Systemic analysis of bottlenecks in routine EPI coverage vaccination among children aged 0–23 months in the health areas of the Mumbunda Health District: a cross-sectional mixed-methods study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Immunization is one of the most cost-effective public health interventions and plays a vital role in reducing infant mortality. However, routine immunization coverage remains suboptimal in the Democratic Republic of Congo, including Lubumbashi, despite progress since the establishment of the Expanded Program on Immunization (EPI). This study aimed to: (i) Identify the bottlenecks in immunization coverage in the health areas of the Mumbunda DH, in Lubumbashi; (ii) Identify the root causes of these bottlenecks; and (iii) prospects for strengthening routine EPI coverage in the HA of the Mumbunda District Health. Methods A cross-sectional mixed-methods study using a sequential explanatory design was conducted in the Mumbunda Health District between May 2025 and August 2026. Bottlenecks were analysed using an adapted conceptual model based on the WHO's four health-system functions (2000). The quantitative component constructed bottleneck scores and profiles, while the qualitative component analysed data from semi-structured interviews using the systematic thematic analysis approach developed by Naeem et al. (2023). Results A total of 45 healthcare providers from 29 first-level health services (FLHS) across 15 Health Areas participated in the quantitative component, and seven Health Area Nurse-in-Charge for Health Areas participated in the qualitative component. Most quantitative participants were women (64.4%), and their mean length of service was 14 ± 9.7 years. The main bottlenecks identified were in stewardship functions [8.33% (IQR: 0–42%)] and funding. [(21% (IQR: 7–36%)]. Qualitative analysis identified informational and territorial fragility of the EPI, weak ownership of peripheral planning, non-institutionalized adaptive governance and underfunded peripheral operational capacity as major root causes. Conclusion The main bottlenecks identified were in the stewardship and financing functions. These two functions thus become the primary levers for strengthening routine immunization coverage in Lubumbashi.
Source: Research Square
Institution: University of Lubumbashi
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7204548685