Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya.MethodsA micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel®, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated.ResultsIn Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future

The status of vaccine availability and associated factors in Tshwane government clinics

Vaccines have greatly contributed to the control of vaccine preventable diseases. The adoption of the Decade of Vaccines (DoV) by the World Health Assembly in 2011 is an indication of how the global community values the benefits of vaccines. Efforts by many countries to introduce new vaccines are a significant move towards attaining this vision. However, new vaccines put strain on vaccine supply chains. The immunization programme in South Africa has similar challenges, with indications of vaccine stock outs in clinics since the introduction of three new vaccines in 2009. This study set out to establish the status of availability of vaccines in Tshwane government clinics and associated factors. Method: A cross-sectional study was conducted in a sample of randomly selected government clinics in Tshwane health district of Gauteng province. Data was collected using a structured measurement instrument during a visit to each of the participating clinics. Data was collated and analysed using excel based software. Results: A total of 31 clinics participated. In the preceding 12 months, clinics experienced vaccine stock outs, especially of the 3 new vaccines: pneumococcal conjugate vaccine (PCV), rotavirus (RV) vaccine and Pentaxim ®. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock outs were: poor management of stock, depot out of stock, unreliable deliveries, lack of pharmacy assistants, and limited fridge capacity. Further burdening the situation is the emergency ordering system that does not function effectively. Conclusion: Significant vaccine shortages occur in Tshwane government clinics. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology. Urgent measures should be taken to address the identified causes of stock outs including ensuring reliable deliveries of stock and emergency orders

Challenges in the logistics management of vaccine cold chain system in Ile-Ife, Osun State, Nigeria

Background: The success of national immunization programmes depends largely on effective logistics management of the vaccine cold chain system. This study assessed cold chain equipment functionality, healthcare workers’ knowledge and practice of the logistics management of vaccine cold chain system in Ile-Ife, Nigeria.Methods: A descriptive study was conducted in immunization clinics of 35 health facilities in Ife East and Central Local Government Areas (LGA) in Ile-Ife. There were 100 immunization service providers in the (LGAs) and they were all recruited into the study. Information was obtained with the aid of an interviewer-administered, structured questionnaire. Cold chain equipment functionality was assessed using a checklist. Data were analyzed using SPSS version 20.0.Results: Eleven (31.4%) of the facilities had functional refrigerators for storing vaccines, 16 (45.7%) had cold boxes while 13 (37.1%) had thermometers for vaccine temperature monitoring. Fifty-four (54.0%) of the healthcare workers were aware of the “shake test” and 19 (19.0%) could correctly interpret colour changes on a vaccine vial monitor. Consumption record was considered by 69 (69.0%) of healthcare workers when making vaccine requisitions while the required lead time was considered by 24 (24.0%) of them. Only 29 (29.0%) of healthcare workers kept records of vaccines stock-on-hand.Conclusion: Adequate training and supportive supervision is essential to improve healthcare workers’ knowledge and cold chain practices. Relevant cold chain equipment should be provided to boost storage capacity across health facilities.Keywords: Vaccine cold chain; Logistics management; Nigeri

Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia

AbstractIntroduction: Preventive programs which have proven to be effective in clinical trials may not necessarily impact the health and wellbeing of the community unless they are implemented with fidelity. While cold chain is the backbone of immunization programs, limited studies exist to explain fidelity implementation which likely contributes to a lack of evidence-based instructional practices of cold chain management.Aim: This study aimed to explore the fidelity implementation and challenges of optimal cold chain management in the Benshangul-gumuz region.Methods: A qualitative approach was utilized to explore the underlying challenges to optimum implementation of cold chain management in Benshangul-gumuz region. Observational techniques and key informant interviews with 12 key-informants were conducted. Data was collected at all levels of the health system including, the regional health bureau, Ethiopian Pharmaceuticals Supply Agency hub, district health offices, Health centers, and health posts. Data analysis and interpretation was performed using the framework analysis approach. Open Code 4.02 software was used for analysis.Findings: This study identified three main themes including adherence to intervention, human resource development, and availability and use of resources. The findings also revealed that a significant number of the employees were not adhering to the optimal cold chain management guidelines. Staff development, availability and utilization of equipment and related finances were major fidelity implementation challenges of cold chain management.Conclusions: Across the health facilities under study, implementation fidelity of cold chain management was considered poor. Human resource development, proper allocation and effective management of logistics and related finance could facilitate optimal cold chain management practices, and efforts to save lives through delivery of safe and quality vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3):03-08]Keywords: Cold chain management, Implementation fidelity, Challenges, Ethiopi

