Field-level vaccine supply chain indicators: Efficiency of distribution (post 4 of 4)

Many country vaccine distribution systems in low to middle income countries feature scheduled deliveries from central to intermediate level stores. But they depend on collection or a mix of collection and delivery at service delivery level of the system. The mode of travel varies as transport becomes available, the timing of trips varies widely and there are many unexpected delays. Under these unpredictable conditions requests by those collecting and arriving vaccine deliveries are often unscheduled, even chaotic at times. There are five features of efficient vaccine distribution system to enable them to be regular, reliable, complete and timely while being achieved at least cost. These are:

1. Every vaccine collection or delivery is pre-planned and scheduled to occur on a certain day in each supply period and at a certain time (within a set tolerance).
2. The design of the distribution system, the circuits that are chosen are optimized for duration and best use of the visiting team
3. The choice between collection and delivery is dependent mainly on availability of dedicated transport, or managerial control over shared transport and availability of a travel budget for distribution
4. The cost of the distribution of 1m3 of tertiary packed vaccine per km travelled is minimized
5. Supervision combined with supply can be very effective.

These features promote high efficiency but they require a high degree of management control to implement, monitor and refine. This level of control is rarely available at service delivery level for immunization. For example, the health centre often has no vehicle but if it does, the vehicle is shared but priority is rarely given to vaccine supply. The district, on the other hand manages a transport budget, exercises more control over the use of vehicles and over vaccine supply chain procedures if they are responsible for deliveries. Thus, delivery of vaccines to health centers facilitates high performance distribution in most circumstances, although a sufficient budget has to be centralised at the district, instead of the practice of reimbursement at the health center. The table below sets out the options for an indicator of efficiency of distribution: Table: Alternative Vaccine Distribution Efficiency Indicators *Recommended SC indicator for District Supervisors to monitor Health Center performance. Note that suitable tolerance needs to be defined for late deliveries (e.g. Supply date +/-1 day) Assessing the three choices a), b) and c), all three indicators give a measure of efficiency and indicators a) and b) give also a measure of availability. The cost indicator does not have strong utility at field level and could be dropped. Of the remaining two indicators the timely execution of planned trips seems to have the most value. Consider that ‘short shipments’ of vaccine will show up both as supplementary supply trips and potentially, as stock-outs. Recommendation Adopt to following distribution efficiency indicator: “The number of vaccine timely arrivals as a percentage of the total number of arrivals pre-planned/scheduled during the supply period”