Unveiling and addressing implementation barriers of vaccination communication strategy: Perspectives from government officials at national and provincial levels.

Communication strategy is one of the support of primary health care (PHC) that can address demand-side barriers and socio-cultural factors to promote better services. Conversely, communication strategies have not been a distinct emphasis of vaccination research in the country until now. Therefore, this study aimed to find the elements that influence the provision of vaccination communication in Pakistan. Twenty-two semi-structured interviews with key stakeholders in vaccine communication were conducted using qualitative methodologies (Jan 2022-March 2022). The interviews revolved around factors affecting the implementation of communication. Interviews were transcribed and analyzed using thematic analysis. By using the SURE framework, numerous factors that affect vaccination communication were identified under three major themes such as organizational-level, constitutional, and community-level factors. Five subthemes marked the organizational-level factors such as constrained budget, infrastructure deficits, inconsistent comprehensive strategy, health workforce, and inadequate training. Two subthemes are derived regarding constitutional and community-level factors, respectively, such as governance and leadership, health communication interventions not a policymaker's priority, community perceptions and practices, and formal partnership lacking between national and local stakeholders. Additionally, employment of established communication committees, improved money allocation, engagement of traditional and religious institutions, and political backing were identified as solutions for improvement. Communication activities are an important part of immunization programs in order to increase vaccination coverage. To be able to execute communication interventions more successfully, national and provincial stakeholders must work together to identify the elements that affect vaccine provision. Additional rigorous implementation studies could aid in the development of clearer knowledge of the system-wide constraints obstructing the program's efficiency.