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Samson Gebremedhin Gebreselassie, Speaker at Vaccines Conferences
Project HOPE, Ethiopia
Title : The Ethiopian vaccine supply chain and logistics system’s performance after the last mile delivery initiative: Phenomenological study


Background: Uninterrupted availability of potent vaccines requires robust vaccine supply chain and logistics system (VSCLS). With special focus on remote and underserved settings, we assessed the reach and bottlenecks to end-to-end delivery of the Ethiopian VSCLS after the initiation of the last mile transition. 

Methods: We explored the perspectives of key stakeholders of the VSCLS using a qualitative phenomenological study. We captured the viewpoints of the Ethiopian Pharmaceutical Supply Service (EPSS), the health system, partner organizations, health workers, and community members through 327 in-depth interviews and 22 focus group discussions. The study was sequentially implemented over two phases to understand the bottlenecks at national and regional (Phase-I), and lower levels (Phase-II). Data were analyzed thematically using data-driven coding.

Results: After the transition, EPSS started supplying vaccines directly to health facilities bypassing intermediaries. The transition reduced supply hiccups and enabled the health sector to focus on its core activities. However, in remote areas achievements are modest, and health facilities are receiving supplies indirectly through district health offices. By design, health posts collect vaccines from health centers, causing demotivation of health extension workers, and frequent closure of health posts. Challenges of the VSCLS include artificial shortage due to ill-forecasting and failure to request needs on time, lack of functional refrigerators secondary to scarcity of skilled technicians and spare parts, and absence of dependable back-up power at health centers. From EPSS’s perspective, shortage of refrigerated tracks and unmanageably large catchment areas are major blockades. Vaccine wastages owing to poor forecasts, negligence, and cold chain problems are common. The VSCLS has not sustainably embraced digital logistics solutions so far. The system is overstrained by frequent outbreak-responses and introduction of new vaccines.

Conclusion: The last mile delivery has improved the VSCLS. However, the reach remains suboptimal in remote areas, threatening national coverage and equity goals. 
Keywords: vaccine supply chain; cold chain management; vaccine wastage; last mile delivery

Audience Takeaway:

  • Systematic redesigning of the vaccine logistic system, especially bypassing intermediaries, improves  the availability of routine vaccines in LMICs like Ethiopia. 
  • However, additional strategies need to be considered to reach to remote and underserved settings.


Dr. Samson Gebremedhin is an Associate Professor of Public Health, at Addis Ababa University, Ethiopia. Recently he has served as the Principal Investigator for Bill and Melinda Gates Foundation funded research project “Reaching zero-dose and under-immunized children in Ethiopia” implemented by the Project HOPE. Dr. Samson has served in the academia for more than two decades.