{
  "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.",
  "abstract_shown": true,
  "affiliations": [
    "Kenyatta University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "C. Karanja-Chege"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0vzgkn4vj6w9z.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.26.26364071",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1.full",
  "id": "0vzgkn4vj6w9z",
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  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1",
  "language": null,
  "licence": "PDM-1.0",
  "licence_label": "Public domain",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/publicdomain/mark/1.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "public and global health"
    ],
    [
      "openalex",
      "3306|Vaccine Coverage and Hesitancy"
    ]
  ],
  "openalex": "W7215031397",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0vzgkn4vj6w9z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:51Z",
      "native_id": "10.64898/2026.09.26.26364071",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:public and global health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Perspectives from EPI personnel on immunization programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis",
  "title_text": "Perspectives from EPI personnel on immunization programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:51Z",
  "url": "https://research.draconitic.com/paper/0vzgkn4vj6w9z",
  "venue": "medRxiv",
  "versions": []
}