Integrating oxytocin delivery through the vaccine cold chain system within the expanded programme of immunisation in Ethiopia: a case of evidence-informed decision-making

Abstract

This paper shares Ethiopia’s experience and lessons in applying evidence-informed decision-making (EIDM) aiming to improve quality of oxytocin delivery at the point of care for managing postpartum haemorrhage. A 2022 survey of sampled health facilities in Ethiopia showed that a significant number of facilities did not store oxytocin in a refrigerator, and a little over half of them monitored the oxytocin temperature daily. In response, the Maternal and Child Health Department of the Ministry of Health engaged its Research Advisory Council (RAC) to examine the policy question. The RAC convened local researchers, programme managers and development partners to analyse the problem, synthesise global and local evidence and gather expert input using structured tools such as the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision framework. The process unfolded over 2 years, involving iterative engagement, validation workshops and leadership consultations. Ultimately, the Ministry endorsed integration of oxytocin into the vaccine cold chain, a decision shaped by both scientific evidence and contextual realities. This case highlights practical lessons on structuring and facilitating EIDM processes in health systems, including the value of institutionalised knowledge translation platforms, transparent evidence synthesis and sustained leadership engagement. The experience provides transferable insights for other low- and middle-income countries seeking to strengthen mechanisms that translate evidence into policy decisions.