Vaccines Last Mile Delivery Project: Endline assessment report

Executive Summary
Background: The Uganda National Expanded Program on Immunization (UNEPI) in collaboration with National Medical Stores (NMS), and with funding from GAVI commissioned an 18-month pilot study in 3 districts (Nakaseke, Nakasongola and Wakiso) for the distribution of vaccines to the last mile through an outsourced logistics service provider (LSP). The pilot commenced in May 2018 and was implemented by UPS in partnership with Freight in Time Clinton Health Access Initiative (CHAI) was contracted to evaluate the pilot effectiveness and feasibility through three sets of assessments (baseline, midline and end line) and (iii) evaluate the overall LMD pilot effect on  coverage. This report provides a summary of the key findings from the endline assessment.

Key insights from the pilot:

I. Improved delivery of vaccines to the last mile (at HF level).
District delivery of vaccines to health facilities increased from 4% (6/150 HFs) at baseline to 97% (145/150 HFs) at endline. And the proportion of health facilities with their orders honored in full at endline was reported to be at 73% (110/150)

II. Improved availability of vaccines at HF level
Across all vaccines, HPV and ROTA showed the highest improvements in stock availability between baseline and endline; from 56% (84/150) to 95% (142/150) and from 65% (98/150) to 97% (146/150) respectively. The proportion of facilities with all vaccines in stock at the time of the assessment increased from 54% to 85% and the average stock out days reduced from 16 days at baseline to 10 days at endline.

III. Improved cold chain equipment management and temperature monitoring at HF level
Cold chain functionality was maintained above 90% at endline with a slight improvement from 92% to 96% and the availability of fridge tags within functional fridges increased from 75% (110/146 functional equipment) to 92%. At baseline 35 health facilities reported having had temperature excursions as opposed to 54 at endline mainly because monitoring of temperature improved as already highlighted. However, all health facilities that reported having had temperature excursions in the month preceding the endline assessment also reported having resolved them under a week with support from the LSP. This is an improvement from baseline where all health facilities that had excursions reported resolving them after week. Additionally, monthly temperature review form submission by health facilities improved from 22% to 72% demonstrating strengthened temperature monitoring at health facility level

IV. Provision of additional technical assistance by logistics service provider (LSP)
Ninety five percent (95%) of the respondents reported a good working relationship with the LSP citing responsiveness in case of emergencies and repair of faulty equipment. Eighty seven percent (87%) reported that safety and security measures were adhered to by the LSP during delivery of vaccines. Also, at endline, 75% (112/150) of the health facilities reported to be conducting physical count every month after having received mentorship and technical support from the LSP.

V. Vaccines Last Mile Delivery pilot effect on coverage
Across the 3 districts, improved availability of stocks for vaccines at the last mile (health facilities) contributed to improved coverage in immunization. Coverage for the tracer vaccine (PENTA) improved from 86% pre-pilot to 95% during the pilot and likewise measles coverage improved from 75% pre-pilot to 81% during the pilot.