Assessiment of vaccines distribution system in public healthcare facilities in coast region, Tanzania

Abstract

Background: Extended Programme on Immunization performance is among the four main indicators selected for general budget support to the health sector. The declining trend in performance of the immunization program is a major concern, routine immunization coverage in Tanzania declined from 94% in 2004 to 85% in 2009(MOHSW, EPI REVIEW 2010) Vaccination is one method that has been proven effective in preventing the transmission of infectious diseases. However to be effective a number of elements in a vaccination program need to be implemented properly, including cold chain management, vaccine management, logistic management and waste management. Failure to properly implement these can reduce the level of protection that is expected from a vaccination program. Objectives The study examined current distribution system of vaccines from second level which is Regional stores, third level which is District stores to fourth level which is health facility and storage practices. Methodology It was a cross-sectional survey, staff responsible for vaccine distribution system and storage were interviewed about their knowledge and practices of vaccine distribution, handling and storage. Data collection started in April to 16th June 2012. Data was from 40 selected healthcare facilities and 5 warehouses in Coast region based on geographic representation. Vaccine storage conditions were also assessed and determined at different levels. Availability of 6 tracer vaccines for the past 10 months was assessed and this aided in assessing inventory management and stock control of vaccines at the health facilities. Results Availability of 6 tracer vaccines during the time of survey was high at regional vaccine store (100%), followed by district vaccine stores (93.3%) and low at healthcare facilities (82%). Stocks out duration were more at healthcare facilities level (72 days) than district vaccine stores (33 days). Most of the parameters of storage conditions were not met by the XIII facilities. Knowledge level of healthcare givers was inadequate. The study reveals that all personnel involved in handling and storage of vaccines were non pharmaceutical personnel. Conclusions & recommendations: Managing effective distribution system at public health facilities is associated with many challenges/problems including inadequate vehicles for distribution especially in lower level, poor storage conditions, unreliable electricity and lack/delay of gas, no involvement of pharmaceutical personnel in program, no quantification at low facility level and lack of on job training. It is recommended that MOHSW & PMORALG should strengthen distribution system. MOHSW/EPI needs to involve pharmaceutical personnel in the program.