Background: Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels and enhance the development of continuous improvement plan to strengthen the system. This study was conducted to determine the vaccine management performance in Health Facilities of Mwanza Region, Tanzania.

Methods: This was a descriptive cross-sectional study that was carried out in 102 health facilities providing immunization services from eights districts of Mwanza Region in Tanzania. The World Health Organization (WHO) effective vaccine management assessment tools were used to collected data. Both quantitative and qualitative (through key informant interviews) approaches were used. The quantitative data were analysed using the existing WHO criteria for analysing effective vaccine management assessment data, while deductive thematic analysis was used for the qualitative data.

Results: The finding shows that the overall score for vaccine management performance was 53% which is below the WHO acceptable minimum score of 80%. None of the health facilities had reached the benchmark but only 67% had an average performance (> = 50–< 80%). The highest health facility score was 76% and the lowest being 27%. Among the categories assessed, the highest score was on information technology with 72%, while the lowest was on standard operating procedures with a score of 43%. The major challenges which contributed to low performance were lack of training, low knowledge about vaccine management practices, unavailability of standard operating procedures (SOPs), and limited financial resources to support operations for vaccine management practices. Skills gap, incomplete stock records and management, as well as low availability of SOPs were the key challenges reported that affected vaccine management practices.

Conclusions: Effective vaccine management performance was low across all districts under the study. Increasing personnel capacity and ensuring availability of resources to support operations were reported as key interventions in improving vaccine management practices. Hence, effectively working on continuous improvement plan with key highlighted actions is highly recommended to all actors from national level to sub-national level managers and healthcare workers as frontline vaccine handlers.