graphic showing the IRMMA Framework

Evidence Map

Our Evidence Map (below) is a guide to the different types of interventions and the existing research relevant to reaching zero dose children, missed communities and populations facing vulnerabilities. Evidence briefs on each topic are linked within the evidence map. Peer-reviewed research and grey literature are organized by topics (rows) and evidence categories (columns). Click on a bubble on the map to see the list of relevant publications; then, click on a title to read the article. Click on the title of the topic in each row to view the corresponding evidence briefs.

Map Key

To be included in the evidence briefs, studies had to meet certain inclusion criteria and topic definitions that are outlined in each brief. The size of the bubble corresponds to the number of existing studies or programs that were identified for each topic. The color of the bubbles in the effectiveness columns corresponds to the effectiveness category:

Red: Potentially ineffective
Grey: Inconclusive
Yellow: Promising
Green: Proven
Blue: Not Available
Evidence BriefsReviewsEffectivenessImplementation in Equity Reference Group (ERG) Settings
 Evidence from Existing Reviews (From Immunization and Other Fields)Evidence of Effectiveness (From Immunization and Other Fields)Urban PoorRemote RuralConflictGender BarriersOther (Not Specific to ERG Settings)
Campaign Integration (PDF, 2.72 MB)
Incentives for Users (PDF, 2.82 MB)
Leveraging Women's Groups (PDF, 2.79 MB)
Measure & Monitor  
Supportive Supervision (PDF, 2.69 MB)
Targeted Surveys (PDF, 2.7 MB)
Social Accountability (PDF, 2.69 MB)
Microplanning (PDF, 2.74 MB)

The intervention topics varied in terms of definition, scope, and outcomes to answer specific research questions about the effectiveness and implementation considerations of each intervention. A methods document (PDF, 630 KB) summarizes the process used to complete the literature searches and the approach used to classify intervention effectiveness and implementation.

The slide deck (PDF, 1.98 MB) also presents an overview of the methods, results, and conclusions from the evidence syntheses.

For low-bandwidth versions of the briefs, please click on the links below:

  1. Surveillance to Identify Zero-Dose (ZD) Evidence Brief (PDF, 422 KB)
  2. Geographic Information Systems (GIS) Mapping Evidence Brief (PDF, 635 KB)
  3. Integrated Campaigns Evidence Brief (PDF, 404 KB)
  4. Financial Provider Incentives Evidence Brief (PDF, 418 KB)
  5. Nonfinancial Provider Incentives Evidence Brief (PDF, 382 KB)
  6. User Incentives Evidence Brief (PDF, 527 KB)
  7. Leveraging Women Groups Evidence Brief (PDF, 499 KB)
  8. Community Groups and Community Health Workers (CHWs) Evidence Brief (PDF, 372 KB)
  9. Community-Based Monitoring Evidence Brief (PDF, 419 KB)
  10. Supportive Supervision Evidence Brief (PDF, 567 KB)
  11. Targeted Surveys Evidence Brief (PDF, 399 KB)
  12. Social Accountability Evidence Brief (PDF, 449 KB)
  13. Microplanning Evidence Brief (PDF, 533 KB)