A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region

ABSTRACT

Introduction

To describe vaccine stock-outs at national, district, and health facility levels in the WHO African region.

Areas covered

We conducted a systematic review to identify studies reporting on vaccine stock-outs at national, district, and health facility levels in 47 African countries. We searched both published and unpublished literature, including the WHO/UNICEF Joint Reporting Form (JRF), for eligible studies.

Expert opinion

Countries within the WHO African region continue to face the challenge of vaccine stock-outs at national, district, and health facility levels and this impacts on the delivery of immunization services. The frequency and the proportion of stock-outs vary between countries and between regions within a country. Countries need to put more efforts toward finding lasting solutions to vaccine shortages. We look forward to having more countries reporting vaccine stock-outs especially at the health facility level. Furthermore, countries are currently exploring different approaches for improving vaccine stock management. It is expected that in half a decade from now, more well-designed studies will be available that will inform decision-making

KEYWORDS:

• Vaccines
• immunization
• stock-outs
• shortages
• availability
• supply chain
• WHO Africa

Article highlights

• Based on the data from the WHO/UNICEF Joint Reporting form (JRF), approximately 50% of the countries in Africa reported stock-outs of at least one vaccine for at least 1 month at national and district levels, in 2017.

• Fourteen (30%) countries reported vaccine stock-outs in 2017 at the national level.

• BCG vaccine is the most affected vaccine, with an increase from five countries in 2010 to 16 countries in 2015.

• There is an 86% chance of stock-out at the district level being linked to national-level stock-outs and a 62% chance of this leading to interruption of immunization services at the facility level.

• At the facility-level stock-out reports from Africa were few. A total of eight studies reported vaccine stock-outs across Africa; South Africa (5); Nigeria (1); Guinea (1) and Kenya (1) and Ethiopia (1).

• South Africa is one of the few countries that seems to have a routine survey for stock-outs at the health facility levels and this has been ongoing since 2013.

• Commonly reported causes of vaccine stock-outs at the facility level include poor stock management, disease outbreaks, poor supply chain structure, delays in deliveries and lack of trained health personnel.

Acknowledgments

We are grateful to Alvina Mathee, of the Medicine and Health Sciences Library of Stellenbosch University, South Africa for assisting with the search.

Authors’ contributions

CJI and CSW conceptualized the review. CJI drafted the manuscript and edited subsequent drafts. E.P conducted the literature search. AJ and AW were involved in screening and data extraction. CSW and UC supervised the study and made contributions to the contents of the manuscript. NN and CSW provided technical advice and support. All authors read and approved this manuscript.

Declaration of interest

C. Iwu and C. Wiysonge are supported by the South African Medical Research Council and the National Research Foundation of South Africa. N. Ngcobo is an independent consultant. A. Jaca and A Wiyeh are supported by the South African Medical Research Council. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The research reported in this publication was supported by the South African Medical Research Council with funds received from the National Research Foundation of South Africa through its competitive program for rated researchers. (Grant Number: 106035).