# To what extent are vulnerability issues included and addressed in Kenya's health and immunization policy documents? A systematic review of documents

## TL;DR

This study reviews Kenya's health and immunization policies to see how they address vulnerable groups and suggests more comprehensive approaches to improve vaccine access.

## Contribution

The study identifies gaps in how vulnerability is framed in policy documents and proposes a more holistic approach to addressing vaccine access disparities.

## Key findings

- Kenya's policy documents outline vulnerable groups but often fail to recognize overlapping vulnerability factors.
- Proposed strategies include rights-based approaches, removing financial barriers, and outreach activities.
- Future policies should consider the intersecting nature of vulnerability to improve vaccine access.

## Abstract

Globally, childhood immunization is one of the most important public health interventions contributing to a significant reduction in childhood mortality and morbidity. This achievement has been made possible by several concerted efforts at the international and national levels. However, challenges persist, including disparities in vaccine coverage, consequently increasing vaccine vulnerability. This review aimed to examine how vulnerability issues are framed and addressed in Kenya's health sector and immunization policy documents.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines guided the review process. Policy documents were retrieved from online searches, searching through the reference list of retrieved documents and requesting relevant documents from stakeholders. To select documents, we screened the titles and executive summaries of documents guided by the exclusion and inclusion criteria. Data was extracted using a data extraction template prepared in Excel, capturing the general information about the documents and the specific information about vulnerability. The extracted data was then organized thematically to address the review objectives.

Twenty-one documents were included for final review. Of these, four were immunization programme documents, 15 were documents that cut across the entire health sector and two were legislative documents. Across the documents, different vulnerable groups were outlined. We developed four typologies of vulnerability from the groups listed in the documents, namely: vulnerability as socio-economic condition; vulnerability as biological and health condition; and vulnerability as a physical location. Some of the strategies proposed in the documents to address vulnerability issues included, adopting a rights-based approach to service provision, removing financial barriers and conducting immunization outreach activities.

Future policy development should recognize the overlapping and intersecting nature of vulnerability factors and develop comprehensive and flexible approaches to address various forms of vulnerability.

Childhood immunization plays an important role in preventing childhood diseases and deaths. This has been possible because of many measures that have been put in place by different countries. However, several countries are still experiencing challenges related to childhood vaccine access, hence putting children who miss out on vaccines vulnerable to not fully enjoying the benefits of vaccines. We reviewed health sector policy documents in Kenya to understand how vulnerability has been framed and addressed in the documents.

We conducted online searches to retrieve relevant policy documents. In addition, we requested documents from stakeholders and searched through reference lists of identified documents. We then selected relevant documents by screening the titles and executive summaries of the documents. Using a template prepared in Excel, we extracted information relevant to the study objectives from the documents.

A total of 21 documents were included for final analysis. In these documents, different vulnerable groups were outlined. However, only individual-specific factors were used to define the vulnerable without recognizing the potentially overlapping and interacting nature of these factors. We therefore suggest that for future policy development, the multiple and intersecting nature of vulnerability factors should be considered. In addition, comprehensive and flexible strategies would be more suitable to address the co-existence of multiple factors that can prevent an individual not accessing health services like immunization.