Gavi Immunization Supply Chain Strategy

Strengthening Immunization Supply Chains

Increasing vaccine coverage and reducing under-five mortality through stronger immunization supply chains

In 2014, the Gavi Alliance partners developed the Gavi Immunization Supply Chains (iSC) Strategy focusing on strengthening country immunization supply chains. From the port of entry to the immunization in clinics, the supply chain is critical to ensure potent vaccines are available to the beneficiaries in an efficient manner.

The strategy is built on five fundamentals essential to strengthen the performance of immunization supply chains. The fundamentals are: Supply Chain Leadership, Continuous Improvement & Planning, Supply Chain Data for Management, Cold Chain Equipment and Supply Chain System Design.

Through the Gavi iSC Strategy, national immunization managers, implementing partners and other immunization supply chain experts will gain access to targeted technical assistance and guidance documents, tools, case stories and other material that can help them improve immunization supply chains in countries.

TechNet-21 - Forum

  • Recent reports [1] of counterfeit yellow fever vaccination certificates in Zambia follow reports of falsified proof of vaccination documents being used in other countries, including Ethiopia [2], India [3], Nigeria [4], Pakistan [5], Sudan [6], Uganda [7], Tanzania [8] and Zimbabwe [9]. While the World Health Organization (WHO) published guidelines in 1999 [10] to support countries in developing measures to combat counterfeit pharmaceutical products and issued a report in 2017 [11] highlighting the public health and socioeconomic impacts of falsified medical products, neither publication discussed the current problem of false or fraudulently obtained proof of vaccination documentation. Counterfeit proof of vaccination in home-based records (HBRs), particularly those issued to provide documented proof of vaccination against yellow fever virus or polio virus [12], presents a threat to the health and security of countries and their citizens and warrants further discussion and action.

    Given the imperative of preventing the spread of vaccine-preventable diseases at a time when increased air travel and globalization link communities worldwide as never before [13], efforts seem warranted to (1) understand the magnitude and impact of counterfeit proof of vaccination and (2) work with national health authorities to develop practical counterfeit-deterrent strategies as part of the Eliminate Yellow fever Epidemics (EYE) global strategy (2017–2026) [14] as well as ongoing WHO activity around protection of essential medicines and health products [15]. Efforts to combat counterfeiting are also timely and urgent as part of the Global Health Security Agenda [16] as the likelihood of deadly, cross-border epidemics increases [17] and as countries continue to require international travelers to provide proof of vaccination as a prerequisite for entry (or exit) as part of international health regulations recommended by WHO [18]. This directive combined with improved enforcement at ports of entry into a country and a global yellow fever vaccine shortage [19] could further drive the demand for counterfeit vaccination documents.

    As providing proof of vaccination for travelers is one of several important HBR functions [20], HBRs deserve particular attention. For many travelers, proof of vaccination status is provided through a duly completed version of the International Certificate of Vaccination or Other Prophylaxis [18] recommended by the World Health Organization. In June 2007, a revised international certificate of vaccination was adopted following the 2005 revision of the International Health Regulations [21]. The revised certificate replaced the International Certificate of Vaccination or Revaccination Against Yellow Fever but did not include any anti-counterfeit guidelines or recommendations.

    The prevalence and impact of counterfeit medical products highlighted in the 2017 WHO report [11] point to a very real public health problem: a counterfeit problem that is not limited to medicines [22]. In Nigeria counterfeit proof of yellow fever vaccination records have been noted since at least 2012 when travelers from the country holding alleged counterfeit documents were denied entry by officials on arrival in Ghana [23] and South Africa [24]. As a result, the Federal Ministry of Health has attempted to curb the problem by issuing documents that included additional security features; however, a November 2018 report from Lagos airport highlights opportunities for further improvement as the problem of counterfeit documentation may continue [25].

    It is far too easy to dismiss HBR counterfeit incidents as a trivial matter. Such incidents are anything but trivial. More must be done to investigate HBR counterfeiting incidents with local authorities. Additionally, we must leverage existing knowledge and explore novel approaches to combat counterfeit proof of vaccination while also exploring design-related solutions to better ensure the integrity of HBRs. The risks of spread of vaccine-preventable diseases by international travelers is a public health concern [26], placing increased importance on safeguarding HBRs as a verified source of travelers’ vaccination status.



    The author acknowledges the editorial support of Ms Stacy Young of Applied Scientific Consulting in preparing this work.



    1. “Fake Health Certificates Scam Exposed.” Zambia Daily Mail Limited. 29 December 2018. Available online at: Accessed 4 January 2019.

    2. “Ethiopia to Launch Massive Yellow Fever Vaccination.” Ethio Dailypost. 26 June 2018. Available online at: Accessed 4 January 2019.

    3. “Fake Yellow Fever Vaccine Certificates Pose Risk to Whole Indian Population.” RESET. 19 Jul 2013. Available online at: Accessed 4 January 2019.

    4. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: Accessed 4 January 2019.

    5. “India warns against ‘fake polio certificates’.” DAWN. 9 October 2014. Available online at: Accessed 4 January 2019.

    6. “Sudan’s Vaccination Card Black Market.” The Daily Beast. 31 August 2015. Available online at: Accessed 4 January 2019.

    7. “Travellers Resort to Fake Yellow Fever Cards.” TravelSafe Clinic. 28 October 2016. Available online at: Accessed 4 January 2019.

    8. “Seven in Trouble Over Fake Vaccination Cards.” Daily News. 28 January 2017. Available online at: Accessed 4 January 2019.

    9. “Fake vaccination certs sold.” The Zimbabwean. 9 January 2013. Available online at: Accessed 4 January 2019.

    10. World Health Organization. Counterfeit Drugs. Guidelines for the development of measures to combat counterfeit drugs. Geneva: World Health Organization, 1999. Available online at: Accessed 4 January 2019.

