Cold Chain Management Practice, Vaccine Wastage, and Mitigation Strategies in Primary Healthcare Facilities: A Systematic Review

Background: Vaccine wastage remains an ongoing challenge to the efficiency of immunization programs in primary health care facilities, and the primary contributing factor is cold chain management. Objective: This systematic review summarizes the evidence on cold chain management practices related to vaccine wastage in primary health care facilities and identifies mitigation strategies reported to be effective. Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, and Google Scholar in accordance with the 2020 PRISMA guidelines, using the Population-Exposure-Outcome framework. Eligible articles were those published between 2016 and 2026 that focused on cold chain practices and vaccine wastage in primary health care facilities. We assessed study quality using the JBI critical appraisal checklist. Results: Of the 432 studies identified, 22 met all eligibility criteria for synthesis, covering various regions across Africa, Asia, the Middle East, and Southeast Asia. Vaccine wastage and the quality of cold chain management are driven by four main factors: weak infrastructure, adherence to standard operating procedures, resources, and training of health workers. Strategies for implementing immunization services in the field indicate that wastage rates can be measured. Conclusion: Vaccine wastage in primary health care facilities occurs due to recurring factors; improvements in infrastructure- such as solar-powered cold chains-and regular training for health care workers are mitigation strategies supported by the best available evidence, although neither of these measures alone is adequate to achieve the 80% target set by the WHO’s EVM standards.