Publication:

Quality assessment of immunization clinics in Bondo sub-County, western Kenya: a descriptive study

Background Childhood vaccine coverage remains suboptimal in the second year of life. In Kenya, the fourth dose of the RTS,S/AS01 malaria vaccine stands at 34%. Demand and supply factors influence vaccine uptake but the quality-of-service delivery- a critical supply-side factor- remains underexplored. An immunization clinic quality assessment framework was developed to evaluate services in 29 health facilities in Bondo sub-County, Kenya.

Methods The WHO pediatric quality of care framework was adapted and used to conduct a cross-sectional survey of 29 health facilities between April and May 2025. The framework included 33 measurable indicators categorized as provision of care, experience of care and availability of child friendly resources. Immunization clinics were scored 1 or 0 per indicator, with total scores expressed as percentages and categorized into three quality levels: “below average” (0-50%), “average” (51-79%), and “above average” (80-100%). A Mann-Whitney U test compared quality scores between level 2 and levels 3/4 health facilities.

Results Of the 29 clinics, 58.6% were level 2, 34.5% level 3, and 6.9% level 4; 89.7% were government owned. Clinic scores ranged from 70% to 91%, with 52% classified as “average” and 48% as “above average.” Levels 3 and 4 facilities performed significantly better than level 2 (U=41.5, n1=17, n2=12, p=0.006). Key deficiencies included vaccine stockouts and absence of child-friendly spaces.

Conclusions Vaccine stock-outs is the key challenge to delivering quality services. Improving immunization service quality requires increased government investment that ensures uninterrupted vaccine supply and enhancing clinic environments.