    11. World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: World Health Organization; 2017. License: CC BY-NC-SA 3.0 IGO. Available online at: Accessed 4 January 2019.

    12. Soghaier MA, Saeed KMI, Zaman KK. Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top. AIMS Public Health. 2015;2(2):218-222. doi: 10.3934/publichealth.2015.2.218.

    13. Brent SE, Watts A, Cetron M, German M, Kraemer MU, Bogoch II, Brady OJ, Hay SI, Creatore MI, Khan K. International travel between global urban centres vulnerable to yellow fever transmission. Bull World Health Organ. 2018;96(5):343-354B. doi: 10.2471/BLT.17.205658.

    14. World Health Organization. Eliminate Yellow fever Epidemics (EYE): a global strategy, 2017–2026. Wkly Epidemiol Rec. 2017;92(16):193-204.

    15. World Health Organization. Essential medicines and health products. Available online at: Accessed 4 January 2019.

    16. Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and the international health regulations: moving forward. Biosecur Bioterror. 2014;12(5):231-8. doi: 10.1089/bsp.2014.0038.

    17. Suk JE, Van Cangh T, Beauté J, Bartels C, Tsolova S, Pharris A, Ciotti M, Semenza JC. The interconnected and cross-border nature of risks posed by infectious diseases. Glob Health Action. 2014;7:25287. doi: 10.3402/gha.v7.25287.

    18. World Health Organization. International Health Regulations (2005). Third Edition. Geneva: World Health Organization, 2005. Available online at: Accessed 4 January 2019.

    19. “What is behind the global shortage in yellow fever vaccine?” VOA News. 5 May 2016. Available online at: Accessed 4 January 2019.

    20. World Health Organization. Practical Guide for the Design, Use and Promotion of Home-based Records in Immunization Programmes. Geneva: World Health Organization, 2015. Available online at: Accessed 4 January 2019.

    21. Gostin LO, DeBartolo MC, Friedman EA. The International Health Regulations 10 years on: the governing framework for global health security. Lancet. 2015;386(10009):2222-6.

    22. Hamisu Hassan, Kate Kolaczinski, and Angela Acosta. Preventing, identifying, and mitigating the impact of fraud, theft, and diversion of insecticide treated nets: A summary of experience and best practices from country programs. VectorWorks Project, Johns Hopkins University-Center for Communication Programs (JHU-CCP), and Tropical Health LLP. 2016. Available online at: Accessed 4 January 2019.

    23. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: Accessed 4 January 2019.

    24. “On Yellow Fever, Yellow Cards, Nigeria And South Africa.” Nigeria Health Watch. 6 March 2012. Available online at: Accessed 4 January 2019.

    25. “Investigation: Inside Nigerian airport where cleaners, touts issue fake yellow cards to travelers.” Premium Times. 10 November 2018. Available online at: Accessed 4 January 2019.

    26. Gautret P, Botelho-Nevers E, Brouqui P, Parola P. The spread of vaccine-preventable diseases by international travellers: a public-health concern. Clin Microbiol Infect. 2012;18 Suppl 5:77-84. doi: 10.1111/j.1469-0691.2012.03940.x.

  • The BID Initiative is featured in the most recent issue (December 2018) of the MMS Bulletin #148 "Digital Health - A Blessing or Curse for Global Health."

    • "Marrying engineering with health policy to bring digital health to scale," by Steven C. Uggowitzer, Sima C. Newell, Dykki Settle, Alice Liu and David J. Hagan. 

      Just as medical doctors take the Hippocratic Oath as they graduate into their profession, so do many engineers solemnly promise to carry out work to the highest quality, recognizing that any errors may put lives at stake. Given this sharing of fundamental values, engineering is a profession that could be leveraged even further towards public health information systems to address opportunities created by the fusion of the early and relatively informal eHealth and mHealth paradigms into the more mature and complex one that is Digital Health. Recently, the World Health Assembly (WHA) adopted a key resolution on Digital Health, urging member states to assess and prioritise the scale-up of the implementation of digital technologies towards the “universal access to health for all”(WHA 71.1, 2018). For the full article, visit the MMS Bulletin.

    • "The challenges of implementing a data use culture," by Hassan Mtenga, Dr. Alex Mphuru, Dawn Seymour, and Laurie Werner. 

      To increase coverage and equity of routine immunization services, the government of Tanzania is strengthening the data use culture through the implementation of a package of data quality and use interventions, including an electronic immunization registry, for immunization service delivery. Three key phases for achieving scale as a government-owned model emerged during the implementation: user-centered design and testing, PATH-led implementation, and government-led implementation with scale-up. A combination of factors contributed to achieving a government-owned model of implementation and ultimately showed significant time and cost savings, as well as greater ownership and ability to sustain and scale the interventions. For the full article, visit the MMS Bulletin.

    Other articles in the MMS Bulletin #148 can be found here.


  • Hello,

    I am brand new to TechNet-21 so this will be my first posting. 

    I am trying to find an SDD (Solar Direct Drive) freezer which will maintain -10C and below. The product I need to store in Nigeria is surfactant (injected into the lungs of premature babies with collapsed lungs to give them life) which must be kept at that cold temperature to maintain a shelf life of 3 years. The electricity supply throughout the country in Nigeria is erratic and undependable, thus I would like to install an SDD freezer with a distributer (in Lagos) which would be independent of grid power. Surfactant is a very high value and low volume product so a smaller (50-100 liters) SDD freezer would be ideal.

    My understanding is the freezers designed for freezing ice packs may not maintain -10C and colder thoughout a 24 hour cycle which includes night.

    The only other solar option I am aware of is to revert back to older technology that relies on solar charged batteries to either operate a 12 or 24 volt DC freezer of use an inverter to power an AC powered freezer. I was hoping to eliminate the weak link in the system, the battery.

