Abstract
To improve equity in immunization coverage, potent immunization products must be available in the communities in which low coverage rates persist. Most supply side investments are focused on replacing or establishing new health facilities to improve access to immunization. However, supply chain design must be improved to ensure that potent vaccines are available at all facilities to promote immunization equity. We used the supply chain design process in Pakistan as an opportunity to conceptualize how supply chains could impact equity outcomes. This paper outlines our approach and key considerations for assessing supply chain design as a contributing factor in achieving equitable delivery of immunization services. We conducted a supply chain analysis based on sub-national supply chain and immunization coverage at district level. Supply chain metrics included cold chain coverage and distances between vaccination sites and storage locations. Immunization coverage metrics included the third-dose diphtheria- tetanus-pertussis (DTP3) vaccination rate and the disparity in DTP3 coverage between urban and rural areas. All metrics were analyzed at the district level. Despite data limitations, triangulation across these metrics provided useful insights into the potential contributions of supply chain to equitable program performance at the district level within each province. Overall, our analysis identified supply chain gaps, highlighted supply chain contributions to program performance and informed future health system investments to prioritize children unreached by immunization services.
Highlights
A strategic target of the Global Vaccine Action Plan is to achieve 90% national immunization coverage in all countries and 80% in each district by 20201
This paper describes the process by which equity was considered during an immunization supply chain design analysis in Pakistan through a collaboration between the Pakistan Expanded Program on Immunization (EPI)[24], the United Nations Children’s Fund (UNICEF)[25], Gavi, the Vaccine Alliance[26], and VillageReach, an international non-profit that transforms health care delivery to reach everyone[27]
The lack of clear trends is expected because many variables affect immunization coverage rates, including but not limited to supply chain, which were beyond the scope of our analysis[42]
Summary
A strategic target of the Global Vaccine Action Plan is to achieve 90% national immunization coverage in all countries and 80% in each district by 20201. Global coverage has improved steadily since 1980, beginning in 2009 progress stagnated and it is unlikely these targets will be met by the end of 20202–4. As part of the effort to improve equity in immunization coverage, immunization products must be available and of sufficient potency in the communities in which low coverage rates persist[4,5]. Immunization supply chains should be tailored to address health system barriers to equity in service delivery such as vaccine stockouts, inadequate storage capacity, non-functional cold chain equipment (CCE), as well as difficult terrain and road conditions[4,17,18,19,20,21,22]. There is limited research and evidence on how the design of supply chains can be tailored to deliver potent vaccines to all children
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