A scoping review of interventions for vaccine stock management in primary health-care facilities

Cost analysis of an innovative eHealth program in Nigeria: a case study of the vaccine direct delivery system

INTRODUCTION

Vaccine stockout is a severe problem in Africa, including Nigeria, which could have an adverse effect on vaccination coverage and even health outcomes among the population. The Vaccine Direct Delivery (VDD) program was introduced to manage vaccine stockouts using eHealth technology. This study conducts a cost analysis of the VDD program and calculates the incremental costs of reaching an additional child for vaccination through the VDD program.

METHODS

We used the expense reports from eHealth Africa, an NGO which implemented the VDD program, to calculate the VDD program's overall operating costs. We also used the findings from the literature to translate the effect of VDD on the reduction of vaccine stockouts into its effect on the increase in vaccination coverage. We calculated the incremental costs of reaching an additional child for vaccination through the VDD program.

RESULTS

We calculated that implementing the VDD program cost USD10,555 monthly for the 42 months that the VDD program was operating in Bauchi state. This figure translates to an incremental cost of USD20.6 to reach one additional child for vaccination.

DISCUSSION/CONCLUSIONS

Our study is one of the first to conduct a cost analysis of eHealth technology in Africa. The incremental cost of USD20.6 was within the range of other interventions that intended to increase vaccine uptake in low- and middle-income countries. The VDD program is a promising technology to substantially reduce vaccine stockout, leading to a reduction of over 55% at a reasonable cost, representing 26% of the total budget for routine immunization activities in Bauchi state. However, there is no comparable costing study that evaluates the cost of a supply chain strengthening intervention. Future studies should investigate further the feasibility of eHealth technology, as well as how to minimize its costs of implementation while keeping the efficacy of the program.

Perceptions of and Practical Experience with the National Surveillance Centre in Managing Medicines Availability Amongst Users within Public Healthcare Facilities in South Africa: Findings and Implications

The introduction of the National Surveillance Centre (NSC) has improved the efficiency and effectiveness of managing medicines availability within the public healthcare system in South Africa. However, at present, there is limited data regarding the perceptions among users of the NSC and challenges that need addressing. A descriptive quantitative study was performed among all registered active NSC users between August and November 2022. Overall, 114/169 users responded to a custom-developed, self-administered questionnaire (67.5% response rate). Most respondents used the Stock Visibility System (SVS) National Department of Health (NDoH) (66.7% for medicines and 51.8% for personal protective equipment (PPE) or SVS COVID-19 (64.9% for COVID-19 vaccines) or RxSolution (57.0% manual report or 42.1% application programming interface (API)) for reporting medicines, PPE, and COVID-19 vaccines to the NSC and were confident in the accuracy of the reported data. Most respondents focused on both medicines availability and reporting compliance when accessing the NSC, with the integrated medicines availability dashboard and the COVID-19 vaccine dashboard being the most popular. The respondents believed the NSC allowed ease of access to data and improved data quality to better monitor medicines availability and use. Identified areas for improvement included improving internet connectivity, retraining some users, standardising the dashboards, adding more data points and reports, and expanding user adoption by increasing licence limits. Overall, this study found that the NSC in South Africa provides an effective solution for monitoring and improving medicines availability.

Improving the availability of vaccines in primary healthcare facilities in South Africa: is the time right for a system redesign process?

An uninterrupted supply of vaccines at different supply chain levels is a basic component of a functional immunization programme and care service. There can be no progress toward achieving universal health coverage and sustainable development without continuous availability of essential medicines and vaccines in healthcare facilities. Shortages of vaccines, particularly at health facility level is an issue of grave concern that requires urgent attention in South Africa. The causes of vaccine stock-outs are multifactorial and may be linked to a broader systems issue. These factors include challenges at higher levels such as delays in the delivery of stock from the pharmaceutical depot; health facility level factors, which include a lack of commitment from healthcare workers and managers; human resource factors, such as, staff shortages, and lack of skilled personnel. Therefore, there is a compelling need to address the factors associated with shortages of vaccines in health facilities. This paper highlights the challenges of vaccine availability in South Africa, the associated factors, the available interventions, and recommended interventions for the expanded programme on immunization in South Africa. We propose a system redesign approach as a potentially useful intervention.

