Assessment of Immunization Supply Chain of Ethiopia Using the WHO-UNICEF Effective Vaccine Management (EVM) Assessment Tool

This study aimed to assess the Ethiopian immunization supply chain (iSC) using the WHO-UNICEF Effective Vaccine Management (EVM) assessment tool in 302 nationally representative facilities. Ethiopian Pharmaceutical Supply Service (EPSS) center, the Sub-national hubs, lower distribution centers, and service provision levels of the Ethiopian immunization supply chain participated in this assessment. The finding is presented in 9 facility operations (E1-E9) and 4 management criteria (M1-4) across levels. The overall composite score of Effective Vaccine Management (EVM) is 69%. EPSS center or Primary level (PR) scored 85 % and EPSS hubs or Sub-National (SN) levels scored 81% hitting the WHO-recommended target score. The lower distribution (LD) and service provision (SP) levels scored 65% and 61% respectively, both being lower than the recommended WHO target score which is 80%. Vaccine management was a criterion that surpassed the WHO target recommended score. Temperature management, storage and transportation, and iSC performance monitoring criteria were consistently lower than the WHO target. Ethiopia's immunization supply chain management system is still far from meeting the WHO targets, particularly at lower distribution and service provision levels. EPSS centers perform well in many criteria but struggle with temperature management, storage, and transportation capacity. Ministry and stakeholders must prioritize improving facility operations and management at lower distribution and service provision levels. There is a need to develop a continuous improvement plan based on EVM findings and implement and systematically monitor the improvement activities to ensure their success.