Integrating COVID-19 vaccination into routine healthcare: a feasible model for epidemic response at mildmay hospital Uganda

Abstract

Introduction

As the Coronavirus Disease 2019 (COVID-19) pandemic overwhelmed healthcare systems globally, integrating vaccination into primary health services became essential to expedite immunization efforts, especially in resource-constrained settings. This report explains the multifaceted process of integrating COVID-19 vaccination services at Mildmay Hospital Uganda (MUgH), focusing on the strategies, challenges and outcomes associated with this project.

Methods

MUgH, a general hospital in Uganda, implemented COVID-19 vaccination services between March 2021 and December 2022. Using the 7 S framework; Structure, Systems, Shared Values, Skills, Style, Staff, and Strategy, the hospital aligned resources effectively. Structure was strengthened by creating dedicated vaccination areas, optimized Staff through targeted training, and aligned Skills for task-specific roles. Strong Systems ensured streamlined vaccine administration, while strategic Style (management) fostered adaptability. Collaborations with the Wakiso District unit supported Shared Values for public health, and social media was used effectively to counter misinformation and engage the community.

Results

MUgH successfully administered 13,370 of 15,000 available COVID-19 vaccine doses, including 8,906 first doses, 3,568 s doses, and 84 boosters. MUgH’s collaborative approach, reinforced by targeted media engagement and strategic partnerships with local vaccine distributors, secured a steady vaccine supply and built public trust. This demonstrated the value of a resource-efficient and adaptable model in addressing community healthcare needs. Key challenges included labour-intensive shifts, task-shifting among staff, misinformation and hesitancy, occasional vaccine stock-outs, and managing demand from ineligible individuals.

Conclusion

Integrating COVID-19 vaccination into MUgH services using the 7 S framework proved effective in enhancing healthcare resilience and public health. This adaptable model offers valuable insights for strengthening health systems and preparing resource-limited settings for future epidemic responses.

Introduction

The COVID-19 pandemic, declared by the World Health Organization (WHO) as a Public Health Emergency of International Concern in January 2020 and later a pandemic in March 2020 [1], reshaped global health priorities. With over six million lives lost worldwide [2], and a significant number of fatalities in Uganda, surpassing 3,000 [2], the pandemic highlighted the vulnerabilities within healthcare systems, particularly in resource-limited settings [3]. Uganda, like many low-income countries, faced challenges balancing preventive measures, economic constraints, and the ambitious goals of the United Nations Sustainable Development Goals (SDGs), established in 2015 [4–6]. Addressing this pandemic required a multi-faceted response, relying heavily on evidence-based approaches and trust in healthcare systems.

Before the COVID-19 pandemic, Uganda managed epidemics with international support, such as the response to Ebola, which mobilized resources from global partners [7, 8]. However, COVID-19 required a different approach, as countries that would typically assist were themselves overwhelmed [2, 9, 10]. The pandemic exposed the gaps in healthcare systems globally, but it also emphasised the importance of rapid response, integration, and resource optimization in healthcare, particularly for public health emergencies. Uganda’s Ministry of Health implemented early measures to prevent viral spread, including immediate border closures, face mask mandates, hand sanitization, and physical distancing [11]. Days later, a total lockdown of the country was imposed to further restrict movements and curb the transmission of the virus [12]. When COVID-19 vaccines became available, the decision to integrate vaccination services into existing healthcare structures like MUgH was informed by stakeholder discussions and prior experience with routine immunization. Leveraging existing infrastructure ensured efficient service delivery, overcoming challenges that standalone vaccination programs often face in achieving widespread coverage. MUgH, a multidisciplinary general hospital known for family-centered care and extensive involvement in HIV prevention, care, and treatment, was ideally positioned to implement this campaign. Its expertise and existing structure in maternal and childhood immunization program allowed for a relatively seamless adaptation to support COVID-19 vaccination [13].

This report details MUgH’s integration of COVID-19 vaccination services using the 7 S framework, highlighting key elements, challenges, and recommendations that contribute to an adaptable model for epidemic response in resource-limited settings.

