Work

Management of vaccine cold chain equipment in the Ethiopian immunization supply chain system: evidence from the Ethiopian national immunization program evaluation

Year: 2026

Type: article

Abstract: Objectives: There is insufficient evidence on the current condition of vaccine cold chain equipment (CCE) in Ethiopia. This study is aimed to assess the status of the CCE of the Ethiopian immunization supply chain system and generate evidence to inform policymakers and donors for effective planning and decision-making. Methods: A cross-sectional study was conducted across nine regions in Ethiopia using the World Health Organization Expanded Program of Immunization review guide and the effective vaccine management 2.0 tool. Data were collected through direct observation and face-to-face interviews using the effective vaccine management assessor mobile app, assessing vaccine storage capacity, including CCE type, brand, and model, at one Ethiopian Pharmaceuticals Supply Service (EPSS) center and 15 hubs, and 286 lower distribution (LD), or service provision (SP) sites (a total of 302 immunization supply chain sites). Results: All EPSS hubs use passive storage devices and have refrigeration and/or freezer units. A total of 425 refrigerators and/or freezers were found at LD and SP levels, including 335 regular refrigerators, 17 freezers, and 73 combined units (refrigerators and freezers); 45 facilities (15.7%) reported having at least one non-functional refrigerator; 47 (16.5%) reported having at least one refrigerator that was working but in need of repair; and the remaining 194 (67.8%) reported that all their refrigerators were working well. During the survey, 235 of these refrigerators had a functioning 30-day temperature record system, 397 refrigerators were in good functional status with respect to temperature control, and 40 refrigerators/freezers were equipped with a computerized temperature-monitoring system. The total positive-temperature (2-8°c)vaccine storage capacity was 440,768 l at the central hub and 51,953 (38,666) l (mean, SD) at the sub-central hubs. The total negative-temperature (-25 to -15°c) vaccine storage capacity was 40,000 l at the central hub and 1980 (3504) l (mean, SD) at the sub-central hubs. At the LD and SP levels, the overall total positive-temperature (2-8°c) vaccine storage capacity averaged 1562.0 l (SD 12,062.1; median 37.5, interquartile range 140.0). The total negative-temperature (-25 to -15°c) vaccine storage capacity averaged 490.4 l (SD 5895.8), the total cool pack storage capacity averaged 687.8 l (SD 8188.5), and the total coolant pack storage capacity (cool pack and ice pack combined) averaged 826.9 l (SD 9627.5). The total insulated container capacity averaged 22.2 l (SD 43.5; median 7.8, interquartile range 25.6) across all facilities at the LD and SP levels. The EPSS center and 13 hubs have conducted preventive maintenance and repaired refrigerators in the past year. Most institutions (82.95%) at the LD and SP levels lack a documented preventive maintenance schedule. Only 20% of institutions maintain records of preventive maintenance. Conclusion: Improving cold chain management through better temperature-monitoring, increased refrigeration, and enhanced transportation is essential to ensure vaccine potency and reduce wastage.

Source: IJID Regions

DOI: 10.1016/j.ijregi.2026.101034