From Effectiveness to Embedding: Developing the Preliminary Mobile Vaccination Embedding Framework for Sub-Saharan African Health Systems

Background/Objectives. Mobile phone-based vaccination interventions, including SMS reminders, voice calls and tracking applications, have repeatedly shown effectiveness in controlled settings across sub-Saharan Africa. Many nevertheless stop operating once project funding ends and do not become part of the routine health systems they were intended to strengthen. This study aimed to develop a preliminary evidence-informed conceptual framework explaining the multilevel conditions required to embed mobile vaccination interventions within routine immunization systems in sub-Saharan Africa. Methods. A systematic evidence synthesis was undertaken to inform framework development. Six scientific databases (PubMed/MEDLINE, CINAHL, EMBASE, Epistemonikos, Web of Science and Global Health) were searched for studies published between January 2014 and April 2024. Selection followed the PRISMA 2020 statement, methodological quality was appraised with the Mixed Methods Appraisal Tool (MMAT, 2018 version), and implementation conditions were synthesized thematically through an iterative framework-development process. Results. Eighteen of 913 identified records were included. Four interdependent domains formed the preliminary Mobile Vaccination Embedding (MOVE) framework: user readiness (acceptability, trust and digital literacy among caregivers and providers); technological reliability (network coverage, electricity access and device sustainability); organizational integration (staff training, workflow adaptation and health worker adherence); and system governance (policy frameworks, multisectoral partnerships, financing and integration into national Expanded Programme on Immunization structures). Together, these domains describe the conditions shaping progression from adoption to institutionalization. Conclusions. The primary contribution of this study is the preliminary evidence-informed MOVE framework, which shifts attention from whether mobile vaccination interventions are effective to whether health systems possess the capacity to embed and sustain them. The framework requires prospective refinement, empirical testing and validation across diverse health-system contexts.