The 7 S approach was particularly relevant to our context as it allowed us to systematically assess and align Strategy, Structure, Systems, Shared Values, Skills, Style, and Staff, ensuring a cohesive and sustainable integration process within MUgH. Given our objective to document implementation processes and key lessons, this model provided a structured framework for understanding the organizational adjustments required for successful integration.

Methodology

Context and preparatory steps for integration

Before integrating COVID-19 vaccination services, MUgH was already well-established as a multidisciplinary healthcare facility with a strong foundation in routine immunization and primary healthcare. The hospital’s longstanding maternal and childhood immunization program provided a solid foundation for expanding services to include COVID-19 vaccination.

MUgH’s preexisting infrastructure supported the rapid adaptation required for COVID-19 vaccine distribution. The hospital was equipped with temperature-controlled storage facilities, critical for maintaining vaccine potency, and had access to portable vaccine carriers to ensure cold chain integrity during outreach activities. Additionally, MUgH’s workforce included midwives, nurses and other healthcare staff who were already trained in immunization protocols, patient interaction, and community engagement.

To prepare for the integration, MUgH focused on identifying and addressing specific logistical needs, including designating dedicated spaces for COVID-19 vaccination within the hospital to streamline patient flow and reduce the risk of viral exposure. Staff were also provided with additional training focused on COVID-19 vaccine specifics, adverse event management, and strategies to counter vaccine hesitancy. By leveraging its existing resources and adapting its infrastructure and staff expertise using the 7 S framework, MUgH was able to integrate COVID-19 vaccination services effectively.

MUgH initiated its COVID-19 vaccination program in March 2021, receiving the first vaccines after Uganda had received COVID 19 vaccines through the COVID-19 Vaccines Global Access (COVAX) facility [14]. The initial doses were prioritized for healthcare workers, the elderly, frontline responders, teachers, and individuals with comorbidities, consistent with the Ministry of Health guidelines [11].

Key elements of integration

Recognizing the limitations in a healthcare system that primarily focused on routine childhood and maternal vaccinations, MUgH needed a comprehensive plan to scale its resources for COVID 19 epidemic response through vaccination. The integration of COVID-19 vaccination at MUgH was guided by McKinsey & Company’s 7 S Framework [15], a strategic management model comprising Strategy, Structure, Systems, Shared Values, Skills, Style, and Staff. This approach not only addressed practical vaccine delivery needs but also ensured the effective alignment of resources and capabilities toward strategic goals. This model is known to foster performance, cultural transformation, and efficiency across sectors, enhancing organizational adaptability and sustained success [16] which was pertinent in this integration process.

The key elements for integration included the following:

Identification and training of staff

Following the 7 S framework, MUgH focused on building relevant skills and developing staffing roles specifically for the campaign, fostering trust and efficiency within the team. MUgH identified and trained a dedicated team with expertise in vaccination protocols, patient communication, and adverse event management. Training covered vaccine handling, cold chain maintenance, and countering vaccine hesitancy. This structured approach allowed staff to adapt to their roles effectively, improving confidence in the vaccination process and enhancing patient trust in the care provided.

Designation of vaccination areas

Recognizing the need for a clear, structured system in place, MUgH designated specific zones within the hospital for COVID-19 vaccination. This setup ensured vaccinees’ comfort and facilitated efficient vaccinees’ flow, especially during peak demand. The hospital’s structure was further optimized by expanding waiting areas to accommodate increased vaccinee numbers safely and minimizing infection risks. By leveraging the hospital’s layout and flexible resources, MUgH created a well-coordinated, client-friendly vaccination environment. This element addressed Structure and Systems, optimizing space for efficient vaccine administration.

Strengthened collaboration with district vaccine distributors

Reliable supply chain management is critical in any vaccination campaign. To this end, MUgH established a close partnership with Wakiso District vaccine distributors, ensuring seamless communication and regular updates on vaccine availability. This collaborative strategy reinforced their approach to supply chain management, allowing MUgH to anticipate and mitigate supply shortages proactively. The open channels of communication also facilitated the hospital’s systematic approach to handle sudden fluctuations in vaccine availability, supporting a responsive vaccination program that could meet community demand with minimal interruptions. This element aligned with Systems and Shared Values, ensuring a reliable vaccine supply chain.

