Bridging health system gaps: Key findings from Kenya’s Gavi HSS Evaluation

In recent years, Kenya has made significant strides in reducing childhood morbidity and mortality from vaccine-preventable diseases. A key contributor to this progress has been the Gavi Health System Strengthening (HSS) support grant, which aimed to enhance immunization systems across the country. In 2024, hera, in collaboration with ICRH-Kenya, was commissioned by UNICEF to conduct a summative evaluation of the Gavi HSS programme to assess its relevance, effectiveness, and impact. .

Evaluation approach

The evaluation employed a mixed-methods approach to assess the relevance, coherence, effectiveness, efficiency, and impact of the Gavi HSS programme. Methods included a review of 62 documents, 100+ key informant interviews, 17 group interviews, 20 focus group discussions, and 51 modified data quality self-assessments and audits. This comprehensive methodology ensured a robust analysis of programme implementation, outcomes, and areas for improvement. 

This evaluation marked a significant learning experience for the hera team, particularly in utilizing the Data Quality Self-Assessment (DQS) tool. Having conducted similar evaluations in the DRC and Burundi, the Kenya assignment allowed us to refine our methodologies further and contribute valuable insights to immunisation programming.  

Key objectives and findings  

The evaluation, guided by five of the six OECD-DAC evaluation criteria, sought to answer three main questions: 

1. Were the agreed HSS programme interventions implemented as intended? 

The evaluation found that the programme was effectively implemented overall, adhering to its design and aligning with Kenya's health policies and strategies. Stakeholder engagement, including political actors, civil society, and community health promoters, was a critical factor in ensuring the programme's effective execution. 

2. What were the outcomes of these interventions, particularly in terms of vaccination coverage? 

Immunization coverage improved substantially during the programme period. By 2023, 59% of sub-counties reported Pentavalent (DPT3) coverage above 80%, a significant increase from 30% in 2017. Among the 17 focus counties, this improvement was mirrored, with coverage increasing from 27% to 57% in the same timeframe. 

3. How did the programme contribute to strengthening immunization systems, improving coverage, and achieving equity? 

The Gavi HSS programme contributed significantly to strengthening Kenya’s immunization systems and improving coverage and equity. Its multi-stakeholder approach and focus on under-served areas drove gains in vaccination rates and highlighted the importance of continued efforts in data quality, community engagement, and inclusive programming to address persisting inequities. 

Challenges and areas for improvement   

Despite its successes, the evaluation highlighted several opportunities for enhancement. To build on the programme’s achievements, the evaluation team provided several recommendations: 

• Maintain Advocacy Efforts: Continue working with political and community stakeholders to prioritize immunization. 

• Strengthen Data Systems: Improve data quality and encourage its use for decision-making at all levels. 

• Sustain Community Engagement: Involve grassroots actors in immunization programming to ensure coverage and equity.  

• Improved Data Quality and Disaggregation: A need for more granular data to better understand disparities and drive equitable coverage. 

• Effectiveness and Efficiency Measurement: Strengthening tools and systems for monitoring programme impact. 

• Sustained Stakeholder Engagement: Maintaining advocacy and collaboration with community-level actors and civil society organizations to ensure long-term success. 

Looking ahead

The Gavi HSS programme in Kenya demonstrates the power of targeted health system investments to drive measurable improvements in child health outcomes. As Kenya continues to build on these achievements, sustained collaboration, data-driven decision-making, and community engagement will be critical to maintaining momentum and reducing health inequities. 

hera is proud to have contributed to this important evaluation and remains committed to supporting immunization and health system strengthening efforts worldwide. 

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