We conducted qualitative and quantitative research on the perception and attitudes of women of childbearing age and mothers towards vaccination and also the challenges faced by healthcare workers in delivering the national vaccination programme before and after the COVID-19 pandemic. This involves:

• Surveys
• in-depth interviews
• key informant interviews
• focus group discussions

Participants are:

• mothers with children under 2
• pregnant women
• women aged 15-35
• healthcare workers at the provincial, district, commune, and village levels.

Our questions include those about vaccination uptake, the purpose of vaccination, as well as about other health-related behaviours of the target population, and the availability of health services within the local area.

Key findings of the research:

• Most community members are aware of the benefits of vaccines and the vaccination schedule and express positive attitudes toward vaccination.
• Ethnic mothers have several structural barriers in accessing vaccination such as lack of transportation or driving license or difficulties taking work absences to take children to vaccination.
• Vaccine adverse reactions are a critical concern that can result in vaccination delays or dropouts; this can be addressed by increased direct communication from local healthcare providers and mutual reassurance among the community members.
• Within all ethnic minority groups in the province, there are some marginalised groups who are particularly socio-economically disadvantaged. These groups have a significantly lower vaccination uptake, access, and involvement in other healthcare activities. Local health providers in these communes also face considerable challenges in increasing vaccination rates.
• Village health workers are essential gatekeepers for encouraging and maintaining community vaccine uptake. However, they reported receiving limited training for their healthcare promotion work. This means they have difficulties communicating with their community members. Furthermore, the relatively few benefits they receive in compensation for their work may decrease their motivation and dedication to continue this healthcare role.
• Increased community engagement activities to promote vaccination may help increase the uptake of vaccine-hesitant members. This can include house visits and collaborative involvement of other community staff,
• Government responses to the Covid-19 pandemic, including national lockdown and strict movement restrictions, decreased routine immunisation coverage during 2020-2021. Intensive Covid-19 vaccination efforts have also placed more pressure and workloads on local healthcare providers, which may have an adverse impact on their capacity to maintain childhood vaccine coverage.