Cold chain maintenance done differently: results from a human-centered design study in Niger, Kenya and Tanzania

Cold chain equipment is required to keep vaccines cold, yet the equipment maintenance system is often overlooked and underperforming. Immunization programs in Niger, Kenya, and Tanzania conducted human-centered design studies to better understand the gaps in the maintenance systems and to identify potential solutions from the perspective of maintenance technicians. Researchers conducted 110 key informant interviews in seven regions across the three countries, including a wide range of stakeholders involved in cold chain management and maintenance. The same participants generated innovative solution ideas during co-creation workshops. Five themes related to the maintenance system challenges were identified with nuances between countries. Themes were linked to the health system management structure, data use for maintenance activities, capacity and expertise, limited autonomy, and spare parts availability. Through co-creation, user-generated ideas for improvements had some similarities between countries, including the desire for a peer-to-peer e-learning and networking platform, tailored technical resources, and a reporting system for maintenance. While basic challenges related to cold chain maintenance have been generally understood, this unique study identified underlying drivers grounded in stakeholders’ experiences and perspectives. The identified potential solutions across three countries tended to coalesce in similar ideas to address multiple challenges. Insights and ideas generated by this study may be relevant to other countries’ maintenance systems.