Title : Advancing vaccine availability and equity in low-resource settings: Evidence from Awendo Sub-County, Kenya
Abstract:
Background: Despite national progress in Kenya’s Expanded Program on Immunization (KEPI), vaccine availability and equitable access remain uneven across sub-counties. Awendo Sub-county in Migori County continues to face challenges related to inconsistent vaccine supply, cold-chain limitations, and socioeconomic disparities that affect timely vaccination. These constraints particularly impact the uptake of Measles Rubella2, Human Papilloma Virus Vaccine, Malaria 4 vaccine and Fully Immunized Child (FIC). Understanding local drivers of inequity is essential for strengthening immunization systems and achieving national and global coverage targets.
Objective: This study assessed vaccine availability and equity in Awendo Sub-county, identifying systemic, logistical, and community-level factors influencing access to immunization services, and proposing actionable recommendations for improving equitable vaccine delivery.
Methods: A descriptive mixed-methods approach was used across all four wards of Awendo Sub-county in 2024. Quantitative data on vaccine stock levels, stock-out patterns, and immunization coverage trends were extracted from KHIS2 and monthly facility stock reports. Qualitative insights were collected through key informant interviews with health workers, community health volunteers, teachers, and caregivers. Data were analyzed using descriptive statistics and thematic analysis to identify bottlenecks and facilitators of vaccine availability and equitable access.
Results: The analysis revealed recurrent stock-outs of Measles Rubella, Human Papilloma Virus , and Malaria antigens, primarily driven by late vaccine deliveries, limited cold-chain capacity at lower-level facilities, and gaps in microplanning. Facilities in more remote locations recorded longer stock-out durations than those closer to the sub-county depot. Human resource shortages, inadequate transport for outreach services, and disruptions during rainy seasons restricted service continuity. Community-level barriers—including low awareness of vaccination schedules, cultural misconceptions, and indirect costs such as transport—contributed to delayed or missed vaccinations. However, facilities that adopted improved defaulter tracing, community health volunteer engagement, and integration of school health activities demonstrated marked improvements in coverage and reduced inequities.
Conclusion: Vaccine availability and equity challenges in Awendo Sub-county arise from interconnected supply chain, infrastructural, and social factors. Strengthening last-mile distribution, upgrading cold-chain systems, supporting outreach through adequate transport and staffing, and enhancing community engagement are critical to improving equitable vaccine access. Data-driven microplanning, stronger school-based vaccination programs, and collaboration between county leadership and frontline workers can substantially reduce gaps in coverage. Lessons from Awendo highlight the importance of context-specific, system-wide approaches to ensure that every child and adolescent receives timely and equitable immunization services.
Keywords: Vaccine availability, equity, immunization coverage, Awendo Sub-county, Kenya, HPV vaccine, cold-chain, health systems strengthening.
