POST 01214E COLD CHAIN MAINTENANCE

POST 01214E COLD CHAIN MAINTENANCE 8 JANUARY 2008 My apologies for the break in communications; and thank you for putting up with the delay. We are finally up and running! Cheers. I have quite a few contributions queued up for this post. But first, please note the change of address for all future communications. Your comments/contributions should be sent to: [[email protected]][email protected][/email]. You can continue to be in touch with Claude at: [[email protected]][email protected][/email]. ---------------------------------------------------------------------- The reference to Dr Steinglass’s study in my last posting (01212E) may have left a few of you wondering. It was only intended to serve as a background to later developments in school immunization. We update the material with Dr Jos Vandelaer’s observations on the topic. Increased school attendance, he says, provides a unique opportunity for health delivery, including immunization. Please do respond to WHO’s query regarding whether you have a school-based programme in your country. ----------------------------------------------------------------------- Finally, we have a fairly long contribution from Mogens Munck on a very pertinent topic: cold chain maintenance. He rightly says that the decision to repair an existing unit should carefully weigh the costs, for sometimes it may be more reasonable to replace the unit rather than repair it. Further, the choice of equipment will definitely depend on the new vaccines that are introduced in the immunization programme. Single-dose presentations of lyophilized vaccines would reduce freezer requirements (for ice-packs) below the district-level. But the suggestion that air conditioners replace refrigerators needs to be examined in the context of unreliable power supply and holdover time. The contributor hopes this will fuel an interesting discussion, just as I do. ----------------------------------------------------------------------- SCHOOL-BASED IMMUNIZATION STRATEGY The posting on Technet on 3 January 2008 (01212E) was a reminder of an aspect of immunization delivery that is often overlooked: school-based immunization. Children in school are indeed a captive group to deliver immunization doses that are due at school-age. WHO and UNICEF have, in the past months, tried to collate information on school-based routine immunization programmes, and of the 100 countries for which we received responses on a questionnaire, 39 reported having implemented school-based immunization, with another 8 countries considering such an approach in the future. This has prompted us to further explore what countries' experiences have been with school-based routine immunization. We are in the process of documenting the programmes in a few countries, so that experiences can be shared with others that are considering introducing or improving a school-based immunization programme. We hope that by the end of 2008, we will be able to summarize and share several different approaches, including what the programme entails (vaccines, other interventions, etc), how it is managed, implemented and funded, how children outside school are reached, how doses are recorded and reported, etc. We are currently, in collaboration with Immunization Basics and the Indonesian MOH, documenting the programme in Indonesia. It is clear that, in line with the Global Immunization Vision and Strategy, introducing booster doses will become more important in the future, including at school-age. In addition, some new vaccines will have school-age children as their primary target group. Increasing school attendance world-wide is providing a unique opportunity to reach a sizeable group with health interventions, including immunization, by using a school-based approach. Readers of Technet are encouraged to inform WHO/UNICEF whether or not a school-based routine immunization programme is being implemented in their country. We are indeed also interested in knowing if there is NO such programme. If there is a school-based routine immunization programme, we will send you a questionnaire to collect some more information. This will hopefully give us a better understanding of the extent to which school-based routine immunization is being used at the country level. Many thanks. Jos Vandelaer WHO/UNICEF Geneva [email protected] ------------------------------------------------------------------------- COLD CHAIN EQUIPMENT: TO REPAIR OR TO REPLACE? Maintenance of cold chain equipment is one aspect of the cold chain that, in my opinion, has been neglected for a long time. In the early years of EPI (the late 1970s and all through the 1980s) thousands of mechanics and technicians were trained to take care of and/or repair the cold chain equipment, which at that time was running on freon gas. However, to the best of my knowledge there is little information on, how many units were actually repaired in those early years and on the quality of those repairs. One reason being that inventory systems were not in place. Only in India, A. L. Bhuyan, from UNICEF, kept an inventory for years, documenting the breakdown rates of Vestfrost and Electrolux equipment. The inventory was made up from the monthly reports sent in by the districts (about 500). (I was informed that unfortunately later the districts stopped sending in reports.) Nowadays the repair work has become much more complicated due to the freon scare. Technicians need considerable training to be able to correctly use the tools and instruments for repairing CFC-free equipment. In addition, the tools and instruments are expensive—prohibitively expensive in fact! The example given below outlines approximate costs to provide tools and instruments and run a training course for 10 technicians. It shows that it might be cheaper to procure new units and not bother to repair broken-down units (inner leaks, burned-out compressor). The following questions are important: Ø How many units are actually being repaired nowadays? Ø How well are they repaired? Ø How many complete tool kits for repair of freon free equipment, costing 6000$ or more, have been requested from the UNICEF Supply Division lately? Ø How much have they been used? And how well? Ø What is the best type of maintenance organization: a mechanic in each district? A team of one or two full-fledged technicians with 1-2 helpers at national level, who then travel out to repair broken-down units, pooled at the regional level? Ø Is it economically viable to set up and run a maintenance organization? If we had proper equipment inventories in most of the countries we could do comparative studies to determine, which make and models are the sturdiest. We could also compare one country with another to determine which countries best protect their equipment, using among other things good quality voltage stabilizers, and how well and how fast the units are repaired. For example, the statistics prepared by A.L. Bhuyan, UNICEF in the late 1980s and early 1990s actually showed the breakdown rates for Vestfrost and Electrolux equipment. At that time, “internal leaksâ€