Submission ID 118400
| Issue/Objective | Immunization is among the most impactful public health interventions for preventing vaccine-preventable diseases (VPDs). Its effectiveness relies on a well-functioning vaccine cold chain (VCC), which preserves vaccine potency during storage and transport. Breakdowns in the VCC expose vaccines to suboptimal temperatures, diminishing efficacy and contributing to outbreaks of VPDs. Recent global and national surges in measles and polio cases have raised concerns over VCC integrity. This study investigates the facilitators and barriers to VCC functionality in Rukungiri District, a hard-to-reach, mountainous area in Western Uganda, contributing context-specific insights for building resilient and equitable immunization systems in low-resource settings, and advancing global health in an increasingly complex world. |
|---|---|
| Methodology/Approach | A qualitative study was conducted in Rukungiri District between October and November 2023. Seven key informant interviews were held with district and facility immunization managers selected purposively for their roles and experience. A semi-structured interview guide, based on the WHO Effective Vaccine Management framework, was used. Interviews lasted about 60 minutes, were audio-recorded with consent, transcribed verbatim, and stored securely. Thematic analysis was conducted using an inductive approach. Ethical approval was obtained from Makerere University School of Public Health Research and Ethics Committee |
| Results | Key facilitators of VCC functionality included dedicated knowledgeable workforce, supportive supervision, and review meetings that informed decisions. Solar-powered refrigerators ensured VCC continuity particularly in case of power outages. Others included effective maintenance systems, rigorous temperature monitoring, adherence to guidelines, and a proactive contingency plan. Key barriers included frequent power outages, reliance on outdated gas-powered refrigerators in some facilities, and delayed maintenance due to transport challenges in the mountains. Human resource constraints, such as limited VCC training and frequent staff transfers disrupted service continuity and affected knowledge retention |
| Discussion/Conclusion | The findings underscore the vital role of a functional VCC in ensuring effective immunization, particularly in low-resource, hard-to-reach areas. Enablers such as solar refrigeration, trained personnel, and supportive supervision enhance system resilience, while barriers like gaps in storage, transport, and workforce hinder performance. Targeted investments in infrastructure, human resources, and sustainable technologies are essential to achieving effective immunization and building resilient systems in an increasingly dynamic global health environment. |
| Presenters and affiliations | Amuzah Nshabaruhanga Makerere University School of Public Health Amuzah Nshabaruhanga Makerere University School of Public Health |
