Beyond the Clinic Gate: Barriers to Childhood Immunization Access and Strategies for Improvement at a Rural Zimbabwean Clinic

Background Childhood immunization through the Expanded Programme on Immunization (EPI) remains central to reducing vaccine-preventable disease morbidity and mortality in sub-Saharan Africa. Zimbabwe's national EPI coverage for pentavalent 3 stood at 83% in 2023, below the 90% global target. Nyaure Clinic in Goromonzi District, Mashonaland East Province, recorded coverage of 65%, 62%, and 67% for pentavalent 3 in 2021, 2022, and 2023 respectively. This study investigated factors affecting access to EPI services at Nyaure Clinic and identified strategies to improve coverage. Methods A quantitative cross-sectional survey design was used. The study population comprised 261 caregivers, 10 community health workers (CHWs), and 3 nurses in the Nyaure catchment area. A stratified random sample of 61 participants was selected using the Raosoft sample size calculator at a 90% confidence level. Data were collected in October 2024 using structured, self-administered questionnaires. Descriptive analysis was performed using Microsoft Excel and results are presented in tables and figures. Results Of 61 respondents, 95% were female. Among caregivers (n = 55), 96% reported receiving information about EPI, with 71% citing health facility workers as the primary source. Vaccines were reported as unavailable 14.36% of the time. Distance was identified as a barrier by 29% of caregivers and 100% of health workers. Religious and cultural beliefs, particularly among Apostolic sects, were identified as contributing to vaccine hesitancy. Poverty and political interference were not perceived as barriers. The leading strategies proposed by caregivers were outreach programmes (93%), health education (71%), and door-to-door vaccination (58%). All health workers (100%) endorsed outreach programmes, health education, door-to-door vaccination, building more clinics, legislation against vaccine hesitancy, and CHW recruitment as improvement strategies. Conclusions Distance, religious and cultural beliefs, intermittent vaccine shortages, and the absence of legislation penalising vaccine hesitancy are the primary barriers to EPI access at Nyaure Clinic. Intensified outreach programmes, health education, door-to-door vaccination, and policy reform are needed to improve coverage. These findings have implications for EPI programme managers, district health teams, and policymakers across rural Zimbabwe.