    To date I have not been able to identify an SDD freezer among the mainline manufacturers -- Dulas, SunDanzer, SureChill, Vestfrost, Haier.

    Thanks for any advice!


  • Dear TechNet-21 community,

    Further to the publication of the English and French versions of the Decommissioning and safe disposal of cold chain equipment guidance earlier this year (available here, we are glad to share with you that the Arabic and Russian versions of the document are now available in the TechNet-21 Resource Library.

    To access these documents, please click on the following links:
    1. For the Arabic version:
    2. For the Russian version:

    On behalf of UNICEF and WHO, I wish you an insightful reading and look forward to interesting and fruitful discussions with the TechNet-21 community!

    Michelle Seidel,

    Cold Chain Specialist - Immunization Supply Chain, UNICEF Programme Division (UN City Copenhagen)


  • New materials are available on the "Coverage Surveys" page of TechNet-21 ( on the "17 Steps to do a Coverage Survey".

    This collection contains a series of documents & presentations outlining the basic steps of a vaccination coverage survey, as well as some presentations on commonly asked questions and variations on a coverage survey. This also contains links to resources (templates, models, examples, etc).

    This link takes you to the drop box folder with all the materials.
  • A new issue of Vaccine is now available:

    Rotavirus Surveillance, Safety and Economic Data before Vaccine Introduction: a Global Perspective from the World Health Organization Global Rotavirus Surveillance Network 
    Edited by Adam L. Cohen, Negar Aliabadi, Fatima Serhan, Jacqueline E. Tate, Patrick Zuber, Umesh D. Parashar

    This can be accessed from:

  • A textbook from lectures we used to give at the “Ciro de Quadros Vaccinology Course for Latin America” just got published by the Sabin Institute:

    The book is available in English and Spanish.

    My chapter on information systems for EPI (part of section 3) is attached.

  • A new article Expenditures on vaccine-preventable disease surveillance: Analysis and evaluation of comprehensive multi-year plans (cMYPs) for immunization, recently published,  is available here:

  • The article Considerations for the development and implementation of electronic immunization registries in Africa, published this year, can be found here:

  • Herein lies the external evaluation results of the Smart Paper Technology Solution (aka MyChild Solution) in The Gambia which has assessed data quality, efficiency gains, operational costs, and the users’ experiences and perceptions associated with the intervention.

    In 2017, Shifo Foundation (Shifo), the Ministry of Health & Social Welfare (MoH&SW) of The Gambia, Gavi, the Vaccine Alliance, Action Aid International The Gambia, IKARE, Swedish Postcode Foundation, and Jochnick Foundation started working together to implement The Smart Paper Technology Solution (SPT) in The Gambia. To date, the SPT is implemented in the Western Regions 1 and Western Region 2, two out of seven regions in The Gambia. The real-time progress of work in The Gambia can be seen here.

    Since the inception of the programme in The Gambia, partners have identified key criteria to evaluate the effects of the programme and make informed decisions. This article summarises the results of the external evaluation conducted by Umeå University in May of 2018. The goal of the external evaluation was to assess four main attributes of the SPT in The Gambia, including 1) the data quality, 2) the annual operating costs, 3) the time efficiency gains for frontline health workers and 4) the users’ experiences and perceptions associated with the intervention.

    Data Quality Assessment

    The WHO Data Quality Review Toolkit was used as the framework to asses the data quality of the SPT over the course of three months. Data quality dimensions including 1) completeness and timeliness, 2) internal consistency and 3) external consistency were measured with this toolkit. The results indicated that completeness and timeliness of health facility reports were at 100%. The data was found to be internally and externally consistent. Moreover, the consistency between the reported data and the original records was at 99,95%. Lastly, the recording errors were between 0.7% to 1.5%. Therefore, the SPT scored highly in all of the data quality dimensions and it was concluded to generate high-quality data.

    Administrative Time Efficiency

    With the SPT, the frontline health workers’ administration time was reduced by 60% for each child who was fully immunised, receiving Vitamin A and deworming supplements.

    Annual Operating Costs

    The operating costs were measured by comparing the annual national cost of the current HMIS forms with the SPT in two different scenarios: excluding and including the monetary value of reduced time which is achieved with the SPT. When the monetary value of reducing the administration time with the SPT was excluded, the SPT (11,675.95 USD) was more expensive than the current HMIS (8,792.54 USD). When the monetary value of reducing the administration time was included, the SPT (3,944.10 USD) was cheaper than the current HMIS (8,792.54 USD).

    Users’ Experiences and Perceptions

    Interviews were conducted with frontline health workers and the regional health directorate staff to assess their perceptions of the SPT. The interviewees expressed how the SPT was user-friendly, how this solution delivered benefits to their health facility, and how the workload was less with the SPT when it was compared to the current HMIS. The health workers acknowledged the value of SMS messages sent to parents which remind them of vaccination due dates. The health workers also confirmed the importance of improving data quality. However, the interviewees also expressed how the initial registration of patients was time-consuming during the introduction of the intervention. The health workers also recommended that other health facilities adopt the SPT. In conclusion, the participants’ perceptions of the SPT were overall positive except for the initial registration of patients.


    The external evaluators provided a number of recommendations such as better planning and projection of the necessary human resources required for the initial registration of children. They also recommended the MoH&SW staff to work more closely with data verification. It may also be beneficial to return the Smart Paper Forms to health facilities after they have been scanned for the purposes of increased ownership. The evaluators expressed that scaling-up the SPT would be beneficial and they recommend it.


    The full reports and additional information about the Smart Paper Technology Solution (aka MyChild Solution) can be accessed using these links below:

    1. Assessment of MyChild Solution in The Gambia: Data quality, administrative time efficiency, operation costs, and users’ experiences and perceptions:
    2. About Smart Paper Technology Solution:
    3. Project progress in The Gambia:
  • The underground classic that explains how authentic activities help learners explore, discuss, and meaningfully construct new knowledge, GO AUTHENTIC: ACTIVITIES THAT SUPPORT LEARNING is now available for free download.

