Abstract:

Introduction of new vaccines (Measles-Rubella second dose [MR2], Inactivated Polio Vaccine second dose [IPV2], Hepatitis B Birth Dose [HepB-BD], and Yellow Fever [YF]) is a major milestone in strengthening Uganda’s Expanded Programme on Immunization (EPI). Assessing performance and system readiness for new vaccine adoption is essential for achieving Immunization Agenda 2030 (IA2030) goals and ensuring long-term sustainability. This study evaluated national, district, and facility-level readiness using the WHO Post-Introduction Evaluation (PIE) framework, focusing on logistics, cold chain capacity, human resources, supervision, and coordination mechanisms. A mixed-methods design was used. Quantitative data were extracted from national, district, health facility, and community PIE tools. Descriptive statistics, readiness scoring, and logistic regression explored determinants of coverage performance. Qualitative data from key informant interviews and facility-level observations were analyzed thematically. Findings were triangulated across data sources to ensure validity. Data-use permission was obtained from relevant authorities. National cold-chain functionality stood at 83.7%, with higher performance in Central and Western regions. Supervision frequency, logistics adequacy, and staff training were significant predictors of new vaccine coverage (p < 0.05). Qualitative findings highlighted strong partner coordination but persistent challenges in preventive maintenance, workload pressure, and staffing gaps. Despite operational successes, regional disparities remained particularly in remote Northern and Eastern districts. Uganda’s immunization system demonstrates strong readiness and capacity to integrate new vaccines into routine immunization. However, sustainability requires improved financing, enhanced supervision, stronger cold-chain maintenance systems, and targeted support for underserved regions. Findings contribute practical evidence for policy planning, Gavi Joint appraisal processes, and future vaccine introductions.

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