title: System redesign of the immunization supply chain: Experiences from Benin and Mozambique.
abstract: Evidence suggests that immunization supply chains are becoming outdated and unable to deliver needed vaccines due to growing populations and new vaccine introductions. Redesigning a supply chain could result in meeting current demands.
  
  
  
  The Ministries of Health in Benin in Mozambique recognized known barriers to the immunization supply chain and undertook a system redesign to address those barriers. Changes were made to introduce an informed push system while consolidating storage points, introducing transport loops, and increasing human resource capacity for distribution. Evaluations were completed in each country.
  
  
  
  Evaluation in each country indicated improved performance of the supply chain. The Effective Vaccine Management (EVM) assessment in Benin documented notable improvements in the distribution criteria of the tool, increasing from 40% to 100% at the district level. In Mozambique, results showed reduced stockouts at health facility level from 79% at baseline to less than 1% at endline. Coverage rates of DTP3 also increased from 68.9% to 92.8%.
  
  
  
  Benin and Mozambique are undertaking system redesign in order to respond to constraints identified in the vaccine supply chain. Results and learnings show improvements in supply chain performance and make a strong case for system redesign. These countries demonstrate the feasibility of system redesign for other countries considering how to address outdated supply chains.
authors.affiliation: VillageReach, Seattle, WA, USA. Electronic address: wendy.prosser@villagereach.org.
authors.forename: Wendy
authors.initials: W
authors.lastname: Prosser
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaillard
authors.affiliation: Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Assy
authors.affiliation: Pittsburgh Supercomputer Center, Carnegie Mellon University, Pittsburgh, PA, USA.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Graça
authors.initials: G
authors.lastname: Matsinhe
authors.affiliation: UNICEF, Cotonou, Benin.
authors.forename: Mawutondji
authors.initials: M
authors.lastname: Dekoun
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D001541:Benin; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D009073:Mozambique; D009934:Organization and Administration; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Benin; Mozambique; Supply chain; System redesign; Vaccine