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Overview
The Choti Khushi Immunization Incentive Program is a government-supported initiative designed to increase routine immunization uptake among children under 2 years of age in underserved communities across Sindh, Pakistan. Led by the Government of Sindh with technical assistance from IRD, the program combines digital tracking through the Zindagi Mehfooz Electronic Immunization Registry (ZM-EIR) and mobile-based conditional cash transfers (mCCTs) to reduce demand-side barriers and promote timely, complete vaccination. The Choti Khushi Immunization Incentive Program launched in January 2022 with a phased rollout across seven high-risk districts.
115,836
total visits completed
76,070
newborns enrolled
39,766
follow-up visits completed
37,821
newborns registered
Our Partners
- Sindh Health Department
- EPI Sindh
- GiveWell
The Need
The Need
Persistent low and delayed coverage
Despite free vaccines for over 40 years, Pakistan continues to report low and delayed immunization uptake. Of the 19.5 million children globally who missed the third pentavalent dose in 2016, nearly 1.4 million (7%) were in Pakistan.
Demand-side barriers
Families in urban slums, remote rural areas, and hard-to-reach districts face financial constraints, transportation costs, lack of awareness, and limited access to services, limiting their ability to complete vaccination schedules.
Equity gap
These systemic barriers disproportionately affect marginalized populations, contributing to preventable disease outbreaks and widening health inequities. An innovative approach that addresses both behaviour and access is essential.
Our approach: Delivery
IRD, designed and supports the Choti Khushi Immunization Incentive Program to strengthen immunization demand and completion using:
- Digital enrollment and tracking: Children aged 0–23 months are registered in the Government of Sindh’s Zindagi Mehfooz Electronic Immunization Registry (ZM-EIR), enabling real-time monitoring of immunization status and visit compliance.
- Mobile conditional cash transfers (mCCTs): Caregivers receive small cash incentives via mobile money upon timely completion of scheduled vaccine visits, helping offset transportation costs and motivating return visits.
- Targeting high-risk geographies: The program operates in seven low-coverage districts — Karachi Central, Karachi East, Karachi West, Kambar, Hyderabad, Jacobabad, and Sujawal.
- Government-led delivery: Implemented through existing EPI infrastructure across 464 immunization centers and 1,121 vaccinators; IRD supports planning, digital systems, training, community mobilization, and monitoring.
Our Reach
- Launch: January 2022, with phased rollout across seven high risk districts.
The Drivers Behind Our Impact
The Drivers Behind Our Impact
Evidence-driven and behaviour-focused
Built on over a decade of research on incentives and behavioural change to improve immunization uptake.
Bridging access and equity gaps
Conditional cash transfers help caregivers overcome financial and logistical barriers to vaccination.
Leveraging existing health systems
Uses government vaccinators, EPI centers and infrastructure, reducing parallel systems and supporting long-term adoption.
Scalable and adaptable
The digital incentive model can be extended to additional districts, provinces, and other health services.