Last Mile Distribution of COVID-19 Vaccines: A Cold Chain Logistical Challenge

The COVID-19 pandemic is a global health and humanitarian crisis that has wreaked havoc on economies and industries around the world. This study aims to address the distribution of the COVID-19 vaccines at the last mile by evaluating the vaccine supply chain and how it can be effectively utilized to address the last mile distribution of the COVID-19 vaccines through simulation. The first part includes a systematic literature review and bibliometric study of vaccine supply chain and cold chain logistics studies conducted in the last decade. The second part examines the distribution of COVID-19 vaccines in Norway as a case study. The study develops a two-stage optimization simulation method to analyse and improve the logistical performance of the COVID-19 vaccine distribution in Inland County, Norway. The study analyses the impact of fleet size and the use of heterogeneous vehicles in the last mile distribution network on some key performance indicators. The findings from the study reveal that the service level, transportation costs and environmental performance of the vaccine logistics system are significantly influenced by routing decisions, fleet size, fleet composition and the types of heterogeneous vehicles used. Based on the findings from the study, some managerial insights are outlined to help logistics managers better understand the interactions between the key parameters of a cold chain vaccine distribution system

Using Electronic Immunization Registries to Improve Vaccination Coverage and Timeliness: Experience of the City of Villa María in Córdoba, Argentina

