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In the last two decades of Universal Immunization Program implementation in India, several surveys and evaluations have found Madhya Pradesh to be one of the weakest states in reaching immunization coverage targets. Low immunization coverage is deemed to be one of the primary reasons for high infant mortality rates and under five mortality rates in the state over the last two decades. This case study is the outcome of a consultative engagement involving a range of stakeholders in Madhya Pradesh and beyond working in health systems and in particular immunization. It lists several learning points for authorities exploring sustenance of supportive supervision in immunization and other RMNCH+A areas, which can be useful for those delivering the UIP at the grassroot level.