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

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.