CHAPTER 3: RESULTS The results are presented in two sections; the first part is based on the health system, socio-economic, access and cultural factors (variables) that affect immunization services, the summarized analysis (see annex V, figure 1) and the second part focuses on innovative practices available to improve vaccination in Benin, Burkina and Ivory Coast.3.1.2 Factors linked to the health system. The majority of policymakers cited vaccine stockouts or occasional stockouts as the main factor causing mothers to miss the immunization schedule. Participants at the health center level identified the lack of equipment and its maintenance as an obstacle to the provision of outreach services, for example lack of fuel for outreach services and lack of equipment (motorcycles). A surprising notion that was also mentioned at the health center level was the long wait. times. When mothers travel long distances and wait for a long time at the health center due to health staff commitment or lack of staff, they are unlikely to return for future services. 3.1.3 Socio-economic factors. Social factors have been identified as primarily related to demand for services. immunization. Even though vaccination services in all three countries are free at the point of contact. However, a health center staff member pointed out that “there is a hidden cost that families pay to receive immunization services. The cost of purchasing the “route to health” vaccination card and the transportation costs to get to the vaccination were associated with poor attendance at the vaccination session. Ignorance was also another factor mentioned by policymakers: “mothers are not aware of the need to get vaccinated and they may not know the actual dates of the next appointment...... middle paper ......ted. Local political and religious leaders are involved in order to gain support from the community in which they are involved, with the aim of instilling local ownership and empowerment of health services, including immunization services, in order to to ensure that every child is vaccinated. Communications about the availability and timing of vaccination services are also announced in churches. 3.2.7 Flexible schedule of vaccination services. The flexible schedule was mentioned as one of the innovative solutions to improve vaccination. Apart from routine vaccination on specific days, specific communities and locations are targeted for vaccination. The choice of the targeted location is based on an analysis of the situation to know who the cases are, where and why are not vaccinated. Markets are one of the places where children are targeted for the provision of immunization services.