Community engagement and public education

Given the high levels of misinformation and vaccine hesitancy, community engagement and public education were central to MUgH’s integration strategy. Alongside the Ministry of Health’s (MoH) risk communication guidance, MUgH’s communications department utilized social media, radio, and community-based information systems to disseminate accurate vaccine information and counter misinformation. The messaging was strategically developed using materials from the MoH risk communication department, ensuring consistency and credibility in public health communication efforts. Additionally, the hospital expanded its outreach campaigns to raise awareness about the importance of vaccination, dispel misconceptions, and manage potential vaccine hesitancy. Following the 7 S model’s shared values and style components, the hospital aligned these communication efforts with its patient-centered care philosophy, fostering community trust. MUgH’s advocacy efforts helped overcome barriers to vaccine acceptance, ultimately enhancing uptake and strengthening public confidence in the healthcare system.

Risk mitigation plans

MUgH implemented detailed risk mitigation plans as part of its integrated approach, ensuring preparedness for unforeseen challenges. This element leveraged Systems, strategy and Style, maintaining service continuity through proactive strategies and structured response protocols. The hospital prepared for potential challenges such as vaccine shortages, staffing needs, or adverse reactions by developing standard operating protocols for rapid response and contingency plans such as back up staff with clearly detailed roles to ensure seamless continuity. These proactive measures ensured that MUgH could maintain service continuity even when unforeseen issues arose. The systems element of the 7 S framework encompassing organizational policies and workflows was instrumental in preparing the team to respond to these challenges without disrupting vaccination services, ultimately supporting the campaign’s long-term success.

Results and lessons learned

The integration of COVID-19 vaccination into routine healthcare at MUgH provided a resilient model for epidemic response in resource-limited settings. Utilising the McKinsey 7 S framework as a strategic guide, showcased the importance of aligning organisational elements for effective healthcare delivery during pandemics; and further demonstrated that integrating vaccination into routine services is feasible, even in a resource-limited setting.

From March 2021 to December 2022, MUgH successfully administered 13,370 of 15,000 available COVID-19 vaccine doses, including 8,906 first doses, 3,568 s doses, and 84 boosters. The integration effort provided several key lessons:

1. Collaboration and Partnerships: Strong partnerships with all relevant stakeholders supported MUgH to maintain a steady vaccines supply. Sustained partnerships with district vaccine distributors and government agencies facilitated reliable vaccine supply and logistical support. Strengthening such collaborations and incorporating predictive supply chain analytics could improve preparedness for future demands.

2. Community Engagement: Social and mainstream media effectively countered misinformation, raised awareness, and encouraged vaccine uptake. Partnering with community leaders further enhanced public trust in vaccination.

3. Workforce Capacity management: Task shifting, and targeted training enabled MUgH to meet high vaccine demand without compromising other services. Continuous psychosocial support for staff remains essential to prevent burnout. Ongoing training and mentorship programs tailored to new public health challenges ensure that staff remain adaptable and competent. Integrating modular training that can be rapidly deployed will help future-proof healthcare responses.

4. Facility Layout Optimization: Designating vaccination areas and expanding waiting spaces facilitated patient flow, minimized crowding, and adhered to safety protocols. Flexible infrastructure planning should be a standard part of epidemic response strategies to ensure that healthcare facilities can quickly scale up or adapt as needed.

Implementation challenges

Despite its successful implementation, MUgH encountered several challenges in integrating COVID-19 vaccination services. These challenges, aligned with the 7 S framework, are detailed below:

1. Misinformation and Vaccine Hesitancy (Shared Values, Style): Continuously circulating misinformation fuelled public scepticism further complicating efforts to boost vaccine uptake.

2. Increased Workload and Task Shifting (Staff, Skills): Healthcare workers were required to take on additional responsibilities beyond their typical duties, raising concerns about burnout and necessitating careful workload management.

