Vaccine storage and stock management practices in Vihiga County, Kenya.

Background: Effective vaccine management is crucial to maintain vaccine potency. To achieve this, elements, such as temperature management, stock management, infrastructure, cold chain equipment and waste management, need to be properly implemented. Therefore, this study was conducted to assess the vaccine storage and stock management practices in public health facilities within Vihiga County. Methods: A descriptive cross-sectional design was used. Eighty-six public health facilities were selected and one staff involved in handling vaccines from each facility participated in the study. The study utilised survey questionnaires and observational checklists to collect data. Results: All facilities visited use standard vaccine requisition forms for ordering and receiving vaccines and physical stock counts are done in all facilities. The majority of immunising healthcare workers knew how to condition icepacks 88.4%; however, 57.0% did not know all the heat-, cold- and light-sensitive vaccines. Status of vaccine equipment, knowledge of healthcare workers and stock management practices were positively associated with vaccine cold chain management at 52.8%. Conclusion: Knowledge of vaccine handlers and stock management practices should be improved to enhance effective vaccine management. Besides, there is a need for the County Government of Vihiga to purchase sufficient WHO-recommended refrigerators.

Accessibility of malaria commodities in Geita District Council, mainland Tanzania: the experiences from healthcare providers and clients.

Background: Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania. Methods: This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients. Results: Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities' clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels. Conclusion: The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution.

Assessing determinants of the availability of HIV tracer commodities in health facilities in Wakiso District, Uganda.

Background: HIV/AIDS commodity stock-outs are still rampant in most African Countries causing treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. Therefore, this study aimed at assessing the determinants of the availability of HIV Tracer Commodities in Health Facilities in Wakiso District, Uganda. Methods: A descriptive cross-sectional design was conducted in 42 Health Facilities [HFs] offering HIV/AIDs services in Wakiso District, Uganda. Semi-structured questionnaire adapted from the Anti-Retroviral Therapy Supervision Performance and Recognition Strategy [ART SPARS] tool Version 2.0 | 2018111 was used to collect data. Results: The majority of the HFs 28 [67%] had all the seven tracer commodities on the day of the visit. The majority of the HFs 33 [78.6%] were using Manual stock management tools that were fully updated. The availability of HIV tracer commodities was high in facilities that made timely ordering [AOR: 2.538, 95% CI: 2.126-3.304, p-value = 0.003] while the use of manual LMIS alone at the facility [AOR: 0.623, 95% CI: 0.131-0.958, p-value = 0.002] was associated with low availability. Conclusion: This study indicated that 67% of health facilities visited had all HIV Tracer commodities on the day of the visit. ART commodity management should be computerised and orders made on time to ensure the availability of commodities.

Barriers to access of maternal health commodities among pregnant women in public health facilities in Ubungo Municipal Council, Tanzania.

Background: Access to maternal health commodities improves maternal outcome and reduce maternal deaths. Tanzania has put in place the fee exemption policy for mothers to access maternal health commodities for free, however, the implementation of user fee exemption has been challenging. Therefore, this study explored the barriers to access of maternal health commodities among pregnant women in public health facilities at Ubungo Municipal Council, Tanzania. Methods: This was a descriptive qualitative study conducted from January to February 2023. Both focus group discussions and key informant interviews were conducted. These involved 72 pregnant women and 40 health care providers respectively. A purposive sampling technique was used to selected facilities and study participants. Thematic analysis was used to analysis data. Results: Findings from this study indicated that fear of stigma and discrimination, decision-making autonomy, additional costs and stock out of health commodities were the main barriers to accessing maternal health commodities. Furthermore, both pregnant women and health care providers reported that shortage of health commodities and the inadequacy of service providers, which led to long waiting times, also hinder access to health commodities. Conclusion: Improving health commodities availability, and increasing the number of service providers are important factors to consider to improve access to maternal health commodities. In addition, factors such as fear of stigma and discrimination should also be addressed to improve maternal health.

Assessment of vaccine management performance in health facilities of Mwanza Region, Tanzania: a cross-sectional study.

BACKGROUND: Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels and enhance the development of continuous improvement plan to strengthen the system. This study was conducted to determine the vaccine management performance in Health Facilities of Mwanza Region, Tanzania. METHODS: This was a descriptive cross-sectional study that was carried out in 102 health facilities providing immunization services from eights districts of Mwanza Region in Tanzania. The World Health Organization (WHO) effective vaccine management assessment tools were used to collected data. Both quantitative and qualitative (through key informant interviews) approaches were used. The quantitative data were analysed using the existing WHO criteria for analysing effective vaccine management assessment data, while deductive thematic analysis was used for the qualitative data. RESULTS: The finding shows that the overall score for vaccine management performance was 53% which is below the WHO acceptable minimum score of 80%. None of the health facilities had reached the benchmark but only 67% had an average performance (> = 50-< 80%). The highest health facility score was 76% and the lowest being 27%. Among the categories assessed, the highest score was on information technology with 72%, while the lowest was on standard operating procedures with a score of 43%. The major challenges which contributed to low performance were lack of training, low knowledge about vaccine management practices, unavailability of standard operating procedures (SOPs), and limited financial resources to support operations for vaccine management practices. Skills gap, incomplete stock records and management, as well as low availability of SOPs were the key challenges reported that affected vaccine management practices. CONCLUSIONS: Effective vaccine management performance was low across all districts under the study. Increasing personnel capacity and ensuring availability of resources to support operations were reported as key interventions in improving vaccine management practices. Hence, effectively working on continuous improvement plan with key highlighted actions is highly recommended to all actors from national level to sub-national level managers and healthcare workers as frontline vaccine handlers.

A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms.

Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system's (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design.

Insights into vaccine hesitancy from systems thinking, Rwanda.

OBJECTIVE: To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS: Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS: A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION: The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.

Insights into vaccine hesitancy from systems thinking, Rwanda

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff ); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings/ A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidencebuilding social structures and context-dependent challenges that affect vaccine uptake were also identified.