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Michel Kabamba Nzaji,1 Anselme Manyong Kapit,1 Kristen B Stolka,2 Shanice Fezeu Meyou,2 Charlie K Kasendue,3 Melissa Dahlke,4 Robert T Perry,4 Reena H Doshi,4 Brooke Noel Aksnes,4 Richard R Luce,3 Stephane Hans Bateyi Mustafa,5 Crispin Kazadi Mwina-Ngoie,5 Cikomola Mwana Wa Bene Aimé,5 Pia DM MacDonald,1,6 Claire J Standley7,8 1Social, Statistical, & Environmental Sciences, RTI International, Kinshasa, Democratic Republic of the Congo; 2Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, NC, United States America; 3Division of Global Health Protection (DGHP), U.S. Centers for Disease Control and Prevention (CDC), Kinshasa, Democratic Republic of the Congo; 4Global Immunization Division (GID), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States America; 5Expanded Programme on Immunization (EPI), Ministry of Public Health & Hygiene, Kinshasa, Democratic Republic of the Congo; 6Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States America; 7Center for Global Health Science and Security, Georgetown University, Washington, DC, United States America; 8Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, GermanyCorrespondence: Michel Kabamba Nzaji, RTI International, Social, Statistical, & Environmental Sciences, Kinshasa, Democratic Republic of the Congo, Tel +243978467432, Email michelnzaji@yahoo.frBackground: Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response.Objective: The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level.Methods: Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation.Results: The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19– 22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response.Conclusion: This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.Keywords: COVID-19, intra-action review, COVID-19 vaccination, public health preparedness and response, Democratic Republic of Congo, public health emergency management