Planning vaccine distribution in rural and urban poor communities is challenging, due in part to inadequate vehicles, limited cold storage, road availability, and weather conditions. The University of Washington and VillageReach jointly developed and tested a user‐friendly, Excel spreadsheet based optimization tool for routing and scheduling to efficiently distribute vaccines and other medical commodities to health centers across Mozambique. This paper describes the tool and the process used to define the problem and obtain feedback from users during the development. The distribution and routing tool, named route optimization tool (RoOT), uses an indexing algorithm to optimize the routes under constrained resources. Numerical results are presented using five datasets, three realistic and two artificial datasets. RoOT can be used in routine or emergency situations, and may be easily adapted to include other products, regions, or logistic problems.

To improve equity in immunization coverage, potent immunization products must be available in the communities in which low coverage rates persist. Most supply side investments are focused on replacing or establishing new health facilities to improve access to immunization. However, supply chain design must be improved to ensure that potent vaccines are available at all facilities to promote immunization equity. We used the supply chain design process in Pakistan as an opportunity to conceptualize how supply chains could impact equity outcomes. This paper outlines our approach and key considerations for assessing supply chain design as a contributing factor in achieving equitable delivery of immunization services. We conducted a supply chain analysis based on sub-national supply chain and immunization coverage at district level. Supply chain metrics included cold chain coverage and distances between vaccination sites and storage locations. Immunization coverage metrics included the third-dose diphtheria- tetanus-pertussis (DTP3) vaccination rate and the disparity in DTP3 coverage between urban and rural areas. All metrics were analyzed at the district level. Despite data limitations, triangulation across these metrics provided useful insights into the potential contributions of supply chain to equitable program performance at the district level within each province. Overall, our analysis identified supply chain gaps, highlighted supply chain contributions to program performance and informed future health system investments to prioritize children unreached by immunization services.

Ensuring the delivery and availability of health products, including temperature-sensitive vaccines, is vital to saving lives in low- and middle-income countries (LMICs). In many LMICs routes are hand drawn by logisticians and are adjusted based on vehicle availability and product quantities. Easy-to-use real-time supply chain tools are needed to create or adjust routes for available vehicles and road conditions. Having more efficient and optimized distribution is especially critical for COVID-19 vaccine distribution. Route Optimization Tool (RoOT) works best for planning routes for 50 health facilities or less, in two minutes. We develop RoOT using a variant of a Vehicle Routing and Scheduling Algorithm (VeRSA) that is coded in Python but reads and writes Excel files to make data input and using outputs easier. RoOT can be used for routine operations or in emergency situations, such as delivery of new COVID-19 vaccine. The tool has a user-centric design with easy dropdown menus and the ability to optimize on time, risk, or combination of both. RoOT is an open-source tool for optimal routing of health products. It provides optimized routes faster than most commercial software and is tailored to meet the needs of government stakeholders We trained supply chain logisticians in Mozambique on using RoOT, and their feedback validates that RoOT is a practical tool to improve planning and efficient distribution of health products, especially vaccines. We also illustrate how RoOT can be adapted for an emergency situation by using a test scenario of a cyclone. Currently, RoOT does not allow multi-day routes, and is designed for trips that can be completed within twenty-four hours. Areas for future development include multi-day routing and integration with mapping software to facilitate distance calculations and visualization of routes.

Delivery of health products from provinces or districts to health facilities, including temperature-sensitive vaccines, is one of the most effective interventions to ensure availability of supplies and save lives in low- and middle-income countries. Currently, routes are hand drawn by logisticians that are adjusted based on vehicle availability and quantity of products. Easy-to-use supply chain tools are needed that planners can use in real-time to create or adjust routes for available vehicles and road conditions. Efficient and optimized distribution is even more critical with the COVID-19 vaccine distribution. We develop a Route Optimization Tool (RoOT) using a variant of a Vehicle Routing and Scheduling Algorithm (VeRSA) that is coded in Python, but reads and writes Excel files to make data input and using outputs easier. The tool takes into account cold chain distribution, is easy-to-use, and provides routes quickly within two minutes. RoOT can be used for routine operations or in emergency situations, such as delivery of new COVID-19 vaccine. The tool has a user-centric design with easy dropdown menus and the ability to optimize on time, risk, or combination of both. Training of logisticians in Mozambique indicate that RoOT is easy to use and provides a tool to improve planning and efficient distribution of health products, especially vaccines. We illustrate using RoOT in an emergency situation, such as a cyclone. RoOT is an open-source tool for optimal routing of health products. It provides optimized routes faster than most commercial software, and is tailored to meet the needs of government stakeholders. Currently, RoOT does not allow multi-day routes, and is designed for trips that can be completed within twenty-four hours. Areas for future development include multi-day routing and integration with mapping software to facilitate distance calculations and visualization of routes.