Publication:

Health system determinants of vaccine cold chain performance at the primary healthcare facilities in Nasarawa State, Nigeria: a mixed-methods study

Background Preserving vaccine potency through a robust cold chain is essential for immunization success. This study evaluates the health system determinants of vaccine cold chain performance at primary healthcare (PHC) facilities in Nasarawa State, Nigeria.

Methods A mixed-methods, cross-sectional study was conducted between August and September 2025. Quantitative data were collected from 147 healthcare workers using structured questionnaires, while qualitative insights were gathered from 10 key informant interviews with immunization and cold chain officers. Data were analyzed using IBM SPSS version 31 and NVivo 15.

Results Findings revealed a successful transition to renewable energy, with 82.3% of facilities utilizing solar power. However, infrastructure gaps persist, as 22.4% of refrigerators were non-functional, 41.5% of facilities face daily power outages, and 38.8% lack backup power systems. A significant workforce gap was identified. While 81.0% of facilities had Standard Operating Procedures, 50.3% of health workers had never attended formal cold chain training. Qualitative data highlighted that low sunlight causes temperatures to rise to +10°C to +11°C, and faulty equipment force workers to incur out-of-pocket expenses for vaccine transport.

Conclusions While Nasarawa State has modernized its cold chain equipment, performance is undermined by inadequate training, poor maintenance, and lack of backup power. To secure immunization gains, the state must prioritize regular supportive supervision, systematic equipment maintenance, and comprehensive capacity-building for healthcare workers.