    When Risintha from Sri Lanka told me that he would never be the same again because he had discovered a life beyond PowerPoint, I thought that I had to share our approach to creating transformational value through authentic learning.

    The course activities that I share in this book have transformed people into change agents and helped them excel in their performances.

    The activities shared in this book work because they are well thought-out and aligned with all other elements of the course. They work because we do not lecture. They work because we believe that every single participant brings a wealth of experiences to our course environment. We respect each and every one of them as a “more knowledgeable other”. This is what makes the collaborative learning so valuable to all of us, including mentors. The activities described in this book work because they are part of a long learning journey, where we believe the end is nothing, but the road is all. They also work in eLearning programmes, because it is never “me and the computer screen”, there is always a human face, a mentor who supports learners whenever they need. They work because instead of shoveling information into learners’ brains and asking them to regurgitate it later, we focus on critical thinking, communication, collaboration, creativity, and, most importantly, on conation. They work because we view failures as an opportunity to learn. They work because we understand that creativity and innovation is a long-term, cyclical process of small successes and frequent mistakes. They work because we do not stop the clock and distribute a test. Instead, assessment is embedded in all of our authentic tasks. This is what makes the biggest difference. Nothing is abstract - all activities are based on authentic learning principles, just like how things work in real-life. These activities help learners to explore, discuss, and meaningfully construct concepts and relationships in contexts that involve real-world problems and projects that are relevant to them.

    I licensed this work under Creative Commons (CC) Attribution-NonCommercial- ShareAlike 4.0 International License (CC BY-NC-SA 4.0) so that it can be reproduced, remixed, tweaked or built upon non-commercially. Through this license, I continue offering a hand in support of open knowledge and free culture as I did with my previous two books.

    My dear friend Thomas Reeves in his foreword says that the design and implementation of learning environments must be acts of “authentic creation” more than ever before: “Go Authentic: Activities that Support Learning is, as Camus put it, a “gift to the future.” A future when learning will be active rather than passive, collaborative learning will be commonplace, tasks will be as authentic as possible, and assessment will be cherished rather than dreaded. In that hopefully near future, learning events will be as well-aligned as a precision racecar, and learning outcomes will be personally and professionally empowering. Ultimately, we hope that even participants in online versions of these authentic courses will shed tears when the courses are over just as they do now on the last day of the face-to-face courses.

    The need for transformational learning opportunities is evident in many fields beyond public health and pharmaceuticals. Enhancing human performance is absolutely essential if we are to meet the challenges facing humankind with respect to climate change, poverty, war, corruption, and the like. Arguably, we live in a time when education and training opportunities across all disciplines must become as transformative as the courses described in this book. To do this, the design and implementation of learning environments must be acts of “authentic creation” more than ever before. Please join us.”

    When it comes to helping learners, you cannot waste their time.

    Go authentic!

    For free download please visit

    The book is available both in interactive PDF (38.1 MB) and ePUB3 (13.3 MB) versions.

    216 pages, including a detailed review of 44 learning activities and games and 30 icebreakers and warmups..

    Happy downloads...



    Extensio et Progressio

  • Hereby to share a new resource on IIS produced by the Vaccine-preventable diseases at ECDC in collaboration with partners globally:

    Designing and implementing an immunisation information system. A handbook for those involved in the design, implementation or management of immunisation information systems

    We would like to hereby acknowledge the contribution of a number of experts in contributing to this report and providing case-studies based on their experience in Immunisation information systems. We hope this document will prove relevant in further informing decisions and discussions at National Level.

    The handbook proposes strategies that build on the experiences of IIS experts; provides case studies from actual programmes to highlight particular aspects of IIS practice, including functionalities, benefits, challenges, and implementation. It aims to share experiences and explore ideas that IIS experts consider valuable for developing a new IIS or upgrading an existing system,. 

    The handbook is intended for all those involved in the design, implementation, management or continuous improvement of IIS, such as immunisation programme managers and operational IIS staff; and also public health experts and policymakers.

    For more information please contact Tarik Derrough, Senior Expert VPD team, ECDC 

  • The Gavi Secretariat has released a global  standards document for immunisation supply chain (iSC) information systems. 

    A hallmark of effective supply chains is end-to-end (E2E) visibility of supply and demand data that are used to make decisions and take effective action. For immunisation programmes, a critical success factor is access to accurate, complete and timely data on vaccine utilisation and distribution, the performance and deployment of cold chain equipment (CCE), and the routine use of this data to inform operations and management decisions.

    Growing demand for digital supply chain software solutions—often referred to as logistics management information systems (LMIS)—from Gavi-eligible countries has stimulated software developers and service providers, remote temperature monitoring device innovators, and refrigerator manufacturers to develop and test a variety of software and hardware products. However, the absence of a normative standard of features required of a LMIS has resulted in costly development of bespoke local solutions, and limited choice of off-the-shelf systems that are interoperable, extensible, and scalable.

    The purpose of the Target Software Standards for Vaccine Supply Chain Information Systems is to help guide the market of potential LMIS solution providers by defining normative standards for LMIS solutions adapted to the unique needs of immunisation supply chains in low and middle income countries.

    The objectives of this Target Software Standards (TSS) are to ensure countries have access to:

    • Best-in-Class digital LMIS that meet the unique needs of the iSC and a country’s particular supply chain design and strategy;
    • Choice in software hosting, administration, and value-added business intelligence services;
    • A range of cost models that enable cost-benefit analysis of different solutions and sustainable total cost of ownership.

    While the TSS is focused on vaccines by incompassing cold chain equipment and temperature monitoring data, the standards can be applied to any other pharmaceutial product that requires an LMIS. Gavi has collaborated with The Global Fund and other development partners to ensure that the TSS supports essential medicines, programme products, and diagnostic supplies in the Global Health supply chain.

