In Madagascar, 33% of children aged 12-23 months of age have never received a vaccination and are therefore entirely missed by country's national immunization system and potentially the broader health system. This report outlines a MOMENTUM Country and Global Leadership assessment that explored four areas that, if addressed, can close gaps in immunization equity: zero dose vaccination, birth dose vaccination, missed opportunities for vaccination, and urban vaccination. The report also details the outcomes of a human-centered design workshop held to co-create solutions to barriers or challenges in each of these four areas.