When Everyone Comes, So Do the Unseen: Kenya’s UHC Pilot and the Unexpected Reach of Routine Immunization

Background: Immunization is a critical component of primary health care and a key driver of Universal Health Coverage (UHC). Yet, many low- and middle-income countries, including Kenya, face persistent challenges in sustaining the financing of immunization programs. As countries shift toward UHC, there is growing concern that broader health financing reforms may not strengthen and could even weaken dedicated funding for immunization. This study examines Kenya’s UHC pilot to explore whether the move toward UHC risks displacing resources currently allocated to immunization, particularly at the county level. Methods : Data were collected between June and July 2021 through in-depth interviews and focus group discussions with key informants across four UHC pilot counties in Kenya. An inductive thematic analysis was used to interpret the qualitative data, utilizing Dedoose software (Version 9.0.17) to facilitate systematic analysis. Identify patterns and themes related to immunization financing at the subnational level. Results: The implementation of UHC increased access to healthcare services, which in turn raised the demand for immunization. However, funding for operational aspects of immunization faced several obstacles. These included insufficient funding that limited outreach efforts, logistical issues, and shortages of human resources. Counties also experienced periodic stockouts of specific antigens and syringes, which were worsened by the limited financial independence of health facility managers. These service disruptions were partly mitigated by additional support from development partners, supplementing government and Gavi funding sources. Conclusion: The UHC pilot had various impacts on funding for immunization services. When services are free, families are more likely to seek care and often bring unvaccinated children with them. This suggests that removing financial barriers could be a powerful strategy for reaching zero-dose children. However, realizing this potential through UHC requires stronger county-level planning and coordination across the government to ensure sustainable financing for immunization services. Further research is needed to assess how to mitigate the impact of UHC reforms on immunization, especially for underserved populations.