Abstract
Achieving universal access to immunization, as envisioned in the global vaccine action plan continues to be a challenge for many countries in Sub-Saharan Africa. Weak immunization supply chain (iSC) has widely been recognized as a key barrier, hindering progress towards vaccination targets in this region. These iSCs, which were designed in the 1980s, have become increasing fragile and are now considered outdated. The objective of this review was to assess the effectiveness of system redesign and outsourcing to improve outdated iSC systems in sub-Saharan Africa. We searched the following electronic databases from January 2007 to December 2017: Medline, EMBASE (Excerpta Medica Database), the Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. Our search strategy yielded 80 records and after assessment for eligibility, seven papers met the inclusion criteria. Five studies evaluated the experiences of system redesign in three countries (Nigeria, Benin and Mozambique), two assessed outsourcing vaccine logistics to the private sector in Nigeria and South Africa. According to these studies, system redesign improved vaccine availability at service delivery points and reduce the cost of distributing vaccines. Similarly, outsourcing vaccine logistics to the private sector reduced the cost of vaccines distribution and improve vaccine availability at service delivery points.
Highlights
Vaccination coverage in Africa has improved dramatically since the Expanded Program on Immunization (EPI) was established in 1976
In 2016, only 19% of Gavi-supported countries in the region met with the 80% minimum threshold for the World Health Organization (WHO) recommendations for effective vaccine management (EVM) [2], representing a marginal improvement from 2010, where no country met the 80% bench mark across all nine EVM categories [5]
An earlier report has shown that over three in four African countries lacked adequate systems for proper vaccine handling, leading to recurrent stock outs, expired products, and stock damage during storage and transit, all of which contribute to missed opportunities for vaccination [2]
Summary
Vaccination coverage in Africa has improved dramatically since the Expanded Program on Immunization (EPI) was established in 1976. These systems, which were designed in the late 1970s to manage fewer, less expensive and less bulky vaccines, are being confronted with several new realities [3] Amongst these are the needs to handle a widening variety of new vaccines and immunization schedules, a greater diversity of service delivery strategies, an ever-expanding target population to vaccinate, and an increased cold chain infrastructure requirement [3]. Taken together, these factors have created significant storage and transport shortfalls at all levels, which hinder progress towards coverage and equity goals in the continent [4]. An earlier report has shown that over three in four African countries lacked adequate systems for proper vaccine handling, leading to recurrent stock outs, expired products, and stock damage during storage and transit, all of which contribute to missed opportunities for vaccination [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
