Perspectives from EPI personnel on immunisation programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis
Year: 2026
Type: preprint
Abstract: Background Immunisation system performance depends on effective service delivery and the generation of high-quality data to support planning and decision-making. With the recent scaling down of external health funding, Kenya must identify sustainable strategies to strengthen the resilience of its immunisation programme. Methods We conducted a three-part qualitative study comprising thematic analysis, application of complex adaptive systems (CAS) theory, and the Meadows leverage-points framework. Thematic key personnel interviews were conducted with selected Essential Programme on Immunisation (EPI) personnel from 14 counties and sub-counties in Kenya to explore factors influencing immunisation system performance. Results Vaccine distribution, health workforce shortages and immunisation financing emerged as the dominant themes affecting immunisation performance. Analysis through a CAS lens revealed that reinforcing feedback loops were more dominant than balancing loops, suggesting that system dysfunctions were more influential than adaptive self-correcting mechanisms, resulting in a tendency toward negative system behaviour. Application of the Meadow’s framework showed that existing interventions were largely concentrated at lower leverage levels, which are more likely to generate short-term operational improvements, while higher-leverage interventions with the potential for long-term system transformation remained underutilised. Conclusion Systems-thinking approaches offer a powerful framework for understanding and improving immunisation system performance. They facilitate the identification of vulnerabilities and bottlenecks, while informing the design of higher-leverage interventions capable of producing sustainable and transformative improvements across the system.
Source: medRxiv
Institutions: Kenyatta University, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of Amsterdam, Kenya Paediatric Research Consortium, Kenya Medical Research Institute, London School of Hygiene & Tropical Medicine, KEMRI-Wellcome Trust Research Programme, Ministry of Health, University of Nairobi, Emma Kinderziekenhuis, Google (United States)
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7215031397