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Background <p>Despite significant immunization achievements, including polio-free certification and neonatal tetanus elimination, the Democratic Republic of the Congo (DRC) continues to face persistent challenges in its Expanded Programme on Immunization (EPI), particularly in governance, structure, and performance. This study aimed to evaluate the institutional and functional capacities of the DRC’s EPI to guide reforms in line with the WHO Immunization Agenda 2030 and the evolving health system context.</p> Methods <p>A qualitative exploratory case study was conducted between November 2024 and February 2025. The audit employed an adapted version of the Participatory Institutional Capacity Assessment and Learning (PICAL) tool to evaluate six critical dimensions of organizational capacity across related indicators. Data were collected through 74 in-depth interviews, six focus group discussions, and a documentary review of over 40 official documents. Fieldwork was conducted at the national level and in three provinces. Thematic qualitative analysis was carried out using NVivo 15, with a hybrid inductive-deductive coding approach.</p> Results <p>This study revealed systemic and cross-cutting organizational deficits across all six capacity dimensions. Consensus scores from the adapted PICAL tool averaged 54% at the national level and 56% in provinces, reflecting insufficient institutional capacity. Core challenges identified include (i) outdated legal and organizational frameworks and overlapping responsibilities; (ii) understaffing of critical services such as cold chain management; (iii) poor administrative data quality and arbitrary decision-making; (iv) overcrowded offices, lack of reliable transportation and maintenance shortfalls with broken refrigerators on the field; (v) reliance on external funding threatening the programme’s financial sustainability; (vi) acute needs in capacity building in cold-chain maintenance and technical immunization programme management.</p> Conclusions <p>The audit underscores the urgent need to reconfigure the DRC’s EPI institutional foundation to meet evolving public health needs and to align with decentralization and IA2030 priorities. Updating the legal framework, redefining roles and responsibilities, harmonizing human resources, and enhancing integration with the national health system are critical steps toward a more resilient and high-performing immunization programme. The findings provide actionable recommendations for policy and operational reforms to support sustainable vaccination coverage in the DRC.</p>

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Institutional and organizational capacity assessment of the expanded programme on immunization in the democratic Republic of the Congo

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Dosithée Ngo-Bebe,
  • Fulbert Nappa Kwilu,
  • Etienne Mwokozi Bwira,
  • Landry Mongondi Egbende,
  • Viviane Masiala Mayala,
  • Yannick Kabadi Musawu,
  • Epiphane Mabanza Ngumbu,
  • Alexandre Kanyama Bukasa,
  • Branly Kilola Mbunga,
  • Théophane Kekemb Bukele

摘要

Background

Despite significant immunization achievements, including polio-free certification and neonatal tetanus elimination, the Democratic Republic of the Congo (DRC) continues to face persistent challenges in its Expanded Programme on Immunization (EPI), particularly in governance, structure, and performance. This study aimed to evaluate the institutional and functional capacities of the DRC’s EPI to guide reforms in line with the WHO Immunization Agenda 2030 and the evolving health system context.

Methods

A qualitative exploratory case study was conducted between November 2024 and February 2025. The audit employed an adapted version of the Participatory Institutional Capacity Assessment and Learning (PICAL) tool to evaluate six critical dimensions of organizational capacity across related indicators. Data were collected through 74 in-depth interviews, six focus group discussions, and a documentary review of over 40 official documents. Fieldwork was conducted at the national level and in three provinces. Thematic qualitative analysis was carried out using NVivo 15, with a hybrid inductive-deductive coding approach.

Results

This study revealed systemic and cross-cutting organizational deficits across all six capacity dimensions. Consensus scores from the adapted PICAL tool averaged 54% at the national level and 56% in provinces, reflecting insufficient institutional capacity. Core challenges identified include (i) outdated legal and organizational frameworks and overlapping responsibilities; (ii) understaffing of critical services such as cold chain management; (iii) poor administrative data quality and arbitrary decision-making; (iv) overcrowded offices, lack of reliable transportation and maintenance shortfalls with broken refrigerators on the field; (v) reliance on external funding threatening the programme’s financial sustainability; (vi) acute needs in capacity building in cold-chain maintenance and technical immunization programme management.

Conclusions

The audit underscores the urgent need to reconfigure the DRC’s EPI institutional foundation to meet evolving public health needs and to align with decentralization and IA2030 priorities. Updating the legal framework, redefining roles and responsibilities, harmonizing human resources, and enhancing integration with the national health system are critical steps toward a more resilient and high-performing immunization programme. The findings provide actionable recommendations for policy and operational reforms to support sustainable vaccination coverage in the DRC.