National immunization programs in developing countries face several challenges in ensuring equitable access to the expanded program on immunization (EPI) vaccines against preventable diseases. Safely storing and transporting larger volumes of vaccines and other immunization commodities to immunization service points has become increasingly difficult, especially in remote and hard-to-reach areas. Critical barriers include lack of inventory, inadequate cold chain capacity, insufficient funding, insufficient coordination of interventions, and low interest in immunization supply chain and logistics policies.
The Effective Vaccine Management (EVM) Initiative, launched by the World Health Organization (WHO) and United Nation Children’s Fund (UNICEF) in 2010, is a process by which countries periodically evaluate the performance of their immunization supply chain and logistics systems against best-practice benchmarks in order to enact an improvement plan accordingly. As part of this effort to improve the supply chain, WHO supports the establishment and reinforcement of NLWGs as a promising strategy for improving supply chain management, decision-making, and accountability at the national level.
NLWGs can address impediments to life-saving vaccines by uniting national stakeholders, opinion-formers, and decision-makers to rally behind a shared vision for the country’s immunization supply chain. The effort should be in alignment with priorities to strengthen national immunization health systems. National ownership and leadership are essential to foster the commitment and collaborative atmosphere that are needed to enable country-led change.
Landscape study
Recognizing the importance of NLWGs, the WHO-UNICEF Supply Chain Hub has made it a priority to support countries in establishing or strengthening NLWGs. In order to gain insight on what NLWGs should do, how they should operate, how they should be managed, and who should be involved, a landscape analysis study was conducted from September 2015 to February 2016. Of the 43 countries that participated in the study, 10 had formal NLWGs, 8 had informal NLWGs, and 25 had none. Key findings from the study are presented by Leab et al. in National logistics working groups: A landscape analysis study.
What NLWGs are
NLWGs are a mechanism for coordinating national immunization logistics and supply chain activities as well as supply chain investments made by government agencies and development partners. The NLWG provides guidance, expertise, and technical assistance on all matters concerning supply chain operations and improvement initiatives. The NLWG engages with key stakeholders in the process to share information, evidence, and lessons learned; to identify and overcome program bottlenecks; to explore opportunities for innovation; and to make optimal use of resources.
Members of NLWGs are usually representatives from EPI, WHO-UNICEF, pharmacy and drug departments, and other technical departments at the ministry of health. Governance of NLWGs is mainly within the purview of the EPI and the Inter-agency Coordination Committee. NLWGs as ‘‘leadership groups” may take different forms and names. Gambia, for example, named its NLWG the ‘‘National EPI Logistics Committee” and Lao PDR named its NLWG the ‘‘National Immunization Logistics Working Groups – NILWG”. Whatever their names, these groups aim to improve coordination among partners to plan and implement initiatives to strengthen national immunization priorities.
Key successes and challenges
The role and successes that NLWGs have achieved in countries—particularly India, Indonesia, Kenya, Mozambique, and Nigeria—suggest that the working group is a key element of the national EPI strategy to ensure the availability of effective vaccines for children and adults at all levels of the health system. Among the greatest achievements of NLVMs includes vaccine management training and demand forecasting, as well as EVM assessment and preparing to introduce new vaccines.
Key challenges include low interest in immunization supply chain and logistics among logistics managers or officers, unclear understanding of the roles and values of NLWGs, lack of specialized human resources and capacity at the national level, lack of systematic and clear mode of functioning, and the size of countries and number of partners.
Actions for moving forward
The recommendations and options suggested by countries to address identified challenges are as follows:
- Improve advocacy to raise awareness about immunization supply chain and logistics issues and establish formal NLWGs.
- Reinforce capacity and knowledge in supply chain management.
- Ensure institutional integration and acknowledgement of the NLWG.
- Use formal written terms of reference and modes of operation.
- Define basic indicators for monitoring and evaluating NLWGs.
- Create regional logistics working groups for small countries.
NLWGs are considered a key element of national EPI strategies that work toward ensuring the availability of effective vaccines at all levels of the health system. Research suggests that NLWGs play or could play an important role in fostering coordination of national immunization supply chain and logistics activities by providing systematic guidance.
These web pages offer programme managers in developing countries a recommended process for establishing or reinforcing an NLWG, as well as a list of tools and resources, such as a sample terms of reference, workplan template, list of core indicators to monitor NLWG's functioning, and other guidance documents and tools including videos and an e-learning module.