Analysis of factors influencing community participation in the administration of vaccination activities in the health district of Tône in Togo in 2024

Background: Limited community involvement remains a major challenge to achieving full immunisation coverage in sub-Saharan Africa. In Togo, despite multiple strategic efforts under the Expanded Programme on Immunization (EPI), vaccination coverage remains suboptimal, with a growing proportion of zero-dose children. Aim: This study aimed to analyse the barriers to community involvement in childhood immunisation activities in the Tône health district of Togo in 2024. Setting: The study was conducted in the Tône health district, located in northern Togo, characterised by both rural and semi-urban settings with heterogeneous geographic accessibility to health facilities. Methods: A qualitative exploratory study with a cross-sectional design was conducted from November 2023 to September 2024. A purposive sampling strategy was used to recruit 112 participants, including parents, community health workers, religious and traditional leaders, health officials and local authorities. Data were collected through individual interviews and focus group discussions and analysed thematically using NVivo14. Results: Barriers were grouped into three main domains: (1) administration of immunisation services (ignorance, poor reception, fear of adverse events following immunisation, vaccine stock-outs, long waiting times, distance to facilities and traditional practices); (2) social mobilisation (low awareness, lack of incentives, social media influence and limited collaboration); and (3) community financing (poverty, low income and transport costs). Conclusion: Community involvement in EPI remains constrained by intertwined sociocultural, institutional and economic barriers. Contribution: This study provides contextual evidence to inform targeted communication strategies and community-based interventions aimed at improving immunisation uptake in fragile settings.