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Introduction: Vaccine stockout is a severe problem in Africa, including Nigeria, which could have an adverse effect on vaccination coverage and even health outcomes among the population. The Vaccine Direct Delivery (VDD) program was introduced to manage vaccine stockouts using eHealth technology. This study conducts a cost analysis of the VDD program and calculates the incremental costs of reaching an additional child for vaccination through the VDD program., Methods: We used the expense reports from eHealth Africa, an NGO which implemented the VDD program, to calculate the VDD program's overall operating costs. We also used the findings from the literature to translate the effect of VDD on the reduction of vaccine stockouts into its effect on the increase in vaccination coverage. We calculated the incremental costs of reaching an additional child for vaccination through the VDD program., Results: We calculated that implementing the VDD program cost USD10,555 monthly for the 42 months that the VDD program was operating in Bauchi state. This figure translates to an incremental cost of USD20.6 to reach one additional child for vaccination., Discussion/conclusions: Our study is one of the first to conduct a cost analysis of eHealth technology in Africa. The incremental cost of USD20.6 was within the range of other interventions that intended to increase vaccine uptake in low- and middle-income countries. The VDD program is a promising technology to substantially reduce vaccine stockout, leading to a reduction of over 55% at a reasonable cost, representing 26% of the total budget for routine immunization activities in Bauchi state. However, there is no comparable costing study that evaluates the cost of a supply chain strengthening intervention. Future studies should investigate further the feasibility of eHealth technology, as well as how to minimize its costs of implementation while keeping the efficacy of the program., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: Vaccine stockouts are prevalent in Africa. Despite the importance of this as a barrier to universal vaccination coverage, rigorous studies looking at ways to reduce vaccine stockouts have been limited. We causally evaluated the effect of Vaccine Direct Delivery (VDD), an intervention to ensure the vaccine stock availability at health facilities, on the reduction of stockouts in Bauchi state, Nigeria., Methods: Employing the interrupted time-series method, we evaluated the change in the occurrence of vaccine stockouts before and after the introduction of VDD in July 2015. We used health facility level data from January 2013 to December 2018 among 175 facilities in Bauchi state, collected through the District Health Information Software 2 (DHIS2) for monthly information on stockouts and stock balances in all the health facilities in Nigeria. Data were analyzed using Stata 15 SE. To validate the causal relationship between VDD and vaccine stockouts, we conducted two sets of robustness checks. First, we evaluated the effect of VDD on the stockouts of other commodities. Second, we compared the trend of the prevalence of vaccine stockouts among health facilities between Bauchi state where VDD was introduced and another state (Adamawa state) where VDD was never introduced., Results: After the introduction of VDD, vaccine stockouts in Bauchi state decreased by 9 percentage points on average, and they have been decreasing monthly by 0.4 percentage points more than pre-VDD. In Adamawa state, where VDD was never introduced, the prevalence of vaccine stockouts did not change over time. In Bauchi state after VDD introduction, the stock balances of target vaccines all increased, and the number of vaccinations carried out increased in neighboring health facilities., Conclusions: VDD intervention resulted in a significant reduction of vaccine stockouts as well as in an increase in the number of vaccinations performed. However, we should consider how to improve the system to provide vaccination service to the population in a sustainable way., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)