The greatest challenge to child health in sub Saharan Africa is poor immunization service for major child illnesses. The World Health Organisation’s (WHO) review of the health systems of the World, looking at various health indicators including child mortality, in the year 2003 placed Nigeria in 187 th position among 191 countries, and little has been achieved since then. This paper is an overview of routine immunization in Ekiti State of Nigeria. The State serves as a case for understanding the prospects and challenges of child health care in South Nigeria. The study used qualitative data derived from focus group discussions and key informants and secondary data of state and national surveys. The findings identify factors that account for the relative poor immunization coverage. The salient issues include ignorance and social cost of access to the service. Also the quality of the immunization service: availability to the remote areas, health personnel commitment, and consistent availability account for low coverage. It is concluded and recommended that there is a need for improvement in the supply side of immunization service especially taken the service to the physically and socially marginalized areas and also extend the campaigns for immunizations beyond the current emphasis on Polio vaccination to incorporate other antigens.