Implementation of a health system intervention involving immunization requires strong country leadership and ownership in the form of experienced logistics professionals and knowledgeable, dedicated staff in national vaccine and immunization programs.

To maximize efficiencies, the Gavi Cold Chain Equipment Optimization Platform and other initiatives of similar size require coordination and alignment with ministry systems and processes as well as those of other funder/partner initiatives.

Outsourcing a specific function such as installation of equipment to a third-party provider can benefit countries, but governments need to analyze the cost benefit of outsourcing to providers and the skills and systems required to manage and coordinate with them.

Cold chain equipment strengthens the vaccine supply chain and improves immunization equity and coverage, but its continued sustainability as an investment in the health system depends on ongoing resources to maintain it. Without assuring operational and financial sustainability, unreliable cold chain systems dependent on external funding and the immunization programs that rely on them will remain unimproved.

In 2016, the Gavi Cold Chain Equipment Optimization Platform (CCEOP) was approved and launched in recognition of the fact that functional cold chain equipment (CCE) is essential to strengthening vaccine supply chains and ultimately achieving Gavi’s immunization equity and coverage goals. Through CCEOP, Gavi committed to investing US$250 million between 2016 and 2021 to commission CCE in more than 63,000 facilities to upgrade and expand their CCE footprint while stimulating the market to provide affordable, technologically advanced, and accessible equipment. We present case studies from Guinea and Kenya, both of which received CCEOP support, that highlight 2 ways for countries to prioritize investments and implement activities through a large funding and support mechanism. The studies explore the different ways that each country implemented CCEOP and consider how aspects of leadership and technical capacity influence country priorities and results. They also uncover key lessons on sustainability of a large immunization supply chain effort. The experiences of Guinea and Kenya can help other countries embarking on similarly large health system interventions, especially related to supply chain strengthening and immunization programs. In particular, these experiences offer important lessons in leadership, processes and systems, country ownership, technical capacity, and sustainability.

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