Perspectives from EPI personnel on immunization programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis
- 1Kenyatta University
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.
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BibTeX
@misc{karanjachege2026perspectives,
title = {{Perspectives from EPI personnel on immunization programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis}},
author = {C. Karanja-Chege},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.26.26364071},
url = {https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1},
note = {Public domain},
}
RIS
TY - UNPB
TI - Perspectives from EPI personnel on immunization programme performance in Kenya: a thematic, complex adaptive systems and leverage-points analysis
AU - C. Karanja-Chege
PY - 2026
DA - 2026/09/26
PB - medRxiv
DO - 10.64898/2026.09.26.26364071
UR - https://www.medrxiv.org/content/10.64898/2026.09.26.26364071v1
AB - 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.
ER -