Transforming cold chain performance and management in lower-income countries
In many countries, one of the common factors limiting full and equitable access to effective immunization is the existence of gaps in cold chain and logistics (CCL) systems. This article focuses on the critical contribution that better management of CCL performance can make in addressing these barriers, as well as some essential practices needed to achieve and sustain these gains. These include (i) an emphasis on continuous improvement in CCL performance indicators, (ii) strong coordination and accountability across multiple stakeholders, and (iii) making the most of limited financial resources.
This article is informed by the Clinton Health Access Initiative’s (CHAI’s) experience working with National Immunization Programs (NIPs) and immunization partners to improve the effectiveness and efficiency of CCL systems (including CCE deployment and maintenance, temperature monitoring and control, stock management and distribution) across ten Gavi-supported “focus” countries.
1. Introduction
Vaccines can dramatically reduce morbidity and mortality from many serious diseases [1], and have a high return on investment [2].1 Unfortunately, gaps in vaccine cold chain and logistics (CCL) systems are one of the common factors limiting full and equitable access to the benefits of immunization. This is because such gaps undermine the availability and potency of vaccines at the point of administration, prevent the introduction of new life-saving vaccines, and waste precious human and financial resources [3].
2. Section I: Targeting CCL performance
The vaccines CCL system is considered to be performing well when (i) the full schedule of antigens is consistently available to serve the target population, (ii) in potent condition, (iii) at an affordable cost, and (iv) with a CCL network of sufficient capacity and reach to meet current and upcoming NIP goals (e.g., new vaccine introductions) [5].
3. Section II: Three key management practices to maximize CCL performance
Once programs appropriately target CCL performance, three management practices are critical to achieve effective and sustained improvements in these KPIs.
- 3.1. From “firefighting” to continuous improvement
- 3.2. Better coordination and accountability
- 3.3. Making the most of limited resources
4. Conclusion
Investing in improved CCL management is crucial to sustainably improve CCL performance and provide the maximum benefit to immunization programs. As detailed above, success will require CCL management to focus on continuously improving CCL performance, have strong coordination and accountability, and make the most of the limited resources available.
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