African immunization supply chains need to be transformed. Between 2010 and 2020, new vaccine introductions will quadruple the storage volume of vaccines required per immunized child. The number of vaccine doses that health workers will order, track, and administer is increasing six-fold. Evidence from Effective Vaccine Management (EVM) assessments in 70 developing countries found that in nearly all countries, immunization supply chains are not functioning well enough to ensure vaccine availability and potency and to meet coverage targets. Worse, only a few countries have prioritized supply chain strengthening as a strategy to strengthen immunization program performance.
The future of immunization supply chains was the topic of an evening dialogue at the January 25-29, 2016 “Exchange of best practices workshop on Reaching Every Community (REC); Equity and Integration of Child survival interventions in East and Southern African Countries” in Cape Town, South Africa. The key theme of the meeting was to support the increase of coverage for immunization and child survival interventions through the reaching every community/child approach.
This evening session, organized by John Snow, Inc. in collaboration with PATH, featured a panel of EPI officials from four African countries that are transforming their public health supply chains to accommodate the increasing demands on these supply chains from immunization and other health programs. Each of the four panelists discussed ongoing changes in their country supply chains; their key points are highlighted below.
From Ethiopia, Nafkot Abadura, an EPI Officer in the Ministry of Health, highlighted the central role of the Pharmaceutical Fund and Supply Agency (PFSA), which is mandated to procure, store and distribute medicines and medical supplies, including vaccines from Addis Ababa to a series of hub warehouses and then directly to health facilities or districts. PFSA has started integrating vaccines in three of the biggest regions—Oromia, Amhara and Tigray—with the remaining regions to be added during a second phase. To strengthen the cold chain system, PFSA has procured cold trucks for distributing vaccines from the center to the hubs, and added cold rooms at their central cold store regional hubs. The MOH has also procured, and PFSA is distributing 2,000 solar direct drive (SDD) refrigerators, and additional SDD refrigerators are in the pipeline. PFSA’s electronic management information system is implemented in all of PFSA’s hubs and in all the districts of one region, as well as in over 500 facilities.
From Uganda, Henry Luzze, the MOH’s Deputy Manager, discussed the 2013 decision to transfer responsibility for the distribution of vaccines from EPI to the parastatal National Medical Stores (NMS). NMS now distributes vaccines from the center to the districts each month, and districts have been supplied with vehicles to distribute to their health facilities. Since NMS took over vaccine distribution, there has been a significant reduction in vaccine stock-outs at health facilities, leading to increased immunization coverage and reductions in missed opportunities. With financial support from Gavi, the country has also addressed cold chain capacity; 12 walk-in cold rooms were installed at NMS and over 600 refrigerators and freezers have been installed in districts and health facilities. Hard to reach areas and those without power have been supplied with solar powered refrigerators. The districts have also recruited new cold chain technicians to conduct preventive maintenance and make minor repairs.
In Mozambique, Graça Masinhe, EPI Manager, discussed the use of modeling to guide distribution planning for Rotavirus vaccine, and the optimized distribution of vaccines from province level to health facilities through an informed push, direct delivery system in six (out of 11) provinces. This optimized system has improved vaccine availability, while enabling more timely supply chain data collection, site supervision, and minor cold chain equipment maintenance. Graça noted that the MOH also undertook a national cold chain inventory to assess cold chain needs; the results guided the allocation of 600 cold rooms and refrigerators (including solar direct drive) across the system, ensuring adequate cold chain storage capacity in the most remote areas. The MOH also distributed cold chain temperature monitoring devices (30 day data loggers), which allow for monitoring historic temperatures, and remote temperature monitoring devices for real time monitoring using an alarm system. In conjunction with Central Medical Stores, EPI is piloting a distribution system in one province in which vaccines are integrated with the delivery of essential medicines.
Tanzania’s EPI Program Manager Dafrossa Lyimo talked about the current efforts to improve data visibility for the vaccine supply chain and to strengthen the cold chain. A web-based stock management tool was deployed at all regional and district cold stores, but the functionality is now being transferred and extended in a new vaccine information management system (VIMS) module within Tanzania’s integrated electronic logistics management information system (eLMIS). With launch expected within the next few months, VIMS will capture all routine data reported by the District Vaccine Data Management Tool, as well as stock data and cold chain inventory and status, and will exchange data with DHIS2 to avoid redundant reporting. VIMS will also accommodate data from temperature monitoring devices and bar code scanners and will help guide cold chain technicians in monitoring cold chain equipment performance and maintenance schedules.
As these examples show, supply chain innovation is happening in Africa, and there are valuable lessons to be shared among countries. The impact of these changes will take time because scale-up takes time, but innovation, even transformation, begins when governments, programs, and development partners embrace and commit to real change.
Read: “Next-Generation Immunization Supply Chains are Needed to Improve Health Outcomes” a set of key messages for policy makers and advocates for immunization supply chains developed by JSI in partnership with PATH, the Bill & Melinda Gates Foundation, Gavi, and VillageReach