A process evaluation of the implementation of COVID-19 vaccine deployment in Kenya

<ns3:p>Background The coronavirus disease 2019 (COVID-19) vaccines were introduced in Kenya in March, 2021. Effective deployment arrangements are crucial to vaccine access. This study aimed to examine the implementation experiences of the COVID-19 deployment process and their influence on access to inform future pandemic responses. Methods We conducted a cross-sectional qualitative study in two purposively selected counties in Kenya (urban and rural) using in-depth interviews with national-level officials, developmental partners, county and sub-county health managers, and front-line workers (n=26). Data were analyzed using a framework approach in line with the study’s conceptual framework on the process evaluation of COVID-19 vaccine delivery. Results The findings indicate that most deployment activities (regulation, vaccine supply chain, service delivery, and supervision) leveraged existing systems and were integrated with routine processes, increasing efficiency. A mixed approach to service delivery enhanced reach, and the electronic data management system resulted in the timely availability of vaccines and reduced vaccine expiries. However, several challenges remain to be overcome. First, the national stockouts of certain vaccine types hindered uptake due to vaccine preferences or eligibility criteria. Second, financing for some deployment activities was insufficient and was mainly done through supplies and equipment sourced from the national government or through donor support, with limited financial autonomy at county and facility levels. Despite demand-generation efforts involving community health volunteers, leaders, and outreaches, vaccine hesitancy remains a pertinent challenge. Conclusion Our findings highlight the importance of pandemic preparedness, including addressing public finance management bottlenecks, resource mobilization, and adaptable health systems that can be leveraged for vaccine deployment during a pandemic. We also emphasize the importance of multi-sectoral approaches, including capacity building for local vaccine manufacturing and utilizing electronic data systems to reduce inequities and ensure sustainable, equitable access. Furthermore, we emphasize the need for process evaluations to track program implementation and address challenges.</ns3:p>