    Countries are encouraged to use the Target Software Standards when determining their LMIS needs and seeking off-the-shelf software, or in guiding upgrades to existing systems. Software suppiers are encouraged to use the TSS to inform their software development roadmap priorities to ensure their product supports the range of features called for in the TSS. 

    Download a copy of the Target Software Standards for Vaccine Supply Chain Information Systems.

  • The HR Country Support Package for Immunization SC Managers is available!

    The success of immunization systems in countries through the past decades can be attributed to a large extent, to the supply chain and logistics system. This system is one of the backbones of national immunization programmes (EPI) that strives to ensure the uninterrupted availability of quality vaccines and devices, from the national level through to the service delivery points in rural and remote areas. By 2020, countries are projected to manage significant increases in the value, volume, number of doses, and stock keeping units placing increased stress on already weak supply systems. In response to this need, the Immunization Supply Chain Strategy was built around five (5) fundamentals; system design, supply chain leadership, data for management, better cold chain and continuous improvement plans to help achieve the vision that by 2020 immunization supply chains efficiently provide potent vaccines to all.

    Supply Chain Leadership
    Next-generation immunization supply chains require dedicated and competent managers and workforce as well as adequate numbers of skilled, accountable, motivated and empowered personnel at all levels of the health system. Countries are supported to strengthen and build supply chain managers’ and workforce capacity by providing focused technical assistance, tools, training and other resources. The aim is to help ensure that dedicated supply chain leaders and HR are in place at all levels of the health system, with the right capabilities, authority and accountability in every country.

    The HR country support package provides a set of tools and guidelines to support and develop immunization supply chain managers to be able to effectively manage their supply chain to cover the areas described in the HR for health building block. These tools are constantly updated with new ones and also in line with current realities.

    Key Questions addressed through the Country Support Package
    • What lessons can I learn from other countries and from the private sector? 
    • How can I strengthen my leadership skills? 
    • How can I build a comprehensive plan to meet all HR issues, not just training? 

    These resources can be accessed here: 

    For more information, please contact: 


     HR country support package

  • People that Deliver Launches a New Resource for Health Supply Chain Practitioners: the Human Resources for Supply Chain Management Theory of Change

    Like all chains, supply chains are no stronger than their weakest link. Although hundreds of millions of dollars in commodities flow through the health supply chain (SC) system, the critical, strategic function of the supply chain within health systems is rarely acknowledged—and the SC workforce seldom has the right technical and managerial competencies to perform optimally or the empowerment to affect supply decisions and policies. Insufficient numbers of competent staff can cause breakdowns in supply chain systems and lead to poor system performance. The Human Resources for Supply Chain Management Theory of Change (HR4SCM ToC) analyzes the conditions needed to ensure that workers at every level are performing optimally, in order to fulfill all the necessary functions of an effective supply chain system.

    A theory of change (ToC) describes how a desired change is expected to occur. The HR4SCM ToC provides a useful basis for strategic planning, by providing a foundation for developing strategies—such as to manage the quantity, type, and capacity of human resources required to operate health supply chains. It also serves as a foundation for monitoring and evaluation, by specifying how to measure activities undertaken to make change. The HR4SCM ToC resource also captures complexity in a concise form and allows users to understand how a number of program activities link to one another and lead to program goals.

    PtD has developed two resources for the HR4SCM ToC - a two-page brief provides a high-level overview of the HR4SCM ToC describing the four pathways to success, our long-term outcome, and our foundational principle as well as a  longer narrative that covers the HR4SCM in more detail, with a full description of the critical assumptions, an explanation of the ToC diagram, and an indicators and interventions catalog. All HR4SCM ToC materials are available for download on the People that Deliver website ( The HR4SCM ToC’s official launch will take place at the Global Health Supply Chain Summit in Lusaka, Zambia on 27 November, 2018 ( HR4SCM ToC co-author Dr. Andrew Brown will facilitate a pre-conference workshop on Using a Theory of Change and whole of SCM labor market approach to catalyze country investments to improve HR for SCM: A practical toolkit. If you are attending GHSC and would like to participate in the workshop, please fill out this online form:

    The HR4SCM ToC can be found here:

    About People that Deliver
    The People that Deliver (PtD) Initiative was established in 2011 as a global partnership of organizations focusing on professionalization of supply chain personnel by advocating for a systematic approach to human resources (HR) for supply chain management (SCM) at the global and local level. It is based on the global recognition that without trained professionals to manage the health supply chains, drugs and other health supplies do not reach the patients who need them.

    Alexis Strader, Project Officer
    Tel: +45 45 33 57 99

  • New article on "Global Routine Vaccination Coverage - 2017" was recently published in the CDC MMWR.

    Article can be accessed here:

  • Dear all,

    Did you know that there is a dedicated subsite on Immunization Supply Chain (iSC) strengthening on TechNet-21? In 2014, the Gavi Alliance partners developed the Gavi Immunization Supply Chains (iSC) Strategy around strengthening country immunization  supply chains, focusing on five fundamentals: Data for Management; System Design; Leadership; Cold Chain Equipment; and Continuous Improvement Plans. 

    The iSC subsite houses information, tools, and resources that can help country governments and implementing partners aiming to strengthen these five fundamentals. You can find guidance on implementing DISC indicators, system design optimization case studies, HR rapid assessments, and other practical tools and guidance documents. 

    Explore the site at: Interested in contributing to the subsite? You can find guidance on the iSC topics page here:

  • The WHO Immunization Monitoring Academy is a learning and capacity-building initiative. The Academy is open to all immunization professionals with an interest in the use, collection, and improvement of immunization data.

