In view of recent proliferation of online/desktop routing tools (such as qgis road graph plugin, osm routing machine, google maps engine, routexl, OpenRouteService etc), it is imperatives to provide empirical evaluation of comparative strength and weakness of a number of predominant routing algorithms. This is crucial in view of its implication on the success and otherwise on routing related projects such as supply chain logistics, supply/delivery operations, and emergency services, among others. In this paper, comparative evaluation of these tools has been carried out in terms of weaknesses and strength with respect to healthcare delivery service through routine vaccine delivery in Kano, Nigeria. Kano state being one of the states in Nigeria with huge burden of health challenges with records of 3062 maternal death between 2005 – 2010 (Ibrahim, 2014). Thus vaccine delivery is one of such healthcare delivery programme used to addressing some of these health challenges. The primary objective of this paper is to demonstrate comparative advantage of using open source applications to optimize the vaccine delivery process such that there would be significant reduction in logistics and manpower (travel time I.e travel route distance, road type/quality, traffic and travel speed, vehicle/driver, delivery schedule, among other parameters). The capacity of few selected routing tools was evaluated against this backdrop. Hence drive test analysis was carried on selected number of delivery routes and the results were compared with values derived from routing using these tools. QGIS routing tool is the only desktop tool using OSM vector base map and a routing plugin (road graph) while others such as Google Map Engine, OpenRouteService, OSM Routing Machine, and RouteXl were all online platform. The drive test result was used as the benchmark for determining the best routing tool. The overall outcome indicated QGIS to have the closest routing value compared to drive test result for most of the considered delivery routes. This was largely as a result of rich content of the OSM vector base map (which our team had extensively worked on) as well as the geo-positioning of QGIS as primarily mapping software. This was the advantage QGIS had over others, even when compare with OSM RM that uses same base map with QGIS. OSM RM had deficiency in geo positioning accuracy thus explain slight discrepancy noted in OSM RM output compared with QGIS and drive test result. Google map engine routing output had capacity for multiple routing (origin to multiple destinations) but the content of the vector base map is very limited for Kano State. The response time to make amendment to google vector base map before it is available for routing usually takes 12 – 24hrs, longer than its take using JOSM. RouteXL is consistently constrained by geo-positioning accuracy which affects its routing output. The routing output derived from desktop QGIS powered by road graph plugin provide the best routing output compared to the output from drive test result but it is limited by the fact that it does not have provision for multiple (batch) routing.