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Improving the last mile delivery of vaccines through an informed push model: Experiences, opportunities and costs based on an implementation study in a rural district in Uganda

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  • Pamela Bakkabulindi
  • Solomon T Wafula
  • Anthony Ssebagereka
  • Rogers Sekibira
  • Aloysius Mutebi
  • Jimmy Ameny
  • Christabel Abewe
  • John Bosco Isunju

Abstract

Developing countries face challenges in ensuring equitable, timely, and efficient vaccine availability at health facilities. In Uganda, the distribution of vaccines from district stores to the last-mile health facilities is hindered by an unpredictable and unreliable mixed push-pull delivery system. This system often results in poor vaccine management, stock-outs, and missed vaccination opportunities. This pilot study aimed to enhance the efficiency of last-mile vaccine delivery by implementing an informed push model. The specific goals were to improve vaccine lead time, standardize cold chain management during transportation, and evaluate the costs of implementing the informed push model. A mixed methods approach was used to evaluate the impact of the informed push model in Gomba district, Uganda. Both quantitative and qualitative data were collected at baseline and endline. Quantitative data included mode, frequency, lead-time, and costs of vaccine delivery, vaccine stock status, and cold chain maintenance during transportation, gathered through semi-structured interviews. Qualitative data on experiences and challenges were collected using a guide. Descriptive statistics were used for quantitative data analysis, while an ingredients approach was used for costing data. Thematic analysis was applied to qualitative data. The informed push system significantly improved vaccine delivery efficiency and quality in Gomba district. The average lead-time for vaccine delivery reduced from 14 days at baseline to 5 days at endline. Timely vaccine receipt at health facilities increased from 36.8% to 100%. Temperature monitoring during transit improved from 26.3% to 100%. The proportion of facilities experiencing stock-outs dropped from 79.0% to 36.8%. Monthly distribution costs decreased from $494.8 ($0.07 per child) to $445.9 ($0.06 per child). The informed push model is a cost-effective strategy for improving last-mile vaccine delivery by reducing lead times, enhancing cold chain management, and decreasing stock-outs. Integration into the national immunization program is recommended for broader adoption in Uganda.

Suggested Citation

  • Pamela Bakkabulindi & Solomon T Wafula & Anthony Ssebagereka & Rogers Sekibira & Aloysius Mutebi & Jimmy Ameny & Christabel Abewe & John Bosco Isunju, 2024. "Improving the last mile delivery of vaccines through an informed push model: Experiences, opportunities and costs based on an implementation study in a rural district in Uganda," PLOS Global Public Health, Public Library of Science, vol. 4(10), pages 1-22, October.
    • Handle: RePEc:plo:pgph00:0002647
    DOI: 10.1371/journal.pgph.0002647
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    References listed on IDEAS

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    1. Yang, Yuwen & Bidkhori, Hoda & Rajgopal, Jayant, 2021. "Optimizing vaccine distribution networks in low and middle-income countries," Omega, Elsevier, vol. 99(C).
    2. Lin, Qi & Zhao, Qiuhong & Lev, Benjamin, 2020. "Cold chain transportation decision in the vaccine supply chain," European Journal of Operational Research, Elsevier, vol. 283(1), pages 182-195.
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