A Sociotechnical Systems Analysis of Vaccine Accessibility for Young Mothers in a Kenyan Referral Hospital
Abstract
Public health vaccination programmes evaluate access through coverage metrics, treating the clinic as a neutral delivery point. This paper argues that in/accessibility for young mothers is systemic, produced by the configuration of the sociotechnical system constituting the maternal and child health clinic. This paper draws on a systems science perspective grounded on assemblage ethnography guided by Actor-Network Theory, conducted at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya in 2026. The paper maps human and non-human system components and analyses how interactions generate in/equities for young mothers aged 18 to 24. Seven component categories are identified: spatial configurations, documentary artefacts, cold-chain infrastructure, procedural instruments, informational materials, cultural protective objects, and post-vaccination pharmaceuticals. Each is an active system element whose feedback dynamics determine whether vaccination is genuinely or merely formally available. The weighing scale processes anthropometric data through a Z-score mechanism with no human override. The clinic booklet depends on literacy, a property the system design ignores. Post-vaccination care depends on purchasing capacity that informal settlement mothers do not uniformly possess. A pharmacy closure redirected vaccinated infants through a general outpatient area, a design failure with epidemiological consequences. Equity failures are structural, produced by assemblage configuration rather than individual actors. Redesign, specifically relocating pharmacy services, integrating antipyretics into the free package, sharing anthropometric data with mothers, and producing materials in the community language, addresses these failures directly. The paper demonstrates that systems science offers a practical diagnostic and redesign framework for healthcare delivery constraints in low-resource settings.
