Background The Ghana-based SAVING consortium aims to identify and address implementation challenges for the delivery of new medical interventions, such as RTS,S, the malaria vaccine introduced in Ghana in 2019. Inoculation is at 6, 7, 9 and 24 months of age. The lifesaving potential of the vaccine can be limited by its effectiveness and implementation issues.

Methods In November 2022, a qualitative study, employing in-depth interviews of five managers, three health workers and two community health volunteers was performed on: steps and challenges in introducing RTS,S; acceptability of RTS,S among health workers and community members; vaccine coverage.

Results There was a cascade training approach on RTS,S in the 10 districts that received RTS,S; the national centre trained staff at regional level. The region then trained the districts, which then trained the frontline healthcare workers and widely informed the population about RTS,S. In general, the training was perceived as adequate and well deployed. Acceptance of RTS,S by the healthcare workers and the population was good in spite of some misconceptions and a low perceived need for the vaccination. Awareness among the population and one health worker about the low level of effectiveness of the vaccine was limited. Vaccination coverage for the 4th dose of RTS,S was 40.1% among the eligible children (as of June 2022). A large drop-out rate between dose 3 and 4 was observed.

Use of the Med Safety Mobile App: the Regional Health Administration/Directorate introduced this MedApp in collaboration with the Food and Drug Authority. The motivation of the health delivery system to make full use of the MedApp was limited. In the visited district hospital, the MedApp was not being used.

Conclusion The encountered challenges are common to other vaccines, including COVID-19 vaccines. Governments and stakeholders should take note of the existing evidence to anticipate these issues.