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3 questions to Dr Mercy Mukui Mwangangi, Senior Health Systems Strengthening Director at Amref Health Africa

Published 10 June 2024 in News

Ahead of the launch of the 2026-2030 Gavi Investment Opportunity, on 20 June in Paris, Focus 2030 wishes to highlight the key issues around global immunization in a special edition.



Interview with Dr Mercy Mukui Mwangangi, Senior Health Systems Strengthening Director at Amref Health Africa

Focus 2030 : 30 million children suffer from preventable diseases on the African continent, among which half a million die every year. As an organization operating in the field with local and national institutions, can you detail the actions Amref Health Africa is conducting to support access to immunization by local populations in your countries of intervention ?


Dr. Mwangangi : Amref employs a Health Systems Strengthening approach to support access to immunisation in all the Countries of operation in East, West and Southern Africa. Amongst many other programs and projects, Amref is a Lead Partner for the Saving Lives and Livelihoods initiative (funded by the Mastercard Foundation, through Africa CDC) providing immunization services in different settings – hospitals, primary health care centres and through mobile clinics. One of our primary approaches involves supporting governments to strengthen health systems, particularly at the community level by integrating routine immunization into different Primary Health Care and special programs to improve coverage, sustainability of programs, enhanced demand and improved user satisfaction. We have trained thousands of health workers in several African countries, including Ethiopia, Kenya, Uganda, Tanzania, and South Sudan, in proper immunization procedures providing Job Aids and refresher training for Health Care Workers on integrated Routine Immunization.

Additionally, we aid in establishing and maintaining cold chain infrastructure to preserve vaccine potency and ensure last-mile delivery to hard-to-reach and low coverage areas. Furthermore, we assist governments at the sub-national level in enhancing data collection and monitoring systems for tracking vaccination coverage using innovative technological approaches. For instance, the mVaccination program in Tanzania trained 100 healthcare workers from 50 facilities, resulting in significant registration and immunization rates, along with updates on stocks and temperatures, and SMS reminders to registered caregivers.

Amref also supports community mobilization and education efforts, collaborating with communities to raise awareness on the importance of immunization and address vaccine hesitancy through education campaigns, community dialogues, and engagement with local leaders. In Senegal, we promoted the use of digital technology in accessing healthcare through the Digital Health and Innovative Solutions for Safer Pregnancy, Child Survival, and Nutrition : Cellal e Kisal program, which benefited over 9,000 pregnant women and 67,662 children aged zero to five years.

We prioritize reaching the most vulnerable children in the countries we support, as demonstrated by our work in Ethiopia’s Afar province and in Kenya using the ‘Kimormor’ project, where we have reached over 20,000 and 1,000 children respectively through our outreach services for immunization. In Uganda, in collaboration with Amref UK and funding from Comic Relief, we supported 650 district and sub-district management teams and communities to improve the provision and uptake of maternal, newborn, and child health services, benefiting over 73,000 people directly. In South Sudan, through the Everywhere = mobile clinics project, we activated eight mobile clinics to identify and treat various health concerns, including ensuring vaccinations for children.

Amref is also engaged in advocacy and policy engagement with like-minded bodies, advocating for government policies that prioritize immunization and supporting the allocation of adequate resources for vaccine programs. We provide technical assistance to governments to develop life course immunization policies & programming tools in line with immunization Agenda 2030.


Focus 2030 : What are the main challenges governments need to take up to ensure a universal access to vaccines for their populations ? What are the main constraints health professionals face to implement successful vaccination campaigns ?


Dr. Mwangangi : While huge gains have been made in increasing access to vaccinations and thus reducing child deaths in Africa, several challenges hinder universal access to vaccines in Africa.


Most African countries have yet to reach the recommended coverage for vaccinations, and it is estimated that 1 in 5 children in Africa do not receive the vaccines they need in a timely manner.


Limited domestic financial resources for vaccines are a critical challenge that many African countries face. Most vaccination programs are heavily financed by external donors, leaving gaps in critical aspects of the vaccination programs such as supply, cold chain, and the purchase of vaccines. As some African countries phase out of GAVI support, this challenge will become more prominent and may lead to a reversal of the gains made in vaccinations in the last decade. Therefore, countries must engage innovative mechanisms to finance vaccination campaigns to ensure access to life-saving vaccines.

Furthermore, vaccine hesitancy and misinformation remain constant challenges for governments in Africa. While most countries work with development partners like Amref Health Africa to create awareness and sensitize communities on vaccinations, there remains a large proportion of African communities that refuse vaccinations due to cultural and societal reasons. Also, political instability and conflict, which are on the rise in a number of African countries, directly disrupt vaccination services and limit access to healthcare. Additionally, these conflicts can result in the destruction of expensive cold chain equipment, which can strain the limited financial resources available to governments to finance vaccination programs.

