Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia


  • Tseganesh Gedlu
  • Kassahun Dessie Gashu
  • Netsanet Birhanu
  • Shawel Tessema
  • Tesfaye Deti
  • Zeleke Abebaw Mekonnen
  • Alemayehu Teklu
  • Amsalu Shiferaw
  • Binyam Tilahun


AbstractIntroduction: Preventive programs which have proven to be effective in clinical trials may not necessarily impact the health and wellbeing of the community unless they are implemented with fidelity. While cold chain is the backbone of immunization programs, limited studies exist to explain fidelity implementation which likely contributes to a lack of evidence-based instructional practices of cold chain management.Aim: This study aimed to explore the fidelity implementation and challenges of optimal cold chain management in the Benshangul-gumuz region.Methods: A qualitative approach was utilized to explore the underlying challenges to optimum implementation of cold chain management in Benshangul-gumuz region. Observational techniques and key informant interviews with 12 key-informants were conducted. Data was collected at all levels of the health system including, the regional health bureau, Ethiopian Pharmaceuticals Supply Agency hub, district health offices, Health centers, and health posts. Data analysis and interpretation was performed using the framework analysis approach. Open Code 4.02 software was used for analysis.Findings: This study identified three main themes including adherence to intervention, human resource development, and availability and use of resources. The findings also revealed that a significant number of the employees were not adhering to the optimal cold chain management guidelines. Staff development, availability and utilization of equipment and related finances were major fidelity implementation challenges of cold chain management.Conclusions: Across the health facilities under study, implementation fidelity of cold chain management was considered poor. Human resource development, proper allocation and effective management of logistics and related finance could facilitate optimal cold chain management practices, and efforts to save lives through delivery of safe and quality vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3):03-08]Keywords: Cold chain management, Implementation fidelity, Challenges, Ethiopia




How to Cite

Tseganesh Gedlu, Kassahun Dessie Gashu, Netsanet Birhanu, Shawel Tessema, Tesfaye Deti, Zeleke Abebaw Mekonnen, Alemayehu Teklu, Amsalu Shiferaw, & Binyam Tilahun. (2021). Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia. The Ethiopian Journal of Health Development, 35(3). Retrieved from



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