Assessing Coverage and Timeliness of the Second-Dose HPV Vaccine in School-Based Programmes for Adolescent Girls in Kigali, 2020: A Policy Analysis

School-based human papillomavirus (HPV) vaccination is a cornerstone of cervical cancer prevention in sub-Saharan Africa. High coverage and timely administration of the two-dose schedule are essential for effective population protection. This policy analysis aimed to assess the coverage and timeliness of the second HPV vaccine dose delivered through the school-based programme for adolescent girls in Kigali. It sought to identify systemic facilitators and barriers influencing these outcomes. A desk-based policy analysis was conducted. This involved a review of national immunisation policy documents, programme reports, and grey literature. A framework approach was used to evaluate programme design, implementation processes, and monitoring systems against stated policy objectives. Second-dose coverage was substantially lower than first-dose coverage, indicating a significant drop-out rate. A principal barrier was the absence of a robust tracking and recall system for girls due for their second dose, especially those absent on vaccination days. Over-reliance on school attendance as the delivery platform was a noted vulnerability. While the policy framework for HPV vaccination in Kigali is established, implementation gaps prevent high, timely second-dose coverage. Strengthening dose-tracking and developing strategies to reach out-of-school girls are critical. Key recommendations include: integrating a digital child-based tracking system into the national immunisation programme; developing and resourcing specific outreach strategies for absent girls; and enhancing data collection on vaccination timeliness for improved programme evaluation. HPV vaccination, immunisation programmes, school-based health services, adolescent health, health policy, cervical cancer prevention, programme evaluation This analysis provides evidence for policymakers and programme managers on specific systemic weaknesses affecting second-dose HPV vaccine coverage, offering direct guidance for strengthening programme implementation.