Exploring gender-intentional implementation of Digital Health Information for Immunization in Ethiopia.

Despite growing investment in digital health for immunization, there is limited evidence on how gender is considered into design and implementation. In 2022, Ethiopia launched a Gender-intentional Digital Health Information Roadmap with the support of Gavi, the Vaccine Alliance; however, the operationalization of gender strategies remains unclear. This qualitative study explored gender inclusiveness in digital health for immunization in Ethiopia, drawing on document reviews, participatory workshops, key informant interviews, and stakeholder analysis across selected three regions in Ethiopia. Findings revealed that women dominate frontline roles as caregivers and vaccinators but remain underrepresented in supervisory, leadership, and digital system development positions. Although gender strategies and units exist, implementation is weak, with limited gender awareness and no intentional planning. In addition, a notable gender digital divide persists. Senior leadership role assignments, despite competence, depend on ability for women to balance responsibilities and travel with household duties. The routine health data systems, like District Health Information Software, version 2, lack sex-disaggregated immunization data, hindering gender-informed decision making. Enabling factors include national prioritization of gender equity, empowerment programs, and partner support, whereas barriers include cultural norms, inadequate advocacy, weak accountability, and insufficient resources. Embedding gender-transformative approaches is vital for equitable, inclusive digital health information and associated health system and immunization outcomes in Ethiopia.