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Article History

Received: 9 December 2025

Accepted: 7 April 2026

First Online: 19 April 2026

Declarations

:

: Ethical approval for this study was obtained from the Kenya Medical Research Institute (KEMRI) Scientific Ethics Review Unit (SERU) prior to the start of the study (KEMRI/SERU/CGMRC-C/290/4707). Informed consent was provided before each interview.

: Not applicable.

: The authors declare no competing interests.

: The research team comprised two women and two men, all working in low- and middle-income country settings. The lead author is a PhD student with prior experience in policy-engaged research, and the three co-authors were senior researchers with established expertise in health systems and qualitative methods. The team’s positionalities, across gender, career stage and professional background, shaped how the study questions were framed and how data were interpreted. The authors’ familiarity with LMIC policy environments facilitated access to participants and informed the analytic lens, while ongoing discussion within the team was used to reflect on assumptions, mitigate individual biases and ensure that multiple interpretations were considered throughout the study.