Immunization Coverage in Nepal by Province & District (DoHS Data)

Nepal runs one of South Asia's oldest routine childhood vaccination programmes, the National Immunization Programme (formerly the Expanded Programme on Immunization, or EPI), coordinated by the Family Welfare Division under the Department of Health Services (DoHS), Ministry of Health and Population (MoHP). Every year the DoHS publishes an Annual Health Report drawing on the Health Management Information System (HMIS, hmis.gov.np), which aggregates facility- and campaign-level records reported from all 753 local units. These are 'administrative' coverage figures: doses given divided by an estimated target population of surviving infants.

Two headline indicators dominate the reporting. The Pentavalent 3 (Penta3) coverage rate is the share of infants who received the third dose of the pentavalent vaccine, which combines diphtheria-pertussis-tetanus (DPT), hepatitis B and Haemophilus influenzae type b (Hib); internationally this is the standard proxy (often written DPT3) for how well a routine system reaches children through the full infant schedule. The fully-immunized-child (FIC) rate is the share of children under one year (or 12-23 months, depending on the source) who received every antigen due before their first birthday.

Because these are the most-searched vaccination metrics for Nepal, it matters that administrative HMIS figures are cross-checked against independent household surveys. The Nepal Demographic and Health Survey (NDHS) 2022 and the Nepal Multiple Indicator Cluster Survey (MICS) 2024-25 both estimate coverage by interviewing mothers and inspecting vaccination cards, and both consistently return lower numbers than the DoHS administrative reports. This page presents both, because the gap between them is itself an important finding.

In the DoHS Annual Health Report, national administrative coverage is high. Penta3 coverage has sat in the low-to-mid 90s in percentage terms in recent fiscal years, and the FIC rate reported for FY 2081/82 (2024/25) was about 92.5 percent, with BCG at roughly 88 percent and a very low Penta1-to-Penta3 dropout of around 0.5 percent. Measles-rubella first-dose (MR1) coverage was reported at about 95 percent and second-dose (MR2) at about 93 percent in FY 2078/79 (2021/22), the level the programme targets for measles elimination (greater than 95 percent at every level).

Household surveys tell a more cautious story. The NDHS 2022 found that 80 percent of children aged 12-23 months had received all basic antigens (BCG, three doses of DPT/pentavalent, three doses of polio, and measles), and that about 4 percent had received no vaccination at all. The trend line has been bumpy: full basic coverage rose from 43 percent in 1996 to a peak of 87 percent in 2011, fell to 78 percent in 2016, and recovered only slightly to 80 percent in 2022. The MICS 2024-25, run by the National Statistics Office (NSO) with UNICEF, put basic coverage at about 81 percent, with roughly 1.7 percent of children receiving no vaccine and about 11 percent incompletely vaccinated.

The practical takeaway for researchers is that Nepal's 'true' childhood coverage is best read as roughly 80-81 percent (survey-based) even though administrative Penta3 and FIC figures print in the 90s. With about 400,000 births a year, even a single-digit shortfall means tens of thousands of under- or unvaccinated children annually - the pool from which measles and other outbreaks emerge.

The clearest, most defensible province-by-province comparison comes from the NDHS 2022, which measured the share of children 12-23 months fully vaccinated with basic antigens. Gandaki led the country and Madhesh trailed it by a wide margin - a persistent pattern across three successive DHS rounds, in which Madhesh has repeatedly shown the highest partial-immunization and lowest full-coverage rates. Notably, Bagmati - the wealthiest, most urban province - ranked mid-table rather than top, reflecting hard-to-reach zero-dose pockets in dense urban settlements.

The MICS 2024-25 broadly confirms the geography while shifting some ranks: Gandaki again posted the highest full coverage (about 95.5 percent), Lumbini around 89.8 percent and Madhesh around 87.3 percent, with Karnali lowest at about 81 percent. The MICS also found the sharpest unvaccinated ('zero-dose') concentrations in rural areas - rural Bagmati had the highest share of children with no vaccine at about 4.6 percent, and rural Lumbini and Karnali around 3 percent - underlining that low coverage is now as much a rural-access and urban-slum problem as a whole-province problem.

