POST 01225E: COLD CHAIN MAINTENANCE

POST 01225E: COLD CHAIN MAINTENANCE 11 FEBRUARY 2008 Follow-up on posts: 01221E, 01218, 01216, 01214E **************************************************************** Reference Mr. Mogens Munck’s initiation on the issue of repairs of refrigeration equipment and importance of inventories under EPI, I have been associated with the cold chain programme since 1985 and would like to share my experiences with all my friends and colleagues. Repair work: We all know that a refrigerator, properly installed with a good quality voltage stabilizer and handled properly provides efficient, long service without major maintenance issues. 1. Dealer’s technicians install and check the functional status of the refrigeration equipment on our personal purchases. The equipment is covered under a warranty for at least a year. We do not get this service/warranty for EPI refrigeration equipment. 2. For the country locations, where the voltage fluctuates, a good quality voltage stabilizer is essential. First, the supply of voltage stabilizers is not considered; second, these are not properly distributed with the refrigeration equipment; third, it is possible that the voltage stabilizer is supplied but not installed; and fourth there is no mechanism for replacement if the voltage stabilizer breaks down. 3. Technicians trained by UNICEF/WHO often cannot acquire the required expertise until they attend repair work at par with the market technicians because of low breakdown rates and far-flung locations of EPI refrigerators. The trained technicians do involve themselves in private repair work and by the time they attain the expertise, they leave the Government job. This benefits the society/country but not the programme (EPI) and we have to look at training replacements. Transportation of the out-of-order refrigerator to the district repair shop and back for its re-installation upon repairs as well as daily allowances for the driver, technician and helper requires funds apart from spares, refrigerant, tools and expertise. An unpacked refrigerator transported for repairs and re-installation could be damaged during transportation. Provincial and central repair shops are not the answer as it would increase transport costs even further. Procurement of the spares and refrigerant, stocking and distribution, if handled from a single point, possibly could be managed, but with the present scenario of decentralization with autonomous regions/zones with a number of stock points would be expensive. At times, correct spares are not available even from the ordered/stocked items. 4. Lack of knowledge of the health workers on the use/operation of the equipment, vaccine storage or ice making (over load) also results in equipment breakdown or unsuitable vaccine storage temperatures. 5. Funds for small items like plug-pins, power cable extensions, kerosene for operation of kerosene refrigerators, general cleanliness of the equipment, etc. are not available. Repair shops are not properly established and petty funds for consumables, oil, welding gas etc are not available. 6. Increased cost of tools and expertise required for the CFC-free refrigerators has further complicated the issue of repairs. Actions required thus are: 1. Installation and proper checking (operation for few hours at least) of the refrigeration equipment by trained technician. 2. Strict instructions for not running the refrigeration equipment without a quality stabilizer. 3. Arrangements for proper warranty repairs through the manufacturer covering the transportation/repair costs, especially if the new equipment is non-functional. 4. Track age of the equipment and have a planned budget for replacement. Equipment in many cases has been seen to function for even 20 years. Aged equipment should be marked as ‘no repairs on breakdown’ and replaced promptly when it becomes unserviceable. 5. Health workers should be trained in the installation and use of the equipment including maintenance and cleanliness. A system for breakdown reporting has to be established, with clear spelling out of responsibilities for repair/replacement arrangements. It would be appropriate to involve private workshops for the repair work with a qualified Cold Chain Officer to oversee the repair work and certify completed repairs after the equipment has been tested by the user. Inventory of the refrigeration equipment: Inventory remains an important tool to have the details of equipment with the programme. Inventory includes: The make/model/type of equipment, functional status, age and numbers available at designated areas/facilities, their adequacy and usefulness. Use of voltage stabilizer and the repairs done can also be listed. Having a base inventory and regular analysis of the inventory can be time-consuming but is essential. Proper analysis can help in: 1. Preparation of short and long-term replacement plans based on the age of equipment criterion. 2. Ensuring the suitability and adequacy of the equipment for future procurement and their addition/inclusion in the programme based on make/models, storage capacities and functional status. 3. Replacement/supply of required number of voltage stabilizers if not installed. 4. Planning repairs of equipment based on its status and fund requirements 5. Redeployment of equipment as needed. 6. Identifying non-functional/non-reparable equipment and take action on their actual disposal to avoid their inclusion in future inventories. Many vaccine stores are found cramped with a large number of refrigerators because of increased vaccine storage requirements/new vaccines. At times, it is difficult to find room for installation of new supplies. Small cold rooms up to the district level with stand by generators would be a better option and would provide adequate storage space with changing vaccine storage temperature requirements. These will require less floor space. What it may lack is sufficient hold over time. However, hold over time is not required with proper electric supply/arrangements. [log in to unmask]">Keerti Kumar Wadhawan Address: F-75, Ram Path, Shyam Nagar Extension, Jaipur, Rajasthan, India: 302019. 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