Facility Readiness Assessment for Maternal Immunization: Results of Field Testing in Kenya and Bangladesh

Recent COVID-19 vaccine experience in low- and middle-income countries has suggested many primary care settings are unprepared to administer new vaccines to pregnant and postnatal populations. Deployment of a new maternal vaccine against respiratory syncytial virus (RSV) to protect against RSV lower respiratory illness in the first 6 months of life has accelerated, with vaccination now offered during pregnancy in some high- and middle-income countries. We aimed to design and assess the feasibility of tools for the evaluation of health facility readiness to introduce new vaccines into antenatal care. The health facility assessment tool for maternal immunization readiness was developed with indicators for key health service delivery domains for maternal immunization and piloted in Kenya and Bangladesh. Pilots were conducted from February to April 2022 in Kenya and January 2023 to June 2023 in Bangladesh. The tool proved feasible for administration via audit of records, facility equipment and operations, interview with officer-in-charge and optional modules for structured nonidentifiable observation of antenatal care and immunization services. The pilot exercise surfaced multiple areas for quality improvement action by health systems in Kenya and Bangladesh. In addition to testing the functionality of the tool, data collected during pilot testing were reviewed and presented to participating subnational managers and national technical working groups, allowing these entities to review and discuss initial assessments of gaps and strengths in readiness for new maternal vaccines. A global adaptable version of the tool is now available for contextualization to other settings that are preparing for rollout of new maternal vaccines.