    Starting in Fall 2018, the Academy will offer a WHO Scholar certificate programme to support competency development in national and sub-national staff. The Academy will offer: 

    • Level 1 certificate course in developing a Data Improvement Plan (DIP) in both English and French.
    • A series of workshops on key topics for immunization monitoring.
    • WHO Survey Scholar modules in French.

    In 2019, the Academy will offer Level 2 certification, focusing on implementation of a Data Improvement Plan.

    To learn more see the Academy's information page:

  • The WHO website was updated with the most up to data WHO/UNICEF JRF data.

    The main launching page for this data is accessible from: . From there you will be able to access:

    For those of you that have the immunization app on their devices, you may have noticed that the data was updated as well. For those that want to download it, instructions and tutorials are available from:

    Comments, feedback and suggestions are welcomed to

    The JRF Team

  • A WHO software application, the Health Equity Assessment Toolkit (HEAT), conceptualized by Ahmad Reza Hosseinpoor and Anne Schlotheuber of the department of Information, Evidence and Research, came "highly commended" in the prestigious British Medical Association (BMA) book competition on 4 September. Readers can use the software on their computers and mobile devices, to assess health equity in countries for a range of indicators and dimensions. Health equity data are visualized in a variety of customisable tables and graphs, making the tool interactive and easy to use. 

    “The issue of health inequalities is central to much of the thinking around health improvement globally and no region is exempt from the pernicious effect of health and social inequalities,” the judges said. “This toolkit is particularly relevant in supporting the achievement of the sustainable development goals (SDGs).”

    The database is continually updated and this, the judges said, is particularly important for low and middle-income countries where people may not have the resources to update the database themselves. When HEAT was first launched, it was restricted to data from the WHO’s Health Equity Monitor database, which contains disaggregated data on reproductive, maternal, newborn and child health for 111 countries.

    The new edition of the toolkit, called HEAT Plus, enables users to upload data from their own sources, making it a comprehensive tool for analysing and reporting in any health topic and beyond at global, national, subnational levels. HEAT Plus, when it was tested in Indonesia, allowed people in that country to analyse and interpret inequalities in many other health topics using vast amounts of its own data including survey and facilities data.

    “Monitoring health inequality is essential to ensure no one is being left behind,” said Dr Ahmad Reza Hosseinpoor, who leads WHO’s work on health equity monitoring. “WHO has developed a package of resources and tools to encourage the practice of and build capacity for global and national health inequality monitoring. HEAT provides evidence on the state of health inequality and can help countries set priorities and establish equity-oriented policies, programs and interventions.”

    --> To access HEAT and HEAT Plus, visit the following website:

    To read more about this, please see attachment.

  • Dear colleagues,

    I am working on a new book project on VVM.

    I would like to include examples of the following and shall be grateful if you could kindly contact me. Your help is much appreciated!

    If you have any of the following, besides sending the material, I'd appreciate it if you could kindly explain and give a short background on the material you are sending (especially for photographs - where it was taken, when it was taken, what is the event, and who is the photographer)

    Please reply to



    VVM posters

    Any poster related to VVM use. If you have the PDF file copy of the poster, I’d appreciate it if you could send it to me.

    If you do not have any PDF copy of the poster, please make a photo of it and send the photo.

    VVM training materials

    If your country has any experience with running training sessions on VVM, either as a standalone VVM training or incorporated into any other training programme (e.g. vaccine management), I’d appreciate it if you could kindly share the material in PDF format with me. If you have it only in hard copy, and can spare one, please let me know, I can arrange a DHL pickup.

    Photographs showing VVM in action

    If you have photographs of health workers during immunization sessions that VVMs are visible on vials, I’d appreciate it if you could kindly send me a copy them. Please make sure that resolution of such photos should be minimum 150dpi and preferably 300 dpi.

    VVM policy documents

    I’d appreciate it if you could share PDF copies of your country’s any policy paper indicating VVM use.

    With many thanks and all the best,


  • Dear TechNet Members,

    Bhutan is going to develop Immunization Supply Chain Action Plan as a recommendation of the Regional ISC review meeting 2017. Appreciate if members could kindly share the sample of similar action plan for us to have an idea. 



  • Dear colleagues,

    On behalf of the WHO Performance, Quality and Safety (PQS) Secretariat, we are delighted to invite your response to our survey on the use of refrigerated vehicles in immunization programmes.

    Refrigerated vehicles are crucial in the delivery of life-saving vaccines. Programmes that depend on one or a small number of refrigerated vehicles may be seriously impeded if a vehicle breaks down or is unable to maintain the temperature range that is required for the safe storage of vaccines.

    The purpose of this survey is to gather information on the performance of refrigerated vehicles that are at least three years old. This information will be used to help PQS develop standards for refrigerated vehicles that meet the needs of immunization programmes. The information you provide will be extremely valuable to WHO PQS and the WHO Expanded Programme on Immunization (EPI).

    The survey can be accessed by clicking on the following link: survey will remain open until October 31, 2018.

    Please complete this survey for each vehicle that has been in regular use for more than three years for the purpose of carrying vaccines or other temperature sensitive pharmaceuticals. Please provide any available photographs where prompted in specific survey questions, by uploading photos directly to this platform.

    Should you require further information on the survey, please contact the PQS Secretariat at

    The survey will take approximately 20 minutes to complete, depending on the extent of your free-text answers.

    Kind regards,

    WHO PQS Secretariat

  • Dear members,

    You may remember an announcement in May 2018 when ThinkWell launched a set of products on the Immunization Economics platform ( on immunization delivery costs. Our launch included findings from a systematic review of delivery costs of immunization programs in low- and middle-income countries, including a unit cost database (Immunization Delivery Cost Catalogue – the IDCC) and summary report with seven pooled immunization delivery unit cost estimates. 

