Outsourcing the vaccine supply chain and logistics system to the private sector The Western Cape experience in South Africa

Foundation. The views expressed herein are solely those of the authors and do not necessarily reflect the views of the Foundation. Abbreviations BCG Bacilles Calmette-Guérin CMD Central Medical Depot DOH (South Africa National) Department of Health DTP Diphtheria-tetanus-pertussis EPI Expanded Programme on Immunization EVM effective vaccine management EVSM effective vaccine stores management FIC fully immunized child Hep B Hepatitis B Hib Haemophilus influenzae type b IPV inactivated polio vaccine KPI key performance indicators MOH ministry of health OPV oral polio vaccine PCV pneumococcal conjugate vaccine PPP public-private partnership R Rand RV Rotavirus SA South Africa SOP standard operating procedures Td Tetanus-diphtheria (reduced dose) TT tetanus toxoid VVM vaccine vial monitor WCDH Western Cape Department of Health WHO World Health Organization vi Acknowledgments The Collaborating Centre for Cold Chain Management in South Africa through Ticky Raubenheimer has been an invaluable partner in facilitating the process to get this study approved by local stakeholders and for doing all the field work related to this review. This review would not have been possible without the support from the following groups and individuals:  The Biovac Institute and its administration and management.  The Western Cape Department of Health.  The cold chain manager of the Western Cape. In recent years, vaccine supply chain management has become a priority for many countries working to scale up vaccine delivery. The introduction of new vaccines is an increasingly complex as well as costly activity, however, bringing with it a number of challenges. In addition, the resources necessary for expanding the supply chain capacity and better enabling health care workers to effectively manage, store, and distribute vaccines are often unavailable. Without external resources, many ministries of health are hesitant to make large capital investments in the kind of vaccine supply chain system that scale-up would require. As a result, more and more countries are engaging the private sector in supply chain and logistic functions. When such expertise is available in country, as it is in South Africa, governments are frequently outsourcing the physical storage and handling of commodities to specialized private-sector logistic operators. 1 Outsourcing is a growing trend in high-and middle-income country settings, yet remains an emerging trend in low-income country settings. Although the theoretical benefits of outsourcing are clear, the true costs and benefits remain unclear. Information regarding the challenges of outsourcing public health supply systems is lacking as is information regarding the conditions necessary …