The Mainstream Project in Malawi used embedded implementation research to strengthen immunization systems and improve equitable vaccine coverage, focusing on zero-dose children and HPV vaccination. Through three district-level studies, the project showed that geospatial and modelling approaches can effectively identify zero-dose hotspots, simple screening tools can support routine identification of unvaccinated children, and integrated service delivery models are needed to reduce missed HPV vaccination opportunities. Overall, the findings emphasize evidence-based decision making, community engagement, service integration, and stakeholder commitment to translate research into policy and practice for improved immunization outcomes in Malawi.
