Management of Vaccine Cold Chain Equipment in the Ethiopian Immunization Supply Chain System: Evidence from Ethiopian National Immunization Program Evaluation

Background: There is insufficient evidence on the current condition of vaccine cold chain equipment (CCE) in Ethiopia. This study is aimed to assess the status of the CCE of the Ethiopian immunization supply chain (iSC) system. Methods: A cross-sectional study was conducted at 302 iSC sites across nine regions in Ethiopia using the World Health Organization (WHO) Expanded Program of Immunization (EPI) review guide and the EVM2.0 tool. Data were collected through direct observation and face-to-face interviews with the EVM Assessor mobile app, assessing vaccine storage capacity, including CCE type, brand, and model, at one EPSS center and 15 hubs. Results: All EPSS hubs use passive storage devices and have refrigeration and/or freezer units. A total of 408 refrigerators and/or freezers were found at lower distribution (LD) and service provision (SP) levels, including 335 regular refrigerators and 73 combined units (refrigerators and freezers). During the survey, 157 of these refrigerators had a functioning 30-day-temperature-record (30DTR) system. The average storage capacity for vaccines positive (2--80) was 1434 liters in 286 facilities. The average storage capacity of vaccine negatives (-25--150) was 538 liters in 286 facilities. The EPSS center and 13 hubs have conducted preventive maintenance and repaired refrigerators in the past year. Most institutions (82.95%) at the LD and SP levels lack a documented preventive maintenance schedule. Only 20% of institutions maintain records of preventive maintenance. Conclusion: Improving cold chain management through better temperature monitoring, increased refrigeration, and enhanced transportation is essential to ensure vaccine potency and reduce wastage.