The toolkit is designed to assist immunization programs in assessing, diagnosing, and solving vaccine procurement challenges
In many low- and middle-income countries, vaccine stockouts can be all too common. Children and their caretakers bear the brunt of lifesaving vaccine shortages, resulting in a lack of trust in immunization services in facilities.
According to UNICEF’s The State of the World’s Children 2023: For Every Child Vaccination, nearly 13 million children in Africa missed out on one or more vaccinations over three years. The report lists limited skilled health personnel and access to essential supplies and equipment, weak capacity for collecting and using data, and shortages of key medicines and vaccines as some of the contributing factors to the large number of unvaccinated and under-vaccinated children.
There are human, data, and systems factors impacting vaccine availability in low- and middle-income countries. Vaccine stockouts are often a result of a lack of trained staff, poor stock management, poor record keeping of vaccine inventory, poor forecasting, and distribution bottlenecks, complexities, and inefficiencies in the procurement process that impact the supply chain.
To help address vaccine stock management, the Clinton Health Access Initiative (CHAI) has developed a toolkit based on its work in Cameroon and Uganda from 2019 to 2023.
Download the Diagnostic Toolkit
Introducing the vaccine procurement toolkit
The toolkit utilizes four modules that comprehensively cover the procurement lifecycle to assist countries in identifying and addressing challenges within their vaccine procurement processes:
- Key Performance Indicator Analysis allows users to diagnose the extent of problems in procurement.
- Process Diagnostic is meant to assist in identifying specific gaps in the procurement process.
- Issue Identification is meant to identify the root causes behind the gaps.
- Solution Identification is meant to support the curation of customized solutions.
A Structured Approach: The Four Modules
1. Key Performance Indicator (KPI) Analysis:
The KPI analysis module serves as the starting point, aiming to evaluate potential barriers within a country’s procurement function. Using two critical indicators—Stock Sufficiency and Financial Sufficiency—the toolkit provides a thorough assessment of existing challenges.
- Stock Sufficiency: Measures the adequacy of antigen doses in comparison to forecasted and ordered doses. This indicator sheds light on whether the country is receiving enough vaccines.
- Financial Sufficiency: Evaluates whether the allocated budget for vaccine procurement aligns with the forecasted and budgeted amounts. This metric ensures that the funds mobilized will meet the anticipated needs.
2. Process Diagnostic:
The process diagnostic module enables a detailed review of the procurement processes within a country. The module allows users to understand and identify performance gaps within the existing processes systematically. The rows in the workbook provide a general breakdown of procurement processes and functions alongside the ideal state of said functions while the columns provide a space for reflections and identifying gaps.
While the toolkit in its current form tries to map a broad array of procurement functions, the process diagnostic module can be customized to country contexts to ensure a relevant and appropriate comprehensive analysis.
3. Issue Identification:
The issue identification matrix plays a crucial role in mapping gaps from the process diagnostic stage, helping to identify root causes that hinder procurement. This module ensures a methodical analysis and categorization of issues for targeted solutions.
- Matrix Allocation: Each gap identified in the process diagnostic module is allocated to one of four inefficiencies—people, process, finances, and data use. Additional space is provided for gaps falling into ‘other’ categories.
- Root Cause Analysis: Each category contains specific questions to guide the identification of the most applicable cause for each identified process gap. Recognizing that each gap may have multiple root causes, the matrix allows for grading each gap by the number of root issues to encourage prioritization of problems by their severity and ease in curating solutions.
4. Solution Identification:
The Solution Identification module provides a structured framework and resources to address the root causes identified in the previous steps. This ensures that solutions are not only identified but also tracked for effective implementation.
- Tracker: The first section of the module provides a tracker where identified solutions can be noted, and their implementation progress can be systematically tracked.
- Framework: The second section provides a framework with general solutions tailored to each of the four inefficiencies—people, process, finances, and data use. Drawing from CHAI’s experience, this framework ensures a targeted and effective approach to problem-solving to resolve the identified bottlenecks. CHAI’s ‘Vaccine Procurement Data Use’ report (linked below) goes into further detail on the interventions.
Learning from the Field
CHAI’s on-the-ground experiences in Uganda and Cameroon were instrumental in shaping the toolkit. In Uganda, the initiative’s efforts in mapping the procurement process and identifying budgeting gaps paved the way for evidence-based advocacy, leading to increased procurement budgets. The importance of analyzing budgetary and population trends beyond simple demand and supply indicators became evident.
Similarly, in Cameroon, CHAI collaborated with the Expanded Program on Immunization (EPI) to conduct key informant interviews for mapping vaccine procurement processes. This in-depth mapping provided crucial insights into key bottlenecks in the procurement process and sparked government-led action to resolve them, including the establishment of a technical working group for vaccine financing and procurement, strengthening stakeholder coordination, and ensuring timely fund disbursement for vaccine procurement. These efforts have started yielding early results, evidenced by more timely disbursement of the government’s vaccine co-financing funds. By December 2022, the Government of Cameroon had paid 100 percent of its vaccine co-financing obligations, a significant improvement from 2019 and 2020, when the government mobilized only 67 percent of funds for vaccine procurement. The shortage limited its capacity to procure adequate quantities of vaccines to meet the population’s needs.
Adapting to National and Sub-National Realities
While this toolkit has been designed to ensure applicability to diverse national and sub-national contexts, its effectiveness relies on a thorough country-level process mapping to adjust for local contexts. Still, due to the complexity of procurement and local government structures, the toolkit and case studies within provide only broad guidance for procurement programs.
Nonetheless, we believe that the framework provided by the tool can help governments and implementing partners improve procurement process efficiency and increase the availability of vaccine stocks at the last mile, ultimately strengthening the trust that vaccinating parents place in the immunization system.
Download the Diagnostic Toolkit
Download the Vaccine Procurement Data Use Guide
This work was made possible by funding from the Bill & Melinda Gates Foundation. The contents do not necessarily reflect the views of the Bill & Melinda Gates Foundation.