La inmunización representa una de las herramientas másimportantes de la saludpública. La acción protectora de las vacunas sobre las enfermedadesinmunoprevenibleses fundamental para su control y la reducción de sumorbilidad y mortalidad1 ydepende estrictamente de que se logrencoberturas de vacunación elevadas2 y deque, además, las vacunassean aplicadas en los tiempos previstos por loscalendarios de inmunización, yaque el retraso en su aplicación genera riesgosevitables3. En losniños, los retrasos en la vacunación son particularmentegraves, ya que sudesarrollo físico y cognitivo puede verse afectado si padecende algunaenfermedad inmunoprevenible4,5.Enjunio de 2016, en el marco del Programa de GestiónTerritorial Integral (PGTI)propuesto por la Secretaría de Salud de la ciudad, yadoptado por el ConcejoDeliberante de la Municipalidad de Villa María, sepropuso una estrategia deuso del registro nominal informatizado, para avanzaren el objetivo de lograrel 95% de cobertura de vacunación para todas lasvacunas y de mejorar laoportunidad de la vacunación.Seconstruyó una serie temporal dividiendo a los niños porcohorte de nacimiento.La serie temporal se inició con los nacidos en enero de2015 (primera cohortecuya vacunación de los seis meses se registró en SIGIPSA)y se incorporarontodos aquellos que recibieron la tercera dosis de vacunaquíntuple hasta un añodespués de los 6 meses. Este criterio se adoptó con todaslas cohortes queintegraron la serie, hasta los nacidos en abril de 2017, paraque losresultados fueran comparables.Para evaluarel resultado del procedimiento, se utilizó comoreferencia la tercera dosis dela vacuna quíntuple. Se utilizó el indicador depromedio de días sin protección,calculado como plazo en días entre la fecha denacimiento de cada niño y lafecha efectiva de aplicación de la vacuna que,según el Calendario Nacional deVacunación, se debe aplicar a los seis meses deedad.La estrategia de uso del registronominal informatizadoSIGIPSA, se mostró efectiva, en primer lugar, paraindividualizar la poblaciónobjetivo, verificar su condición de vacunación yfacilitar la organización deacciones de búsqueda activa para completar losesquemas atrasados. El usosistemático del registro para actualizar lainformación de vacunación y detectarrápidamente la falta de aplicación devacunas fue clave para reducir la demoraen la aplicación de las vacunas. De esta manera, se logró una reducciónsignificativa en elindicador de días sin protección de la tercera dosis devacuna quíntuple,utilizada como vacuna de referencia para la evaluación delresultado de laimplementación de la estrategia. La reducción fue de 35 días enpromedio entrelas cohortes de niños previa y posterior a la implementación dela estrategia.Para la vacunación al ingreso escolar,se alcanzó el 95% decobertura para las tres vacunas correspondientes, para losingresantes en 2017 y2018. En 2018, el logro se alcanzó más de seis mesesantes, debido a que secomenzó tempranamente con el análisis y la intervención.Se requirió una revisión sistemática delregistro nominalinformatizado, SIGIPSA, incluyendo la verificación de la cargade lasvacunaciones realizadas, y la búsqueda activa de información a partir deotrosregistros (carnés de vacunación) en los casos en los que la vacunación nohabíasido registrada en el sistema.Los resultados de todo el trabajo demuestranla utilidad delos sistemas de registro nominalizados e informatizados para laorganización dela vacunación, ya que permiten no sólo realizar evaluacionessobre la situaciónde la vacunación de los ingresados en el registro eidentificar los que tienenel esquema incompleto, si no también elaboraragendas de vacunación para reducirel atraso en la colocación de las vacunas.Fil: Bossio, Juan Carlos. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorios e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Respiratorias; ArgentinaFil: Sanchis, Ivan. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Tottis, Lorena J.. Municipalidad de Villa Maria (cordoba).; ArgentinaFil: Mauhum, Iohana A.. Municipalidad de Villa Maria (cordoba).; ArgentinaFil: Jure, Humberto. Municipalidad de Villa Maria (cordoba).; Argentin

Evaluation of vaccines cold chain monitoring during distribution from litha vaccines to the medical depots in Gauteng

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine, Pharmaceutical Affairs Johannesburg, 2016An uninterrupted cold chain is very important in maintaining the quality and the potency of vaccines. The aim of this study was to assess if the cold chain is maintained at 2°C-8°C during vaccine distribution from Litha Vaccines® to the different depots in the Gauteng Province in RSA. To establish if Litha Vaccines® has a secure cold chain and was not exposing the vaccines to the risk of compromised quality and efficacy. The vaccines were dispatched from Litha with 2 CCM cards, 2 FW’s and 1 data logger per shipper. These were dispatched to the 4 different depots in Gauteng. Two sites declined to participate in the study. The receiving manager at the depot completed the questionnaire which was designed for the purposes of this study to collate important information on the shipment. The temperature data was downloaded from the data logger at Litha after the delivery of the vaccines to assess the temperature recordings for the particular shipment. Of the 186 CCM cards analysed, none had a colour change. All the 186 Freeze watches were intact. This confirmed that the vaccines were not exposed to undesirable storage conditions during transportation to the depots. The total number of data loggers evaluated was 86. The maximum temperatures of all the loggers were constant between 5°C-9°C whereas the minimum temperatures were between 2°C-8°C. Eighty seven percent of all the readings were within the recommended temperature range of 2°C-8°C. The integrity and the quality of the vaccines were not compromised. The study found that although the results were satisfactory there is still a lot of room for improvement. Cold chain monitoring studies such as this one need to be conducted frequently and in different points of the vaccine distribution channel including the storage facilities and the immunization points. Failure to monitor the cold chain all the way means that efforts to maintain the cold chain might be futile since the end user might still receive a vaccine that has lost its potency along the distribution channel. It is crucial to emphasize the importance of continuous staff training on proper vaccine handling and the need for evaluation of vaccine monitoring processes. The managers need to ensure that there are clear guidelines and vaccine handling standard operating procedures (SOP’s) on cold chain maintenance and staff training informed by the Good Distribution Practices. Due to the effects of climate change and global warming, the study might need to be validated for the hotter summer months.MT201

