Routine Childhood Immunization: Pictorial Education Cards for Caregivers

A series of educational cards promoting childhood immunization among caregivers in Mozambique

Despite progress over the last decade, many children in Mozambique who start routine immunizations do not complete them. Our collaborators at VillageReach have worked with the Mozambique Ministry of Health, local health authorities, health workers, and community members on strategies to help reduce childhood immunization drop-out rates in the rural Zambézia Province. In 2022, Digital Medic joined this project to support the development and design of an immunization education solution.

Learn more about the VillageReach ‘Bate-Papo Vacina! (Let’s talk about vaccines)’ project.


According to the World Health Organization, 25 million children worldwide did not complete their recommended immunizations in 2021. In Mozambique’s Zambézia Province, a 2019 study found that nearly 20% of children who begin routine immunizations don’t complete the schedule.

This drop-off in immunization against dangerous but preventable diseases like polio, diphtheria, tetanus, and pertussis poses a serious threat to children’s health. However, caregivers in Mozambique encounter numerous challenges along the immunization journey, such as negative experiences at health facilities and a lack of clear information about vaccines.


VillageReach conducted community-based participatory research to further understand the barriers faced by caregivers and to identify potential community-driven solutions. Photovoice data collected in the Gile and Namarroi districts provided a nuanced understanding of what drives under-two immunization dropouts. To identify a solution to the findings, we held two human centered design (HCD) ideation workshops. With input from the provincial health department, it was determined that pictorial cards accompanied by community health worker (CHW) training could make a difference. 

Continuing the HCD process, VillageReach and Digital Medic created a series of engaging informational cards through an iterative process of prototyping and gathering feedback from caregivers and health officials. The cards cover topics like the value of vaccines in protecting a child from life threatening diseases, routine childhood immunization schedules, vaccine side effects and how to treat them, and how others in the family and community can support a child to be fully vaccinated.


Local health workers are distributing the cards to caregivers during one-on-one and group education sessions. Larger poster-sized versions of the cards are also available for display in healthcare facilities. As of December 2022, health workers have distributed over 400 cards to caregivers and held 118 education sessions. In initial surveys, health workers noted that the educational cards have increased engagement and questions from caregivers.

Read more in this case study: Driving a people-centered approach to expand immunization coverage in Zambézia, Mozambique

Routine Childhood Immunization: Pictorial Education Cards

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