Collaboration: measuring trust around referral & paracetamol provision interventions

Impetus is a strategic consulting organization in Pakistan that specializes in evidence-based solutions to complex development challenges. Working across public, private, and non-profit sectors, the organization combines local expertise with global best practices to design and implement effective programs.

In Sindh, Impetus works in close collaboration with the provincial government to improve immunization coverage through a range of interventions within the Expanded Programme on Immunization (EPI). These efforts span service delivery, demand generation, and data systems strengthening, with a focus on reaching underserved populations and building long-term trust in public health services.

Among these initiatives are two trust-centered interventions currently being implemented in high-priority areas of Karachi.

The first is part of the Zero-Dose Learning Agenda (ZDLA), which seeks to reach children who have never received routine immunizations. Impetus co-developed and now supports implementation of two key strategies: (1) collaborating with local private health providers to act as trusted immunization touchpoints, and (2) engaging traditional birth attendants (TBAs) to counsel mothers during and after home births on the importance of timely vaccination. These strategies were designed through a participatory process with communities and are delivered in partnership with district and local health actors.

The second intervention addresses post-vaccination concerns – specifically, fear of adverse effects like fever – by supporting EPI facilities to offer caregivers both paracetamol and educational materials at the time of vaccination. This approach is designed to increase completion rates for multi-dose vaccines, particularly Pentavalent, which has historically seen high dropout.

We’re currently working with Impetus to measure how both interventions affect caregiver trust—both in vaccines and in the health system more broadly. Together, we aim to generate learnings on how trust-centered approaches can improve immunization uptake—and to provide evidence on what works when trust is both the means and the outcome.