Completed Research

Expanded Program on Immunization: Near-universal Childhood Vaccination Rates

University of Toronto

Geography, a large rural population and extreme poverty, compounded with the 1994 genocide, all contributed to the challenges facing widespread childhood vaccinations. Rwanda scaled up its immunization program and other health and development programs to meet the Millennium Development Goals. Despite its geographic and historic barriers to improving child mortality outcomes, its immunization program clearly demonstrates effective reach.

The Hard to Reach

Geographically hard to reach and impoverished children in Rwanda.

Key Takeaways

In 2015, Rwanda’s Expanded Program on Immunization reported a 98 per cent child immunization rate for vaccinations. This childhood vaccination rate outperforms Rwanda’s regional neighbors and emphasizes the country’s interest in health equity.

  1. Rwanda’s immunization success is driven by strong, centralized leadership and decentralized implementation. An accountability system reinforces the central government’s commitment to service delivery through the many levels of decentralized implementation.
  2. Rwanda effectively uses data analysis to support the implementation of its immunization program. The country’s health management information system is largely electronic and collects vaccination data from the village level in real time. This supports timely analysis and action based on the data.
  3. Rwanda effectively harnesses community health workers to collect community health data – then uses the data to target supportive supervision at the national level – and are integral in educating their communities about vaccinations and in following up to ensure there are no missed cases.


This research was made possible through the Reach Alliance, a partnership between the University of Toronto’s Munk School of Global Affairs & Public Policy and the Mastercard Center for Inclusive Growth. Research was also funded by the Canada Research Chairs program and the Ralph and Roz Halbert Professorship of Innovation at the Munk School of Global Affairs & Public Policy. We express our gratitude and appreciation to those we met and interviewed in Rwanda, specifically those in government, the health services field, international and local NGOs, and all others who contributed to the important process of child vaccination in Rwanda. We also deeply value the continued support and guidance of the Ministry of Health through Rwanda Biomedical Center. Your work and dedication are inspiring.

This research was vetted and received approval from the Ethics Review Board at the University of Toronto.