Barriers to effective utilisation of vaccines and immunisation services in Uganda: a qualitative assessment

Immunisation programmes have influenced the reduction of the global burden of infectious diseases. immunisation through vaccination is a cornerstone for averting death and preventing infectious diseases while protecting the public against outbreaks and life-threatening illnesses. This study examined barriers to effective utilisation of immunisation services in Uganda. The study adopted an exploratory study design that utilised in-depth interviews to collect qualitative data from study participants. The study design was guided by a bottleneck analysis (BNA) framework that aligned key predetermined thematic areas against the research questions. The study gathered deeper analytical and contextual insights about the subject matter from 20 district health officers (DHOs), 27 village health teams (VHTs), 40 healthcare providers and 3 national level stakeholders. Data analysis was guided by both thematic and content analysis through deductive and inductive approaches. The study noted numerous facilitators of vaccination uptake in Uganda including presence of an adequate cold chain infrastructure, positive attitude of healthcare providers, community awareness and outreach campaigns, and availability of EPI activity coordination mechanisms. The study, however, observed four major themes as the key barriers to effective utilisation of immunisation services in Uganda including geographical and physical access barriers, vaccine supply chain and last mile delivery constraints, social-cultural factors including religious and cultural beliefs, and knowledge and awareness gaps among mothers. The study concludes that utilisation of immunisation services in Uganda is influenced by a complex interplay of health system, community, and sociocultural factors. While Uganda has established several critical enablers, these strengths are undermined by persistent community and behavioural barriers. Improving vaccine uptake will require integrated strategies that address service delivery gaps while simultaneously tackling community beliefs, vaccine hesitancy, and inequities in access to immunisation services.