Improving the last mile delivery of vaccines through an informed push model: experiences, opportunities and costs based on an implementation study in a rural district in Uganda
Authors: Bakkabulindi Pamela , Wafula Solomon T , Ssebagereka Anthony , Sekibira Rogers , Mutebi Aloysius , Ameny Jimmy , Abewe Christabel , Isunju John Bosco 
Published: November 2023

AbstractBackgroundMany developing countries struggle to attain equitable, timely and efficient availability of potent vaccines at the health facility level. In Uganda, several challenges prevent the reliable distribution of vaccines from the district vaccine store to the health facility level (last mile). The currently practiced mixed push and pull system mode of vaccine delivery is unpredictable, unreliable, and often presents issues of poor vaccine management, vaccine stock-outs and missed opportunities for vaccination.The overall aim of the study was to improve the efficiency of the last mile delivery of vaccines by implementing an informed push model of vaccine delivery. Specifically, the study aimed to; improve vaccine lead time; standardise cold chain management practices during vaccine transportation; and cost the implementation of the informed push model.MethodsMixed-methods approach to evaluate the impact of the informed push model on the last mile delivery of vaccines in Gomba district, Uganda was used. Quantitative and qualitative data was collected at baseline and endline. Quantitative data was collected on the mode, frequency, lead time and costs of vaccine delivery; vaccine stock status, and cold chain maintenance of vaccines during transportation using semi-structured interview survey, while the experiences and challenges were explored qualitatively using a guide. Analysis of quantitative data used descriptive statistics and that of costing data used an ingredients approach. Qualitative data using was analysed using a thematic framework.ResultsThe findings showed that the informed push system improved the efficiency and quality of vaccine delivery at the last mile in Gomba district. The average lead time of vaccine delivery was reduced from 14 days at baseline to 5 days by endline. The number of health facilities reporting timely receipt of vaccines increased from 36.8% at baseline to 100% by endline. Facilities reporting temperature monitoring of vaccines during transit improved from 26.3% at baseline to 100% by endline. Number of health facilities experiencing stock outs reduced from 79% at baseline to 36.8% by endline. The monthly costs incurred by health facilities in vaccine pick up at baseline were $ 170.8. The monthly costs for the informed push model were $445.9 ($ 0.06 per child reached) and more two and half times more than baseline costs of $170.8 incurred by health facilities during pick-up of vaccines from the district vaccine store.ConclusionThe study concluded that informed push model is a financially feasible strategy that could be efficient in improving the vaccine supply chain at the last mile by reducing lead time delivery of vaccines, improving vaccine cold chain management, reducing vaccine stock outs. We recommend the integration of this model into the national immunization program and its subsequent adoption by all districts in Uganda.