Demand for immunization services is positively influenced (i.e. increased) by high levels of community awareness about immunization, which is in turn also enhanced by effective community mobilization, high literacy levels of mothers, media campaigns and the extent of health education activities. On the contrary, misconceptions about immunization reduce levels of community awareness about immunization, subsequently reducing demand for immunization services. In addition, whereas mothers’ availability increases demand for immunization, maternal family responsibility and low socioeconomic status can negatively affect their availability.

Furthermore, the quality and availability of health services can affect the demand for immunization services either positively or negatively. For example, availability of immunization services increases the number of children immunized, thereby increasing the herd immunity in the community, which reduces the risk of outbreaks of vaccine preventable diseases. This reduction in morbidities due to vaccine-preventable diseases contributes to an increase in confidence of the community in the immunization programmes, which subsequently increases the demand for immunization services. On the other hand, poor quality health services – for example lack of vaccines, long waiting hours, children developing abscesses after vaccinations etc., discourage mothers from bringing their children for immunization. This contributes to high drop-out rates and the proportion of unimmunized children in the community, leading to low immunity and an increased risk of outbreaks of vaccine-preventable diseases. The result is lost confidence in the health system, which contributes further to the reduction in demand for the immunization services.