Promoting equity in immunization coverage through supply chain design in Pakistan

Abstract

To improve equity in immunization coverage, potent immunization products must be available in the communities in which low coverage rates persist. Most supply side investments are focused on replacing or establishing new health facilities to improve access to immunization. However, supply chain design must be improved to ensure that potent vaccines are available at all facilities to promote immunization equity. We used the supply chain design process in Pakistan as an opportunity to conceptualize how supply chains could impact equity outcomes. This paper outlines our approach and key considerations for assessing supply chain design as a contributing factor in achieving equitable delivery of immunization services. We conducted a supply chain analysis based on sub-national supply chain and immunization coverage at district level. Supply chain metrics included cold chain coverage and distances between vaccination sites and storage locations. Immunization coverage metrics included the third-dose diphtheria- tetanus-pertussis (DTP3) vaccination rate and the disparity in DTP3 coverage between urban and rural areas. All metrics were analyzed at the district level. Despite data limitations, triangulation across these metrics provided useful insights into the potential contributions of supply chain to equitable program performance at the district level within each province. Overall, our analysis identified supply chain gaps, highlighted supply chain contributions to program performance and informed future health system investments to prioritize children unreached by immunization services.

Keywords: cold chain; equity; immunization; supply chain.

Figure 1.. Three supply chain metrics to assess equity in supply chain design.

Red - Indicator is outside range of the target; Yellow - Indicator is at the target range; Green - Indicator is well within the target.

Figure 2.. Cold chain capacity per surviving infant against immunization coverage for all provinces.

Figure 3.. Weighted average resupply distance to health facilities against third-dose diphtheria-tetanus-pertussis (DTP3) for all provinces.

Figure 4.. Average hours saved by each vaccinator in a year per health facility from direct delivery in Khyber Pakhtunkhwa province (excluding Tribal Districts).

Figure 5.. Inbound resupply distance of vaccines to district stores for all provinces against third-dose diphtheria-tetanus-pertussis (DTP3) for all provinces.

Figure 6.. Changing sourcing would reduce resupply distance of district stores in KP (excluding Tribal Districts) improving reliability and responsiveness of supply chain, and contributing to improved immunization coverage.