3. Vaccine Stock-Outs (Systems, Structure): Disruptions in the supply chain led to occasional vaccine shortages, impacting vaccination schedules and frustrating the public.

4. Managing Demand from Ineligible Individuals (Strategy, Style): Increased outreach attracted some ineligible individuals seeking vaccination other than the high-risk groups as guided by MOH which caused frustration among these individuals.

Discussion

This report highlights the successful integration of COVID-19 vaccination into existing health services at MUgH through the application of the McKinsey 7 S Framework. Aligning strategy, structure, systems, staff, skills, shared values, and style, MUgH ensured that service delivery remained responsive, cohesive, and resilient during a public health emergency. The 7 S framework offered a structured lens to examine not only operational elements such as staff capacity and supply chain systems, but also the softer dimensions leadership style and shared institutional values which are often overlooked but critical for integration success.

Previous literature consistently highlights that in resource-limited settings, where health systems are frequently overstretched and face significant challenges, integration emerges as a fundamental strategy for ensuring sustainable and efficient service delivery. Leveraging existing resources, improving coordination, and maximizing impact, integrated approaches not only optimize the utilization of available health infrastructure but also strengthen the resilience of these systems in the face of ongoing pressures [17–19]. The MUgH experience illustrates how a well-structured integration model can expand access and availability of essential services without compromising quality or efficiency. Embedding risk communication within national Ministry of Health messaging and leveraging trusted community-based platforms played a key role in addressing misinformation and building public confidence in the vaccination effort.

Despite the qualitative nature of this study, our findings highlight that strategic alignment across all seven elements was essential to minimize service disruptions and maintain public trust. Notably, embedding risk communication within existing Ministry of Health guidance and leveraging community-based platforms proved instrumental in countering vaccine hesitancy and misinformation.

The 7 S Framework provided a structured approach for integrating COVID-19 vaccination into MUgH’s existing healthcare services; however, its application also presented certain limitations. Its qualitative nature made it difficult to measure the direct impact of integration using data-driven metrics, limiting the ability to assess vaccination coverage rates or health outcomes quantitatively. Additionally, the interdependencies among the seven elements meant that changes in staffing, training, or facility structure influenced other components, requiring careful coordination. The framework’s internal focus emphasized organizational alignment but did not fully account for external factors such as vaccine supply chain disruptions or broader policy influences. The successful application of the framework at MUgH relied heavily on strong leadership and commitment, which may not always be replicable in other resource-limited settings. Despite these limitations, the 7 S Framework served as a valuable tool for structuring the integration process and aligning organizational components to ensure a coordinated and sustainable vaccination program within MUgH.

Conclusion

Mildmay Hospital Uganda’s integration of COVID-19 vaccination services offers a scalable model for epidemic response in resource-limited settings. Employing the 7 S framework while leveraging existing infrastructure, skilled staff, and community outreach enabled MUgH to meet vaccination demands and strengthened its system resilience. This experience highlights the importance of embedding emergency response within routine healthcare, particularly in low-income regions. Addressing challenges like staff fatigue, supply chain issues, and demand fluctuations, MUgH’s approach highlights how adaptable, resource-efficient healthcare models are essential for managing future global health crises effectively.

Abbreviations

COVID-19

Coronavirus Disease 2019

COVAX

COVID-19 Vaccines Global Access

HIV

Human immunodeficiency Virus

MUgH

Mildmay Hospital Uganda

MOH

Ministry of Health

WHO

World Health Organization

SDGs

Sustainable Development Goals

Author contributions

Conceptualization and drafting were led by CA*, SC, NI, SN, and YK. Review and editing were carried out by VN, FLM, JM, SN, LW, RM, and YK. Final document review was conducted by CA*, SC, NI, SN, JM, and YK. All authors reviewed and approved the final version.

Funding

There was no funding to report.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This report did not involve human participants or the use of data from a publicly accessible database. As such, informed consent and institutional ethics approval were not applicable. No experimental protocols involving human subjects were conducted. Nonetheless, the report adheres to the ethical principles outlined in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.