Reaching every child in India’s expanding cities: Urban immunization through partnerships and WHO frameworks

Rapid urbanization presents one of the most complex challenges for immunization programmes. In Gautam Budh Nagar district of Uttar Pradesh-part of India's fast-growing National Capital Region-population mobility, informal settlements, and fragmented urban services have made it difficult to identify and reach every eligible child. Migrant families and residents of slum and peri-urban areas are especially vulnerable to being missed by routine immunization systems.

Despite ongoing efforts, immunization coverage in many urban pockets of Gautam Budh Nagar had stagnated. Nearly half of urban areas lacked dedicated mobilizers to identify beneficiaries, resulting in incomplete household headcounts and weak micro-planning. Fragmented service delivery and unreliable population data further limited the district's ability to accurately plan and deliver immunization services.

A partnership-driven solution

To overcome these barriers, the district adopted an innovative public-private partnership (PPP) approach, engaging five local nursing colleges to strengthen beneficiary enumeration and data accuracy in urban areas. Approximately 300 nursing students were mobilized and deployed across urban clusters to conduct structured, door-to-door household surveys, systematically covering clearly defined population units.

The initiative was anchored in strong district leadership. Sensitization meetings with district authorities ensured administrative backing, clarified roles, and facilitated smooth coordination between public health teams and academic institutions. The involvement of nursing colleges not only expanded the available workforce but also introduced motivated, trained personnel who could engage effectively with communities.

WHO technical facilitation at the core

The WHO-National Public Support Network (NPSN) team played a central technical role in guiding implementation. WHO supported the design of standardized data-collection tools, trained nursing students on immunization concepts and survey methodologies, and strengthened community engagement approaches. Emphasis was placed on alignment with WHO immunization frameworks to ensure data quality, ethical engagement, and integration with routine immunization systems.

Field supervision and training sessions led by WHO-NPSN in Gautam Budh Nagar district, Uttar Pradesh
Photo Credit: WHO/India/Virender Kumar

By applying WHO standards, the initiative transformed raw field data into usable inputs for micro-planning-helping health workers better estimate target populations, plan sessions, and allocate resources in densely populated and highly mobile urban settings.

Nursing students conducting door-to-door surveys in urban settlements
Photo Credit: WHO/India/Om Prakash

Survey teams engaging with the community living in migrant clusters
Photo Credit: WHO/India/Virender Kumar

Results that reshaped urban planning

The impact of the initiative was immediate and substantial. Survey teams covered more than 115,000 households, identifying over 14,500 children and 1,100 pregnant women-nearly three times higher than previous estimates. This dramatic increase exposed the extent to which urban populations had been underestimated.

Improved enumeration translated into action. In high-migration areas, immunization coverage increased by more than 10%, demonstrating how accurate data and targeted planning can rapidly improve service delivery. Health authorities now had a clearer picture of where missed children lived and how best to reach them, strengthening overall urban immunization performance.

Lessons for reaching the unreached

The experience from Gautam Budh Nagar highlights several critical lessons. First, urban immunization challenges require locally adapted, integrated solutions that address workforce shortages, data gaps, and community trust simultaneously. Second, academic institutions can be powerful partners, offering skilled human resources while fostering public health engagement among future health professionals. Finally, WHO frameworks provide the structure needed to ensure that local innovations are systematic, scalable, and aligned with global best practices.

As India continues to urbanize, experiences like this demonstrate that with the right partnerships and technical guidance, cities can move closer to the goal of reaching every child with life-saving vaccines-no matter where they live.