The challenges to a successful COVID-19 vaccination programme in Africa

The COVID-19 vaccination campaign is an ongoing worldwide effort to vaccinate large numbers of people against COVID-19 in order to ensure protection from the disease, control the rate of infection, reduce severe outcomes, and get back to normal life. Most African countries had a delay in the initiation of their COVID-19 vaccine national rollout compared to other regions in the world, and the goal of the immunization exercise in the continent is to vaccinate over 60% of the African population to attain herd immunity. Over the years, vaccination programmes are usually faced with challenges in Africa because of numerous factors. So far, some of the major challenges threatening the success of the COVID-19 vaccination rollout in most African countries includes the slow onset of the vaccination exercise, limited funds, concerns around vaccine safety and uncertainties, storage requirements and regulatory hurdles for vaccines, limited shelf life of COVID-19 vaccines, inability to access vulnerable communities in a timely fashion, problems around the use of different vaccines, and wars and conflicts. The solutions and other imperative recommendations to these challenges were provided so as to optimize the vaccination programme and to achieve an appreciable success in the COVID-19 vaccination programme on the continent. In conclusion, a holistic and timely planning, fast execution of plans, rigorous community involvement, and a robust multi-sectoral partnership will ensure a successful COVID-19 vaccination campaign in Africa.

Estimation of health impact from digitalizing last-mile Logistics Management Information Systems (LMIS) in Ethiopia, Tanzania, and Mozambique: A Lives Saved Tool (LiST) model analysis

Background

Digital health has become a widely recognized approach to addressing a range of health needs, including advancing universal health coverage and achieving the Sustainable Development Goals. At present there is limited evidence on the impact of digital interventions on health outcomes. A growing body of peer-reviewed evidence on digitalizing last-mile electronic logistics management information systems (LMIS) presents an opportunity to estimate health impact.

Methods

The impact of LMIS on reductions in stockouts was estimated from primary data and peer-reviewed literature, with three scenarios of impact: 5% stockout reduction (conservative), 10% stockout reduction (base), and 15% stockout reduction (optimistic). Stockout reduction data was inverted to stock availability and improved coverage for vaccines and essential medicines using a 1:1 conversion factor. The Lives Saved Tool (LiST) model was used to estimate health impact from lives saved in newborns and children in Mozambique, Tanzania, and Ethiopia between 2022 and 2026 across the three scenarios.

Results

Improving coverage of vaccines with a digital LMIS intervention in the base scenario (conservative, optimistic) could prevent 4,924 (2,578–6,094), 3,998 (1,621–4,915), and 17,648 (12,656–22,776) deaths in Mozambique, Tanzania, and Ethiopia, respectively over the forecast timeframe. In addition, scaling up coverage of non-vaccine medications could prevent 17,044 (8,561–25,392), 21,772 (10,976–32,401), and 34,981 (17,543–52,194) deaths in Mozambique, Tanzania, and Ethiopia, respectively. In the base model scenario, the maximum percent reduction in deaths across all geographies was 1.6% for vaccines and 4.1% for non-vaccine medications.

Interpretation

This study projects that digitalization of last-mile LMIS would reduce child mortality by improving coverage of lifesaving health commodities. This analysis helps to build the evidence base around the benefits of deploying digital solutions to address health challenges. Findings should be interpreted carefully as stockout reduction estimates are derived from a small number of studies.

Effect of Vaccine Direct Delivery (VDD) on vaccine stockouts and number of vaccinations: Case study from Bauchi State, Nigeria

OBJECTIVE

Vaccine stockouts are prevalent in Africa. Despite the importance of this as a barrier to universal vaccination coverage, rigorous studies looking at ways to reduce vaccine stockouts have been limited. We causally evaluated the effect of Vaccine Direct Delivery (VDD), an intervention to ensure the vaccine stock availability at health facilities, on the reduction of stockouts in Bauchi state, Nigeria.

METHODS

Employing the interrupted time-series method, we evaluated the change in the occurrence of vaccine stockouts before and after the introduction of VDD in July 2015. We used health facility level data from January 2013 to December 2018 among 175 facilities in Bauchi state, collected through the District Health Information Software 2 (DHIS2) for monthly information on stockouts and stock balances in all the health facilities in Nigeria. Data were analyzed using Stata 15 SE. To validate the causal relationship between VDD and vaccine stockouts, we conducted two sets of robustness checks. First, we evaluated the effect of VDD on the stockouts of other commodities. Second, we compared the trend of the prevalence of vaccine stockouts among health facilities between Bauchi state where VDD was introduced and another state (Adamawa state) where VDD was never introduced.