Cold chain management practices of health care workers in primary health care facilities in Southern Nigeria

Introduction: Vaccination has caused a dramatic reduction in the threat of diseases that were once widespread and often times fatal. The efficient practice of cold chain management is therefore key to ensuring that the benefits of vaccination are sustained. The objective of this study is to assess the practice of cold chain management among health workers in primary health care facilities in Benin City, Edo State.Methods: A descriptive cross-sectional study design was employed in this study. The study population consisted of registered nurses, auxiliary nurses and community health extension workers in primary health care facilities in Benin City, Edo State. The tool for data collection was pre-tested, structured self-administered questionnaire. Bivariate analysis between socio-demographic variables and practice of cold chain management was done. Binary logistic regression was also done to determine significant predictors of practice of cold chain management. The level of significance was set at p < 0.05 for all associations.Results: A total of 425 respondents participated in this study. Over two-thirds of respondents 314 (73.9%) had good practice of cold chain management. Significant determinants of practice of cold chain management were cold chain management training (p = 0.004), presence of functional refrigerators (p = 0.016), NPI supervision (p < 0.001) and higher level of education (p < 0.001).Conclusion: The practice of cold chain management among respondents was fair. All stakeholders should ensure they work collectively towards ensuring that favorable environments which would improve the practice among health workers are put in place.Keywords: Practice, determinants, cold chain managemen

Modeling the public health impact of malaria vaccines for developers and policymakers

Efforts to develop malaria vaccines show promise. Mathematical model-based estimates of the potential demand, public health impact, and cost and financing requirements can be used to inform investment and adoption decisions by vaccine developers and policymakers on the use of malaria vaccines as complements to existing interventions. However, the complexity of such models may make their outputs inaccessible to non-modeling specialists. This paper describes a Malaria Vaccine Model (MVM) developed to address the specific needs of developers and policymakers, who need to access sophisticated modeling results and to test various scenarios in a user-friendly interface. The model's functionality is demonstrated through a hypothetical vaccine.; The MVM has three modules: supply and demand forecast; public health impact; and implementation cost and financing requirements. These modules include pre-entered reference data and also allow for user-defined inputs. The model includes an integrated sensitivity analysis function. Model functionality was demonstrated by estimating the public health impact of a hypothetical pre-erythrocytic malaria vaccine with 85% efficacy against uncomplicated disease and a vaccine efficacy decay rate of four years, based on internationally-established targets. Demand for this hypothetical vaccine was estimated based on historical vaccine implementation rates for routine infant immunization in 40 African countries over a 10-year period. Assumed purchase price was $5 per dose and injection equipment and delivery costs were$0.40 per dose.; The model projects the number of doses needed, uncomplicated and severe cases averted, deaths and disability-adjusted life years (DALYs) averted, and cost to avert each. In the demonstration scenario, based on a projected demand of 532 million doses, the MVM estimated that 150 million uncomplicated cases of malaria and 1.1 million deaths would be averted over 10 years. This is equivalent to 943 uncomplicate cases and 7 deaths averted per 1,000 vaccinees. In discounted 2011 US dollars, this represents $11 per uncomplicated case averted and$1,482 per death averted. If vaccine efficacy were reduced to 75%, the estimated uncomplicated cases and deaths averted over 10 years would decrease by 14% and 19%, respectively.; The MVM can provide valuable information to assist decision-making by vaccine developers and policymakers, information which will be refined and strengthened as field studies progress allowing further validation of modeling assumptions