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Achieving universal access to immunization, as envisioned in the global vaccine action plan continues to be a challenge for many countries in Sub-Saharan Africa. Weak immunization supply chain (iSC) has widely been recognized as a key barrier, hindering progress towards vaccination targets in this region. These iSCs, which were designed in the 1980s, have become increasing fragile and are now considered outdated. The objective of this review was to assess the effectiveness of system redesign and outsourcing to improve outdated iSC systems in sub-Saharan Africa. We searched the following electronic databases from January 2007 to December 2017: Medline, EMBASE (Excerpta Medica Database), the Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. Our search strategy yielded 80 records and after assessment for eligibility, seven papers met the inclusion criteria. Five studies evaluated the experiences of system redesign in three countries (Nigeria, Benin and Mozambique), two assessed outsourcing vaccine logistics to the private sector in Nigeria and South Africa. According to these studies, system redesign improved vaccine availability at service delivery points and reduce the cost of distributing vaccines. Similarly, outsourcing vaccine logistics to the private sector reduced the cost of vaccines distribution and improve vaccine availability at service delivery points., Competing Interests: The authors declare no competing interests.

Introduction: Cameroon's cities have a growing concentration of target children not adequately covered by routine immunization programmes., Methods: We conducted a descriptive cross-sectional study, based on exhaustive sampling of legal health care facilities offering routine immunization services in the health district of Djoungolo (city of Yaoundé). The evaluation of the immunization programmes was based on the "Reaching Every District" approach., Results: Out of the 70 health care facilities that participated in the study, 3 (4.3%) had an updated microplan for routine immunization. Out of the 63 (89.4%) health care facilities with functional refrigerator, 12 (19.0%) vaccinated employing a fixed strategy on daily basis. Fifty-seven (81.0%) health care facilities did not conduct immunization sessions employing advanced strategy. Community participation in routine immunization programs was effective in 1 out of 12 districts health areas. A steadily updated vaccine tracking curve was available in 6 (8.5%) health facilities., Conclusion: The "Reaching Every District" approach implemented in Djoungolo health care district doesn't provide adequate coverage of a maximum rate of targeted children. The effectiveness of realistic microplanning, the regularity of vaccination sessions employing fixed and advanced strategies, action-oriented data monitoring, community revitalization plan to promote immunization are ways to improve the provision of vaccination services in this district., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.