RESULTS

After the introduction of VDD, vaccine stockouts in Bauchi state decreased by 9 percentage points on average, and they have been decreasing monthly by 0.4 percentage points more than pre-VDD. In Adamawa state, where VDD was never introduced, the prevalence of vaccine stockouts did not change over time. In Bauchi state after VDD introduction, the stock balances of target vaccines all increased, and the number of vaccinations carried out increased in neighboring health facilities.

CONCLUSIONS

VDD intervention resulted in a significant reduction of vaccine stockouts as well as in an increase in the number of vaccinations performed. However, we should consider how to improve the system to provide vaccination service to the population in a sustainable way.

Mobile reporting of vaccine stock-levels in primary health care facilities in the Eastern Cape Province of South Africa: perceptions and experiences of health care workers

The use of mobile and wireless digital technologies - mobile health (mhealth)- is increasingly been adopted in low- and middle-income countries (LMICs) to improve data visibility, improve decision-making, and consequently help ensure availability of health commodities in health facilities. In a bid to improve availability of medicines in primary health care facilities, the South African department of Health launched the Stock Visibility Solution (SVS), a mobile application developed for the purpose of capturing and monitoring stock levels of medicines including vaccines using mobile phones. The stock levels of medicines in facilities are usually uploaded to the central stock management system so that managers can act promptly to address stock-out situations. Pilot studies show that the SVS has the potential to reduce stock-outs from occurring. This study aimed to explore the perceptions and experiences of the SVS system amongst healthcare workers (HCWs) who are involved with managing stock levels of medicines in primary health care facilities in the Eastern Cape Province. This will help identify potential barriers and facilitators to implementation of the system and contribute to the development of strategies to improve its efficiency and effectiveness. A qualitative research design was employed, including semi-structured interviews with 64 HCWs working in primary health care facilities in the OR Tambo district, Eastern Cape Province in South Africa. Data was transcribed verbatim and analyzed using thematic analysis. Most HCWs understood the SVS as a system for reporting stock levels to managers and conveyed commitment to ensuring the system works. However, they highlighted a number of factors that demotivated efficient usage of the system: inadequate training, staff shortages and high staff turnover, lack of responses from the managers, the extra workload that comes with the system, amongst others. HCWs made various suggestions for how the system might be improved, most pertinently the need for more pharmacists and pharmacy assistants and for these cadres to be primarily in-charge of stock management and the use of the SVS. While HCWs are committed to addressing vaccine stock-outs, they face various barriers to an effective and efficient implementation of the SVS system. We make various recommendations for how these barriers might be addressed.

Experts' opinion for improving global adolescent vaccination rates: a call to action

Worldwide, lifestyle and resource disparities among adolescents contribute to unmet health needs, which have crucial present and future public health implications for both adolescents and broader communities. Risk of infection among adolescents is amplified by biological, behavioral, and environmental factors; however, infectious diseases to which adolescents are susceptible are often preventable with vaccines. Beyond these concerns, there is a lack of knowledge regarding adolescent vaccination and disease risk among parents and adolescents, which can contribute to low vaccine uptake. Promising efforts have been made to improve adolescent vaccination by programs with motivational drivers and comprehensive communication with the public. In May 2017, a multidisciplinary group of experts met in Amsterdam, Netherlands, to discuss adolescent vaccine uptake, as part of an educational initiative called the Advancing Adolescent Health Spring Forum. This article presents consensus opinions resulting from the meeting, which pertain to the burden of vaccine-preventable diseases among adolescents, reasons for low vaccine uptake, and common characteristics of successful strategies for improving adolescent vaccination.Conclusion: There is an urgent "call to action," particularly targeting healthcare providers and public health authorities, for the prioritization of adolescent vaccination as a necessary element of preventive healthcare in this age group.What is Known:• Despite increased risk of certain infectious diseases, adolescent vaccination uptake remains low.What is New:• Barriers to adolescent vaccine uptake include lack of information regarding vaccines and disease risk, health system inadequacies, and insufficient healthcare follow-up.• Successful efforts to improve adolescent vaccine uptake need cohesive leadership and involvement of multiple stakeholders, as well as youth-friendly messaging; healthcare providers and policymakers should prioritize adolescent vaccination and implement proven program strategies to improve adolescent health worldwide.