How to optimize Immunization Supply Management at different levels of the health system in Oromia Region? An implementation science research

Abstract

Abstract
Background: In programs like immunization having strong supply management is important to benefit all the necessary inputs of the health system. In Ethiopia, it has been found, that vaccine availability at service delivery points is low. Moreover, the implementation barriers related to Immunization Supply Management are vague at each level of the health system.
Aim: This study aimed to explore the practice, barriers and alternative strategies related to immunization supply management in the Oromia region, west Ethiopia.
Methods: A phenomenological qualitative approach was used. The data was collected using interview guides among 27 key informants from health posts, health centers, woreda health office, regional hub and Ethiopian Pharmaceutical supply Agency from June 15 to July 10, 2020. All the audio data were independently transcribed verbatim from Amharic and Afaan Oromo languages after repeatedly listening to the records and then translated into the English. The translated transcription documents were imported into Open Code software 4.02 for the purpose of coding. The coding was performed by three experts independently. Thematic analysis was utilized for the analysis of the data.
Results: The immunization supply management practices were categorized into three themes: Vaccine forecast, vaccine request & delivery and stock management of vaccines. Organizational (lack of reviewing processes, lack of transportation, lack of refrigerators, interrupted power supply, absence of vaccine forecasting team, unavailability of performance evaluation reports and lack of electricity), technical (lack of standard leger book and lack of vaccine requisition form) and behavioral (lack of accountability, skill gaps and negligence) barriers were the main determinants that affect vaccine availability. The alternative strategies to optimize the ISM include local data-based forecasting, direct delivery of the vaccine to health facilities, transforming the ISM through digitalization and to establish accountability.
Conclusion: This study showed that the existing immunization supply management practice is not optimal. Organizational, technical, and behavioral barriers were the identified determinants for low availability. Therefore, program managers and policymakers should emphasize addressing the identified barriers and tailoring the alternative strategies to ensure the availability of vaccines at the point of service delivery. [Ethiop. J. Health Dev. 2021; 35(SI-3):65-74]
Keywords: Immunization, Implementation research, Supply Management, Health system, Ethiopia