Background: Pneumonia is a main cause of under-five mortality in
low-income settings. The pneumococcal conjugate vaccine (PCV) has been
introduced in many countries as a tool in the disease\u2019s
prevention. Although PCV\u2019s effectiveness has been established,
less is known about the effects of introducing additional injectable
vaccines into routine immunisation programmes, particularly in the
context of resource-constrained settings. Objectives: To explore the
effects of PCV introduction on the immunisation programmes and health
systems in four low-income countries. Methods: This study was carried
out in Cameroon, Ethiopia, Kenya and Mali. Three to four regions and
nine to 10 districts were selected within each country. Semi-structured
interviews were carried out at national, regional and district levels
(n=173). Researcher-administered questionnaires were completed with
facility staff (n=124). Routine data on monthly vaccination activities
were collected at district and facility levels. Results: PCV was
generally well integrated into existing routine immunisation. Little or
no impact was found in most areas of the health systems. Some minor
effects were found on immunisation programmes, particularly in areas
with either planning activities or investments e.g. staff skills were
strengthened and there were limited improvements in surveillance.
Although health sector workers perceived increases in the coverage of
other vaccines following the introduction of PCV, routine service data
did not confirm this claim. No substantial impacts were seen in health
system management, service delivery or performance. Conclusions: The
introduction of PCV had marginal impacts on the Expanded Programme for
Immunisation and little to none on broader health systems