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].
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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.
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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.
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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]
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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€
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