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A story of Bihar and Uttar Pradesh to bring urban communities with pockets of unimmunized children into a problem-solving process to make a difference.

Authored By: 

• Dr. Ajay Gupta, State Immunization Officer, Directorate of Health and Family Welfare, Uttar Pradesh
• Dr. Sharda Prasad Veenayak, State Immunization Officer, State Health Society, Bihar
• Amrin Fatma, Research Officer, John Snow India, New Delhi
• Dr. Ayushi Agrawal, Project Director, Urban RI, John Snow India, New Delhi

India has made remarkable progress in reducing the number of zero-dose children (that is, children who have not received even their first dose of the basic diphtheria, tetanus and pertussis vaccine). As the country moves closer to reaching every child, the challenge is increasingly about reaching those who remain unreached. Doing so requires solutions that are responsive to local realities, because the reasons children are missed can vary considerably across communities and households. In this context, we are sharing our experience of applying a “Learning by Doing” approach in urban areas of Bihar and Uttar Pradesh, an approach that combined human-centred design with continuous learning to understand local barriers, co-create potential solutions, and adapt them as implementation unfolded.

We mapped out potential solutions by co-creating with caregivers of zero-dose children, frontline health workers, and government stakeholders. These interventions were then tested, refined, and adapted based on ongoing implementation experiences and feedback. 17�Թ��� approach was structured around three phases: Define, Design, and Deliver (3D).