    We are thrilled to announce that the IDCC has now been expanded to include 30 additional unit costs from nine recently published articles/reports. The unit costs include data from nine countries (Benin, Bhutan, Chad, China, Ethiopia, Haiti, Thailand, Togo and Vietnam). The new data covers health facility, school-based and campaign delivery of oral cholera, meningococcal, HPV and PCV10/13 vaccines. More than 400 unit costs are now available.

    All updates are live on Updated IDCC companion products (e.g. summary report, pooled immunization delivery unit cost estimates, etc.) will be released later this year.

    Want to Learn More?

    Join upcoming events to learn more about the IDCC!  Email if you’d like to be kept updated about these events and others moving forward.

    • October 12, 2018, 10:30am GMT+1: Fifth Global Symposium on Health Systems Research (HSR2018), Liverpool, UK: IDCC poster presentation
    • October 30, 2018, 9am EST: Webinar on how to use the IDCC with extensive Q&A

    Written materials and videos with instructions and guidance on using all tools and products are also available at

    Call for User Testers

    Interested in helping improve the IDCC and other products? ThinkWell is looking for individuals to provide structured feedback in person, by phone or via Skype. If you have 30 minutes available, please contact Michaela Mallow at

    About ICAN

    The immunization delivery cost review and analytics were conducted under the Immunization Costing Action Network (ICAN) project. Led by ThinkWell and John Snow, Inc. (JSI), the Immunization Costing Action Network (ICAN) is a project focused on increasing the visibility, availability, understanding, and use of data on the cost of delivering vaccines. ICAN aims to build country capacity around generation and use of cost information to work towards sustainable and predictable financing for vaccine delivery.

    The ICAN is supported by a grant from the Bill & Melinda Gates Foundation.

  • Dear colleagues, 

    The results of external evaluations assessing MyChild Solution based on Smart Paper Technology in Afghanistan are now available. These evaluations assessed the data quality, operational costs, efficiency gains as well as transfer of work processes to the existing health system in Afghanistan.

    In 2015, the Shifo Foundation, the Swedish Committee for Afghanistan (SCA), IKEA Foundation, and the Ministry of Public Health (MoPH) in Afghanistan started a joint collaboration to strengthen child health services in Afghanistan. Data and information are fundamental to inform decisions and assist key stakeholders to allocate appropriate resources to continuously improve the quality of health services. Therefore, one of the main objectives of the collaboration was to strengthen the quality of data and its utilisation in the Expanded Programme on Immunisation using an innovation based on Smart Paper Technology called MyChild Solution.

    MyChild Solution is an innovation developed by Shifo Foundation based on Smart Paper Technology. The solution was implemented and evaluated to inform evidence-based decisions on the scale up of the programme. MyChild Solution was implemented in 141 health service delivery points including fixed, outreached, and mobile clinics in the Mehterlam District of Laghman Province in Afghanistan. Currently, using MyChild Solution, more than 45,000 children have been registered, more than 9,000 children are fully vaccinated and more than 11,000 children are being followed up with SMS messages which inform parents about vaccination schedules.

    From the beginning of the programme, project stakeholders set several programme key success indicators which informed project development and external evaluations. These success indicators measured data quality such as completeness of data, timeliness, internal consistency, and external consistency and analysed if MyChild Solution could be integrated into the existing health system, thus sustained by the government.

    In June 2018, two external evaluations were conducted to assess data quality, operational costs, and efficiency gains as well as the transfer of work processes to the existing health system. This article summarises the results of these external evaluation reports.

    The data quality and review toolkit developed by World Health Organisation was used to evaluate the quality of data generated by MyChild Solution. The assessment showed high-quality data generated from MyChild Solution in every indicator, including completeness (100%), timeliness (91,66%), internal consistency (100%), and external consistency (99,4%). Moreover, the ratio of data recording error was low in the study and ranged from 0.05% to 1.7% for two selected data recording errors.

    The second evaluation investigated time efficiency. This evaluation assessed the time health workers spent on administrative tasks during and after delivery of care with MyChild Solution and compared the results with existing Health Management Information System(HMIS) tools. Results showed that 64% to 96% of time spent on administration could be reduced with MyChild Solution when compared to the current HMIS.

    Incremental cost analysis was done considering two scenarios. The first scenario took into account the monetary value of the reduced time for administration whereas the second scenario was conducted without the time reduction values. The evaluation also took into account two versions of the MyChild Solution. The first evaluation assessed MyChild Forms which is an innovation on facility-based data management tools. The second evaluation assessed MyChild Card which is an innovation modelled after the child health card.

    When adding the value of the reduced administration time, the total national cost of MyChild Card was 611,974 USD and the total national cost of MyChild Forms was 316,436 USD. Comparatively, the existing HMIS total national cost was 873,253 USD. Over a five-year period, MyChild Forms would save around 2,938,543 USD and MyChild Card would save around 1,378,875 USD compared to the existing HMIS system. When administration time is removed from the analysis, MyChild Card (501,622 USD) and MyChild Forms (206,126 USD) amounted to be more costly than HMIS forms (195,581 USD). It is noteworthy that when administration time is excluded from the analysis, MyChild Forms were 5% more expensive than HMIS.

    The second report displayed the results of the transfer of work processes to the existing health system. This is one of the key elements to evaluate the sustainability of the programme as well as how successful management was by the local stakeholders in Afghanistan.

    The results indicate that 95% of the processes essential to the management of MyChild Solution had been transferred to the local stakeholders in Mehterlam District. In most cases, these processes had been transferred in a way that is both accurate and sustainable. The remaining 5% of processes are planned to be fully transferred to Mehterlam by the end of 2018 to increase process accuracy.

    The external evaluation reports provide information on the effects of MyChild Solution from four different perspectives which give valuable insights to key stakeholders. These perspectives are data quality, costs, efficiency gains and transfer of work processes to the local level.

