Bill & Melinda Gates Foundation

Pushing Vaccines: Improving the Supply Chain in Mozambique

October 10, 2013

The first time I went on a vaccine distribution trip in rural Mozambique, we returned to the warehouse at the end of the day with more vaccines than we took with us that morning. Yes, we brought back more!

How is that possible?

 If the distribution team isn’t confirming existing stock levels and actual consumption, you find stockpiles of vaccines, overcrowding precious space in refrigerators, just waiting to be discarded because they spoil before they can be used.At that time, the health distribution system in that area was based on a “pull” system—essentially health centers requested a quantity of vaccines each month based on population numbers and the group of children they expected to vaccinate. This number was not necessarily matched with the actual consumption of vaccines and the actual number of children vaccinated each month. And the warehouse sent out vaccines based on this request, without confirming actual stock or use.

You can imagine what the result of that can be. In some places where population data is underestimated, a health center runs the risk of running out of vaccines because more children than expected are showing up. Their mothers are being turned away and told to return another day when, hopefully, they will have more vaccine. In other places where population is overestimated, more vaccines are being delivered than they can use. If the distribution team isn’t confirming existing stock levels and actual consumption, you find stockpiles of vaccines, overcrowding precious space in refrigerators, just waiting to be discarded because they spoil before they can be used.

Since 2011, I’ve been working with VillageReach to prevent scenarios like this one. In four provinces in Mozambique, we support the health sector with an “informed push” distribution system. Working with the government, the distribution team goes to each health center, confirms the existing stock and verifies consumption data for the past month. Based on this information, the appropriate quantity of vaccines are stocked – enough to cover all of the children who will arrive in the next month, but not so much as to lead to underutilization and overstock.

 More children are getting vaccinated, and stock outs are less than 10%. Even nurses have told me they better understand their jobs because they can now communicate with members of the distribution team.The distribution team goes beyond just delivering vaccines. They ensure the quality of data in the child registers and stock cards. They make sure the nurses understand changes in the system, such as when the pneumonia vaccine (PCV) was introduced a few months ago and the vaccine schedule as well as the child registry changed. And all of this leads to their ability to ensure that vaccines are available when and where they are needed.

I can see the impact that this different distribution system has had. The "before" and "after" is clear in the registry books, with completed and correct data now available. More children are getting vaccinated, and stock outs are less than 10%. Even nurses have told me they better understand their jobs because they can now communicate with members of the distribution team.

We have come a long way since that first day when I found stockpiles of vaccines in health centers. There is, of course, much more to do. I’m looking forward to the day that 100% of children are completely vaccinated.

 
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