Health professionals also face various constraints in implementing vaccination programs successfully. Lack of adequate training, supportive supervision, and resources hinders the effective delivery of vaccinations by health workers, especially in rural and hard-to-reach areas. Healthcare workers may require additional training on proper immunization procedures, cold chain management, and communication skills to effectively address vaccine hesitancy. While Amref Health Africa and other development partners endeavor to close these gaps, there remains a deficit that governments must take leadership to address.

Another challenge is the sub-optimal data systems leading to vulnerable populations being overlooked, the operation of multiple vertical programs at the health facility level, and poor health worker remuneration all contribute to reduced motivation, incentives and ability for effective delivery of vaccination services by health workers.

Logistical challenges with delivering vaccines to remote areas and maintaining the cold chain can be difficult due to limited infrastructure and poor access to transportation networks, and this can hinder the effective delivery of vaccination campaigns. Moreover, workforce shortages are a major challenge to the health workforce in many African countries. Health workers usually find it challenging to dedicate sufficient personnel to vaccination programs. Governments need to improve processes, cold chain equipment/infrastructure, transport and human resource by strengthening National Vaccine Stores and promote seamless use of both pull and push strategies to move vaccines from National Vaccine stores to service delivery points. To do this, there is a need to transition from traditional vertical disease approaches to integrated immunization, integrating vaccination into routine primary health services to reach high-risk populations effectively.


Focus 2030 : Together with the CDC Africa and Gavi, France will co-host the Global Forum for Vaccine Sovereignty and Innovation in Paris on June 20. On this occasion, Gavi, the Vaccine Alliance, will launch its investment opportunity for the years 2026-2030 and present its funding requirements ahead of its replenishment. What are your expectations and recommendations to the international community on this occasion ?


Dr. Mwangangi : Amref Health Africa eagerly anticipates the forthcoming Global Forum for Vaccine Sovereignty and Innovation and the launch of Gavi’s investment opportunity for 2026-2030. Our expectations for the international community are targeted at collectively advancing efforts towards ensuring equitable access to vaccines, and strengthening global health systems.

Firstly, we emphasize the critical need for increased and sustained funding for Gavi’s next replenishment cycle. Gavi plays a pivotal role in bolstering African countries’ immunization programs, and continued financial commitment from the international community is essential to furthering progress towards universal vaccine access.


The international community should therefore reaffirm its commitment to funding global health initiatives, including Gavi’s replenishment, to sustain progress in expanding vaccine access and strengthening health systems.


Additionally, investments should not solely focus on vaccine procurement but also prioritize strengthening health systems at the country level. This encompasses supporting healthcare worker training, enhancing infrastructure, and fortifying data collection and monitoring systems and last mile delivery of vaccines to marginalized communities. This will improve equity of vaccine access on the continent. Additionally, governments, development partners, research institutions and manufacturers should collaborate to accelerate vaccine development and production through technology transfer, knowledge sharing, and joint research efforts to make vaccines more available and affordable to LMICs in Africa. The launch of the African Vaccine Manufacturing Accelerator (AVMA) represents a significant opportunity to bolster vaccine production in Africa. Investment in AVMA should be promoted to support local manufacturing and reduce dependency on imports. Amref expects the Forum to come up with concrete commitments to support the aspirations of the African continent to vaccine manufacture at least 60% of the vaccine doses that the Continent requires.

Efforts to combat vaccine hesitancy and misinformation must persist through targeted communication campaigns, community engagement, and collaboration with trusted local leaders.


Ensuring equitable access to vaccines for all, particularly underserved populations, should be a primary investment priority, irrespective of location or socioeconomic status.


Extensive stakeholder engagement is crucial to furthering universal access to vaccinations in Africa. The private sector should not be left out of plans to improve vaccine access in Africa. Governments must engage the private sector in discussions to improve vaccine access and distribution and they should be part of planning and implementation of vaccination strategies in countries.

Pandemic Preparedness and Response has proven to be critical to maintaining vaccination services during pandemics as exemplified by COVID-19. Governments and partners must collaborate to plan and prepare for future health crisis by identifying sustainable funding mechanisms and guidelines for addressing pandemics effectively and continuing to deliver vaccines during these emergencies.

Finally, data remains the cornerstone for making informed decisions on vaccination programs in countries, regionally and globally. Data systems must be strengthened at all levels to provide accurate and timely data for decision making to strengthen health systems at the national and global levels. Data sharing and real-time surveillance should be encouraged to enhance global security against vaccine preventable diseases.

NB : The opinions expressed in this interview do not necessarily reflect the ideas of Focus 2030.



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