The implementation of vaccination campaigns for COVID-19 in primary healthcare centres in Bamako, Mali

Despite the unprecedented speed of COVID-19 vaccine development, vaccination coverage in Mali was low. Research has primarily focused on individual vaccine hesitancy, overlooking systemic issues related to the implementation of vaccination in health facilities. This article analyses the implementation of Mali’s national vaccination strategy in 2021 and 2022 to understand the challenges associated with COVID-19 vaccination coverage and the lessons learned. The study employed a qualitative approach. Data collection involved field observations (n = 15 days) and semi-structured interviews (n = 57) conducted at two Primary Health Centres ( Centres de Sante Communautaire , or CSComs) in Bamako, Mali. The analysis utilised a conceptual quality implementation framework to identify factors that influenced the successes or limitations of the campaign. Vaccination campaigns intensified gradually between 2021 and 2023. The implementation used a top-down approach controlled mainly by the staff of the Health District. The limited involvement of CSComs in key vaccination activities (planning, capacity building, supervision) prompted them to develop adaptation strategies to meet their assigned objectives. The analyses showed that the implementation of the national vaccination strategy did not have the same intensity depending on the quality phases of implementation. The CSComs conducted very few evaluation activities. We cannot fully understand vaccine coverage without a thorough analysis of implementation mechanisms. This study highlights the importance of building local capacity, customising strategies to fit community realities, and enhancing documentation of field practices for future public health interventions.