Examining evidence use and inclusive, accountable health policy decision-making: The case of introduction and roll-out of vaccines in Kenya

Background: Despite widespread promotion of evidence use to strengthen health systems and health outcomes, its use in health policymaking remains poorly understood. Moreover, although evidence use likely shapes—and is shaped by—inclusive, accountable decision-making, these interactions have been largely underexplored in existing health policy research. This study explores the relationship between evidence use and inclusive, accountable decision-making in vaccine policymaking in Kenya.

Methods: I adopted a qualitative multiple case study approach, focusing on the introduction and roll-out of Human Papilloma Virus and malaria vaccines in Kenya. I collected data through document review, in-depth interviews, and observations. I analysed data using framework approach.

Results: International guidelines reinforced the generation and use of scientific evidence, while local unconventional evidence was valuable in validating and contextualizing guidelines and scientific evidence. Civil society contributions—both scientific and unconventional—helped integrate local socio-cultural values often overlooked by national vaccine policymakers. Actor inclusion and power practices of domination and collaboration often strengthened the voice and evidence from international partners, Ministry of Health, academic and medical professionals during vaccine issue prioritization and policy formulation stages. However, local politicians and civil society leveraged on power during vaccine roll-out stage to negotiate or contest the evidence used in earlier vaccine policy stages. Immunization managers strengthened accountability within the government by using and sharing performance evidence upwards to senior government officials and donors. However, accountability to the public was limited because of the exclusion of civil society and limited transparency of the processes of performance evidence generation, sharing, and use.

Conclusion: The use of evidence in vaccine policymaking in Kenya both promoted and hindered inclusive and accountable decision making. Strengthening the legitimacy and impact of evidence used in health policymaking may require broad conceptualization of evidence, diverse stakeholder inclusion, and increasing transparency in processes of evidence generation, dissemination, and use.