From Zero-Dose to Protected: Thousands of Communities Reconnected
merf-pakistanIn 2019, the union councils MERF now serves were among the most difficult places in Pakistan to vaccinate a child. Coverage for core antigens sat between 72% and 79% -leaving roughly one in four children exposed. These SHRUCs were characterised by chronic vaccine refusals, high population mobility that caused children to fall off tracking systems, and deep-seated mistrust of health workers who arrived only for short, campaign-style vaccination drives and then disappeared.
With support from Gates Foundation, MERF took on management of 15 civil dispensaries embedded permanently within these communities. The strategic shift was deliberate: rather than treating immunization as an isolated campaign activity, MERF folded routine EPI services into a full primary healthcare offering -free OPD consultations, essential medicines, and maternal and newborn care – so that a family visiting for a fever, an antenatal check-up, or a malnourished child would also, in the same visit, be screened, registered, and vaccinated.
This integration proved to be the turning point. As OPD consultations climbed from 40,013 a month in May 2021 to 186,434 by July 2026, each visit became a touchpoint for the immunization team. Community-based mobilizers worked alongside clinical staff to trace zero-dose children door to door, ultimately reaching 31,939 of them, while dedicated counselling teams sat with hesitant families to address their concerns directly -converting 14,990 refusals into acceptance. A parallel defaulter-tracing effort brought 198,803 children who had missed scheduled doses back into the system.
The result, measured against the 2019 baseline, is a set of coverage gains rarely seen at this scale in high-risk settings: OPV-0 coverage rose 28 percentage points to 100%, Pentavalent-III rose 24 points to 98%, IPV-1 rose 30 points to 103%, and MR-1 rose 16 points to 95%. Fully immunized children coverage rose from 81.3% to 83.0% between monitoring rounds -a meaningful gain in a population where every additional percentage point represents real children newly protected against preventable disease, including polio.
These gains did not come from immunization services alone. Maternal and newborn health improved in step: 173,258 antenatal consultations and 53,349 postnatal consultations were delivered, and 1,627 women delivered safely at MERF’s two BEmONC sites at Model EPI and Toor Baba. Nutrition teams screened 184,077 children, catching severe acute malnutrition early in 6.8% of cases and linking them to treatment. And across the wider community, 82,532 SBCC awareness sessions -reinforced by 1,084 focus group discussions and 333 school-based creative activities -reached 907,084 people with health messaging designed to normalise vaccination and routine care.
Perhaps the most telling number is not a coverage percentage but a satisfaction score: 91.3% of patients leaving MERF’s facilities report being satisfied with their care, and 90% say they would recommend the facility to others. In communities that once viewed health workers with suspicion, that is the real measure of what has changed -trust has been rebuilt, one consultation at a time, and with it, some of the country’s hardest-to-reach children now stand protected.
Key Achievements (2021–2026 Reporting Period)
The table below reproduces the full set of programme indicators tracked across the reporting period, consolidated from routine monitoring records of the 15 civil dispensaries.
