Evaluating supply chain management of cold storage for preventive child healthcare programmes: A comparative study from western India

Background & objectives Immunisation is a cornerstone of public health, significantly reducing vaccine-preventable disease (VPD) mortality. The World Health Organization-United Nations Children's Fund (WHO-UNICEF) effective vaccine management (EVM) initiative provides tools to enrich vaccine supply chains. This study evaluated the effectiveness of cold storage management in western part of India, using EVM criteria, comparing performance across districts with varying full immunisation coverage (FIC). Methods A cross-sectional study was conducted in six districts (3 high-FIC and 3 low-FIC). Data were collected from 90 service points (SPs) and six district vaccine stores (DVSs) using the WHO EVM tool and structured questionnaire with 204 stakeholders. Secondary data were obtained from vaccine management records and analysed to assess the performance of the vaccine supply chain. EVM criteria scores (e.g., temperature control, stock management) and category scores (e.g., infrastructure, maintenance) were compared to the global benchmark of 80 per cent. Descriptive statistics were used to summarise the data, while the Shapiro-Wilk test assessed normality. Depending on the distribution, independent samples t-tests or Mann-Whitney U tests were applied to compare EVM scores across relevant groups. Results Gujarat achieved strong scores across most EVM criteria, i.e., temperature control (99%), storage capacity (98%), maintenance (99%), and vaccine management (96%). Management Information System (MIS) and vehicle infrastructure had the lowest scores, with MIS scoring 79 per cent and vehicle infrastructure scoring 80 per cent, slightly below the WHO-recommended benchmark. High- and low-FIC districts showed no statistically significant differences in overall performance, as measured by the EVM composite score (mean EVM score difference: 1.75 percentage points, P>0.05). Category analysis highlighted high scores in buildings (95%), capacity (97%), and training (99%). Compared to earlier assessments, Gujarat demonstrated significant improvements in supply chain efficiency. Interpretation & conclusions Gujarat's vaccine supply chain has demonstrated substantial improvements, meeting or exceeding global benchmarks in most areas, though targeted improvements in MIS and vehicle infrastructure are necessary. The findings emphasise the importance of robust vaccine management systems for public health success.