Diagnostic toolkit for vaccine procurement for immunization programs

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The toolkit is designed to help immunization programs assess, diagnose and resolve vaccine procurement challenges.

In many low- and middle-income countries, vaccine shortages can be very common. Children and their caregivers are bearing the brunt of shortages of life-saving vaccines, leading to a lack of trust in facility-based immunization services.

According to UNICEF The state of the world’s children 2023: vaccination for every child, almost 13 million children in Africa did not receive one or more vaccines in three years. The report lists trained health personnel and limited access to essential supplies and equipment, weak capacity to collect and use data, and shortages of key medicines and vaccines as some of the factors contributing to the large number of unvaccinated or under-vaccinated children. .

There are human, data, and systems factors that affect vaccine availability in low- and middle-income countries. Vaccine shortages are often the result of a lack of trained personnel, poor stock management, poor vaccine inventory record keeping, poor forecasting and distribution bottleneckscomplexities and inefficiencies in the procurement process that impact the supply chain.

To help address vaccine stock management, the Clinton Health Access Initiative (CHAI) has developed a Toolbox based on their work in Cameroon and Uganda from 2019 to 2023.

Download the diagnostic toolkit

Presentation of the vaccine procurement toolkit

The toolkit uses four modules that comprehensively cover the procurement lifecycle to help countries identify and address challenges within their vaccine procurement processes:

Analysis of key performance indicators allows users to diagnose the extent of procurement problems.
Process diagnosis aims to help identify specific gaps in the procurement process.
Identification of the problem aims to identify the root causes behind the gaps.
Solution Identification is intended to support the selection of customized solutions.

A structured approach: the four modules

1. Analysis of key performance indicators (KPI):

The KPI analysis module serves as a starting point, with the aim of evaluating possible barriers within a country’s procurement function. Using two critical indicators (stock adequacy and financial adequacy), the toolkit provides a comprehensive assessment of existing challenges.

Stock Sufficiency: Measures the adequacy of antigen doses compared to planned and ordered doses. This indicator sheds light on whether the country is receiving enough vaccines.
Financial sufficiency: Evaluates whether the budget allocated for the acquisition of vaccines aligns with the planned and budgeted amounts. This metric ensures that the funds mobilized will meet the anticipated needs.

2. Process Diagnosis:

The process diagnosis module allows a detailed review of procurement processes within a country. The module allows users to systematically understand and identify performance gaps within existing processes. The rows of the workbook provide a general breakdown of procurement processes and functions along with the ideal state of those functions, while the columns provide a space to reflect and identify gaps.

While the toolkit in its current form attempts to map a wide range of procurement functions, the process diagnostics module can be adapted to national contexts to ensure relevant and appropriate comprehensive analysis.

3. Problem identification:

The problem identification matrix plays a crucial role in mapping gaps from the diagnostic stage of the process, helping to identify the root causes that hinder procurement. This module ensures methodical analysis and categorization of problems for specific solutions.

Array assignment: Each gap identified in the process diagnostics module is assigned to one of four inefficiencies: people, processes, finances, and data use. Additional space is provided for spaces that fall into “other” categories.
Root Cause Analysis: Each category contains specific questions to guide the identification of the most applicable cause for each identified process gap. Recognizing that each gap can have multiple root causes, the matrix allows each gap to be ranked by the number of core issues to encourage prioritization of issues based on severity and ease of selecting solutions.

4. Solution identification:

The Solution Identification module provides a structured framework and resources to address the root causes identified in the previous steps. This ensures that solutions are not only identified but also tracked for effective implementation.

Tracker: The first section of the module provides a tracker where identified solutions can be noted and the progress of their implementation can be systematically followed.
Structure: The second section provides a framework with general solutions tailored to each of the four inefficiencies: people, processes, finances, and data use. Drawing on CHAI’s experience, this framework ensures a targeted and effective approach to resolving identified barriers. CHAI’s ‘Use of Vaccine Procurement Data’ report (linked below) details more details about the interventions.

Learning from the field

CHAI’s field experiences in Uganda and Cameroon were instrumental in shaping the toolkit. In Uganda, the initiative’s efforts to map the procurement process and identify budget gaps paved the way for evidence-based advocacy, leading to increased procurement budgets. The importance of analyzing budgetary and demographic trends beyond simple supply and demand indicators became evident.

Similarly, in Cameroon, CHAI collaborated with the Expanded Program on Immunization (EPI) to conduct key informant interviews to map vaccine procurement processes. This in-depth mapping provided crucial information on key obstacles in the procurement process and prompted government-led actions to resolve them, including the establishment of a technical working group for vaccine financing and procurement, strengthening coordination of the parties stakeholders and ensuring timely disbursement of vaccine funds. obtaining. These efforts have begun to yield early results, as evidenced by the more timely disbursement of the government’s vaccine co-financing funds. As of December 2022, the Government of Cameroon had paid 100 percent of its vaccine co-financing obligations, a significant improvement over 2019 and 2020, when the government mobilized only 67 percent of funds for vaccine procurement. . The shortage limited its ability to acquire adequate quantities of vaccines to meet the needs of the population.

Adapt to national and subnational realities

While this toolkit has been designed to ensure its applicability in diverse national and subnational contexts, its effectiveness depends on comprehensive mapping of national-level processes to fit local contexts. Still, due to the complexity of local government and procurement structures, the toolkit and case studies it contains only provide broad guidance for procurement programs.

However, we believe that the framework provided by the tool can help governments and implementing partners improve the efficiency of the procurement process and increase the availability of last-mile vaccine stocks, ultimately strengthening the confidence that parents vaccinators deposit into the immunization system.