| Indicator (2021–2026 reporting period) | Result | Notes |
| TPVICs Fully immunized children | 81.3% → 83.0% | Round 3 → Round 4 |
| OPV-0 coverage (2019 vs 2026 – Jan–Jul) | 72% → 100% | (28% ↑) |
| Pentavalent-III coverage (2019 vs 2026 – Jan–Jul) | 74% → 98% | (24% ↑) |
| IPV-1 coverage (2019 vs 2026 – Jan–Jul) | 73% → 103% | (30% ↑) |
| MR-1 coverage (2019 vs 2026 – Jan–Jul) | 79% → 95% | (16% ↑) |
| OPD consultations | 1,506,762 (↑) | 40,013 → 186,434 (May 2021 → Jul 2026) |
| Zero-dose children reached (May 2021–Jul 2026) | 31,939 | ↑ trend |
| Refusals converted to acceptance (May 2021–Jul 2026) | 14,990 | ↑ trend |
| Defaulters vaccinated (May 2021–Jul 2026) | 198,803 | ↑ trend |
| ANC-1 to ANC-4+ consultations (May 2021–Jul 2026) | 173,258 total | – |
| Safe deliveries (2 BEmONC sites) (as of Sep 2026) | 1,627 | Model EPI → 930, Toor Baba → 697 |
| PNC consultations (1st & 2nd visits) (May 2021–Jul 2026) | 53,349 | – |
| Children screened for malnutrition (May 2021–Jul 2026) | 184,077 | SAM rate 6.8% |
| SBCC awareness sessions (May 2022–Jul 2026) | 82,532 sessions | 907,084 people reached |
| Focus Group Discussions (May 2024–Jul 2026) | 1,084 | – |
| School Based Creative Activities conducted | 333 | – |
| Patient satisfaction (Exit Survey) | 91.3% satisfied | 90% would recommend |
1. Closing the Immunization Gap
Coverage for all four tracked antigens has climbed decisively above the 2019 baseline. OPV-0 coverage reached 100% of target, Pentavalent-III 98%, IPV-1 103%, and MR-1 95% -gains of 16 to 30 percentage points. Coverage figures at or above 100% reflect denominator/target-population estimation common in EPI reporting, and signal that the programme is now reaching essentially the full eligible birth cohort in these union councils, not merely a growing share of it.
Figure 1. Antigen-specific coverage, 2019 vs 2026 (Jan–Jul), against 2019 baseline.
2. A Health System People Actually Use
Monthly OPD consultations grew from 40,013 in May 2021 to 186,434 in July 2026 -a 366% increase -cumulating to over 1.5 million consultations across the reporting period. This is the clearest single indicator that communities in these SHRUCs now see MERF’s civil dispensaries as their default, trusted point of care rather than a service to avoid.
Figure 2. Monthly OPD consultation volume, May 2021 → July 2026.
3. Turning Resistance into Acceptance
Behind the coverage numbers is a harder-won achievement: direct engagement with the families most resistant to vaccination. Community teams reached 31,939 zero-dose children who had never received a single vaccine, converted 14,990 outright refusals into acceptance, and traced and vaccinated 198,803 defaulters who had fallen off the immunization schedule. Together these figures represent the demand-side work that made the supply-side coverage gains possible.
Figure 3. Community engagement outcomes, May 2021 – July 2026.
4. Strengthening the Wider PHC & MNCH Platform
Because immunization is delivered as part of an integrated PHC package, gains extend across maternal and child health. The programme logged 173,258 antenatal (ANC-1 to ANC-4+) consultations, 53,349 postnatal (PNC) consultations, and 1,627 safe deliveries across its two BEmONC sites (930 at Model EPI, 697 at Toor Baba). Nutrition screening reached 184,077 children, identifying a severe acute malnutrition (SAM) rate of 6.8% for referral and treatment.
Behaviour-change communication has been central to sustaining these gains: 82,532 SBCC awareness sessions reached 907,084 people, complemented by 1,084 focus group discussions and 333 school-based creative activities that engage the next generation directly. Patient satisfaction now stands at 91.3%, with 90% of exit-survey respondents saying they would recommend the facility -strong evidence that trust, not just access, has been rebuilt.
Trend Forecast: Where the Trajectory Leads
Projecting the observed 2019–2026 trend forward on a linear basis, average coverage across the four tracked antigens -currently at 99.0% -is on track to approach and sustain levels of 100–105% through 2027–2028, placing these SHRUCs consistently inside the high-coverage / herd-immunity zone (≥95%) that is critical for interrupting poliovirus transmission. This projection is illustrative rather than a guarantee: sustaining it will depend on continued financing, retention of community mobilizers, and continued success converting the residual pool of hesitant and mobile families.
Figure 5. Linear trend forecast of average antigen coverage, 2019–2028.
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