Strengthening Vaccine Cold Chain Management to Enhance Quality, Safety, and Efficiency in PHCs - Lean 5S Intervention Results

Sep 12, 2026

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Effective vaccine cold chain management is critical for preserving potency and preventing wastage within primary health care facilities. Baseline data from PSMMC’s multi-site primary care network showed systemic weaknesses, including low transport temperature compliance, frequent temperature excursions, and delays driven by inefficient routing, non-standard workflows, and limited monitoring. A multidisciplinary team applied a Lean 5S intervention supported by root cause analysis tools, validated equipment, digital LogTag monitoring, standardized SOPs, and competency-based training. Results showed improved compliance, eliminated delivery delays, higher staff competency, and substantial reductions in wastage, aligning operations with WHO and MOH standards.

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Strengthening Vaccine Cold Chain Management to Enhance Quality, Safety, and Efficiency in PHCs Mohamed Mohamed Al Shehri 􀀍 , Mona Manea Awad Al Anazi 􀀍 , Khalid Abuzahra , Pacita Angelita Torricer 􀀍 , Maria Gracia Fermo Maligalig , Saud Abdullah Saud Alshagraawi , Hadeel Saleh H. Alissa , Abuobieda Khogali Al Abdalla Abdalrouf , Majed Sameer Saeed Alzahrani , Sahar Mohamed Abdullah Al Shahry , Abdulaziz Mansor A. Bin Rasheed , Mostafa Ahmed Fouad Abbas Kofi Family and Community Medicine Dept., Prince Sultan Military Medical City, Riyadh, Ministry of Defense Health Services, Saudi Arabia Abstract Background: Effective vaccine cold chain management is essential for maintaining vaccine potency and preventing wastage. Baseline data at PSMMC’s multi-site primary care network showed systemic failures, including a 90% transport temperature compliance rate and frequent temperature excursions. Local Problem: The system lacked validated cold chain equipment, standardized workflows, and continuous temperature monitoring. Inefficient routing through the pharmacy and overcrowded storage led to chronic delays and instability in temperature control. Methods: A multidisciplinary team implemented a Lean 5S intervention, guided by RCA tools including a Fishbone Diagram and Pareto Chart. Interventions included validated containers, LogTag digital monitoring, district-based delivery scheduling, visual SOPs, and competency-based staff training. Results: Transport temperature compliance improved from 90% to 100%, delivery delays dropped from 60% to 0%, and staff competency increased from 20% to 100%. Vaccine wastage decreased by 47%, from 0.15% to 0.08%, with corresponding cost savings. Conclusions: The Lean 5S initiative strengthened cold chain reliability, improved operational efficiency, and aligned PSMMC practices with WHO and MOH standards. The intervention created a sustainable, high-reliability system for vaccine safety. More Information How to cite this article: Al Shehri MM, Al Anazi MMA, Abuzahra K, Torricer PA, Maligalig MGF, Alshagraawi SAS, Alissa HSH, Abdalrouf AKAA, Alzahrani MSS, Al Shahry SMA, Bin RasheedAMA, Kofi MAFA. Strengthening Vaccine Cold Chain Management to Enhance Quality, Safety, and Efficiency in PHCs. Eur J Med Health Res, 2026;4(2):187-92 . DOI: 10.59324/ejmhr.2026.4(2) .30 Keywords: Vaccines, Cold Chain, Primary Health Care. This work is licensed under a Creative Commons Attribution 4.0 International License. The license permits unrestricted use, distribution, and reproduction in any medium, on the condition that users give exact credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if they made any changes. Introduction Global authorities – including the WHO, CDC, and Saudi MOH – emphasize that vaccines must be stored and transported strictly within 2-8°C to maintain potency. The uploaded document states: “Maintaining vaccine potency requires strict adherence to a temperature range of 2-8°C”. Key evidence includes: • Validated cold chain containers maintain safe temperatures for >96 hours in 43°C, compared to for non-validated coolers. • Vaccine Vial Monitors (VVMs) reduce unnecessary disposal by up to 60% . • Digital data loggers (LogTags) reduce undetected excursions by >70% and were used successfully during Saudi Arabia’s COVID-19 vaccine rollout. • International pilots (Kenya, Bangladesh, Pakistan) showed: • 35–50% reduction in excursions • 45% reduction in spoilage • Improved delivery timeliness These findings support the project’s use of validated containers, continuous monitoring, and standardized workflows, which were mapped through the Fishbone Diagram (Figure 3), Pareto Chart (Figure 4), and Driver Diagram (Figure 6) . Methods Context The project was implemented at Wazarat Health Center and 19 PHCs. Baseline problems included overcrowded storage, indirect routing, manual thermometer

FAQs

What baseline issues affected vaccine cold chain performance in the PHCs?

The baseline showed systemic failures such as low transport temperature compliance, frequent temperature excursions, overcrowded storage, indirect routing through the pharmacy, manual thermometers, and non-validated containers.

How did the team design and implement the Lean 5S intervention?

The project used root cause analysis tools (Fishbone, Pareto, Driver diagrams) to guide Lean 5S actions: validating containers, deploying LogTag digital monitoring, redesigning delivery routes by district scheduling, and introducing visual SOPs with competency-based staff training.

What outcomes improved after the intervention?

Transport temperature compliance increased from 90% to 100%, delivery delays dropped from 60% to 0%, staff competency rose from 20% to 100%, and vaccine wastage decreased by 47% (0.15% to 0.08%).

Sep 12, 2026

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