Administrative DoHS figures rank provinces very differently and should be read with care. Several provinces report FIC and Penta3 rates at or near 100 percent, and Madhesh has at times reported figures above 100 percent (for example an administrative 'full immunization' reading around 105 percent), which is mathematically impossible for true coverage and signals denominator errors or over-reporting rather than a genuinely best-performing province. This is precisely why the survey rankings below are the more reliable guide to real-world protection.

Coverage in Nepal is tracked and declared at the local level: a ward, municipality or district can be declared 'fully immunized' when its administrative records show all target children reached and sustained. Building on years of district-by-district declarations, the government announced in July 2025 that all 77 districts had been declared 'fully immunised and sustained' - a milestone the DoHS presented as reaching the whole country through routine immunization.

That declaration was quickly questioned. Independent experts, including former Directors General of the DoHS, argued that a claim built on administrative data alone - which they said could be manipulated and is not internationally verified - was not a safe basis for declaring success. A measles outbreak in Sarlahi (Madhesh) in early 2026 sharpened the concern: officials acknowledged that the declaration relied on the prior year's coverage data while surveillance showed immunity gaps accumulated over many years, including during COVID-19 lockdown disruptions.

For anyone using district-level DoHS numbers, the lesson is to treat a '100 percent' or 'fully immunised' district label as an administrative status, not a measured survey estimate. Real protection is uneven within districts, concentrated in urban slums, migrant and marginalized communities, and remote wards, and outbreaks can occur even where the paper coverage is complete.

The persistent gap between DoHS administrative coverage (90s) and survey coverage (around 80 percent) has a few well-understood causes. The most important is the denominator: administrative coverage divides doses given by an estimated target population of surviving infants, and if that population estimate is too low - a common problem where census projections lag actual births and migration - the resulting coverage is inflated, sometimes past 100 percent. Double-counting of doses given in campaigns and at multiple facilities, and pressure to report progress toward 'full immunization' targets, push the same direction.

Surveys avoid the denominator problem by sampling real children and checking cards and recall, but they carry their own limits: card loss, recall error, and sampling variability at the province level (each province's estimate rests on a few hundred children in NDHS, so single-point rankings should be read as indicative). Where administrative and survey figures agree - as they broadly do on the geography, with Gandaki and Sudurpashchim strong and Madhesh weak - confidence is higher. Where they diverge sharply, as on Madhesh's absolute level, the survey figure is the safer estimate of true coverage.

A further nuance is the definition of 'fully immunized.' Nepal's schedule has expanded to include pneumococcal conjugate vaccine (PCV), rotavirus, fractional inactivated polio vaccine (fIPV), a second measles-rubella dose (MR2), Japanese encephalitis (JE) in endemic districts, and typhoid conjugate vaccine (TCV). A child counted as 'fully immunized' under an older basic-antigen definition may still miss newer antigens, so comparisons across years and sources should confirm which schedule is being measured.

For citation and comparison, keep the sources and their fiscal years distinct. Use the DoHS Annual Health Report (HMIS) for administrative Penta3, FIC, BCG and MR coverage and for district/local-unit status, always naming the fiscal year in Bikram Sambat and Gregorian form (for example FY 2079/80 = 2022/23, FY 2081/82 = 2024/25). Use NDHS 2022 for the most authoritative survey estimate of true basic coverage and for the province ranking, and MICS 2024-25 for the most recent survey update and zero-dose (unvaccinated) breakdowns.

When quoting a province figure, state whether it is administrative or survey-based, because the two can differ by 20 percentage points or more (Madhesh is the clearest example: administrative near or above 100 percent versus NDHS 68 percent). For journalism and local-government planning, the survey-based zero-dose and dropout numbers are usually the more actionable, since they point directly at the children the routine system is missing - disproportionately in Madhesh's rural belts, urban Bagmati slums, and remote wards of Karnali and Lumbini.

Finally, treat all figures as periodic, not live: coverage is reported by fiscal year and by survey round, with no reliable daily or monthly national number. The durable, verifiable facts are the NDHS 2022 national figure of about 80 percent, the MICS 2024-25 figure of about 81 percent, the province ordering with Gandaki highest and Madhesh lowest on survey measures, and the 2025 declaration that all 77 districts were 'fully immunised and sustained.'