Urbanization is rapidly occurring in cities in Africa and Asia. 54% of the world’s population lives in cities in 2017.
Some urban settings are poorer than many rural areas. High < 5 mortality due to inequitable access of the urban poor to health services including immunization. Urban population in Madagascar, on steady increase from 9,767,217 in 2019 to 11,145,504 in 2021(World Bank report, 2022). 4.5% increase annually in the urban population in Madagascar. 35% of children are zero dose & 67% of the population living in urban areas live in slums.The national immunization strategy 2022-2027 of Madagascar is equity enhancing. We explored potential strategies, challenges, or barriers and solutions to the implementation of urban vaccination in Madagascar.