    Based on the findings derived from these external evaluations Shifo, SCA, and MoPH will collaborate to further expand and investigate the intervention on a larger level to inform decision making for the national implementation of the programme. The programme positively addressed all the key success metrics set in 2015 and brings opportunities to empower health and social workers at all levels of healthcare delivery who continuously work to improve quality of child health services across the country based on the reliable and relevant information.

    The full reports and additional information about MyChild Solution can be accessed using these links below:

    1) Questing The MyChild Solution in Afghanistan- An external evaluation of Data Quality, Operational Cost and Efficiency

    2) MyChild Solution in Afghanistan: An External Evaluation — Transfer of Work Processes to Existing Health System

    3) About MyChild Solution based on Smart Paper Technology

    4) Project progress in Afghanistan

    5) Link to the summary of the reports 


    Looking forward to your follow up questions/discussions.

    Kind regards, Nargis


  • Dear Colleagues,

    You are invited to contribute to a new discussion on 'When should Ministries of Health use refrigerated vehicle to deliver vaccines?'.

    Discussion co-moderated by James Cheyne and John Lloyd:

    There are at least four good reasons for using refrigerated vehicles to replace the classic pickup trucks loaded with cold boxes:

    1. The number of vaccines used in national immunization programmes has roughly doubled over the past 20 years and the number of new vaccine introductions is likely to increasing at a similar rate over at the next ten years. Larger volumes of vaccines will need larger vehicles.
    2. Refrigerated vehicles with three or four times the carrying capacity cost about the same as a typical pickup truck including the cost of the cost boxes and ice packs.
    3. Refrigerated vehicles eliminate the need to freeze hundreds of ice packs for each trip. Furthermore, continuous temperature monitoring in refrigerated vehicles is likely to reduce the amount of vaccine frozen in transit
    4. Larger capacity vehicles are better adapted to make round trips to deliver vaccines to several remote stores, saving both fuel and time.

    There are also at least four reasons for retaining pickup vehicles that deliver the vaccine in cold boxes and not investing in refrigerated vehicles:

    1. Existing delivery routes can continue to be used without the need for new route planning and new training for drivers and heath staff.
    2. Refrigerated vehicles can be difficult to maintain and spare parts for both the vehicle and the refrigeration unit are not always easy to source.
    3. Even with good maintenance and repair services available a backup refrigerated vehicle is needed to keep the deliveries moving when the first vehicle is being serviced or repaired after an accident.
    4. When not needed for vaccine deliveries pickup vehicles can be used more economically for non-vaccine deliveries.

    The world is not this simple, though. 

    We would like your thoughts and opinions on when you think refrigerated vehicles can be more effective and also when pickup trucks with cold boxes on the back can be the better option. 

    Or, of course, we would like to hear of any other options you know about to delivering large volumes of vaccines simply and reliably.

    Finally, if you are already using refrigerated vehicles, please have a look at WHO’s survey of refrigerated vehicles.  The purpose of the survey is to gather information on the performance of refrigerated vehicles that are three years old or older:

    The information will be used to help PQS develop standards for refrigerated vehicle meet the needs and operating environments of immunization programmes. Your help will be extremely valuable to WHO PQS and the WHO Expanded Programme of Immunization (EPI).

    Best regards from John and James.  We are both looking forward very much to debating your thoughts, ideas and suggestions.  Many thanks.

  • Strategic reuse of appropriate tools is one of the core principles of the BID Initiative. Over the last five years, we have worked with the governments of Tanzania and Zambia to enhance immunization and overall health service delivery by improving data collection, quality, and use, with interventions such as electronic immunization registries. We have created several planning, implementation, and data strengthening tools for use in Tanzania and Zambia, and have taken the most frequently used tools from both countries and made them generic.

    We hope other countries will be able to reuse and modify them for their specific needs. To learn more about the tools and how each was used, visit the BID website.


    Celina, on behalf of the BID Initiative team


  • Good morning,

    If your immunization programme uses a refrigerated vehicle WHO needs your insights and experience to help guide and improve the standards of these vehicles.

    Take this opportunity to share your expertise with the community and contribute to global improvements.  Please post your answers to TechNet-21 to three questions below:

    • Excluding routine servicing, has the vehicle needed to be repaired over the past three years?
    • Inside the refrigerated body have you needed to fit new shelving or change the method of securing the vaccine or pharmaceutical load? 
    • Have there been any problems with the in-cab temperature monitoring of the vaccine storage compartment during the past three years?

    'A Yes' or 'No' answer to each question will be very helpful but even more useful for WHO would a sentence or two describing in more detail the problem and the solution you have adopted.

    These three questions are taken from a more comprehensive survey posted on TechNet-21 at:

    If you choose to answer more answers in the survey, that would be best of all, of course!

    Best regards.

     James Cheyne - contractor to WHO.

  • Dear Colleagues,

    Empower is organizing the International Workshop on Scientific Writing, scheduled from 17th to 21st October 2018, in Bangkok, Thailand

    The overall aim of this workshop is to develop the skills of the professionals in conceptualizing, writing and publishing high-quality manuscripts in peer-reviewed international and national journals.  In addition, participants will learn the publication process from a journal editor's perspective, including the selection of best journal for their paper. 

    Key Objectives:

    • Acquire the skills necessary to develop, write, and publish a scientific manuscript;
    • Discuss the all-important sections of a manuscript (both qualitative and quantitative) including abstract, writing a cover letter, and final submission
    • Describe ethics in scientific publishing and writing
    • Learn how to use mentoring and peer-review to improve a scientific manuscript 
    • Identify the publishing process, including learning about why manuscripts get accepted/rejected and how to effectively respond to reviewers' comments

    The training fee payable is USD 2500, which includes:

    • One week face-to-face training in Bangkok
    • Certificate from Empower School of Health
    • Resources, course material, and workshop kit
    • Accommodation for the duration of the workshop
    • Breakfast, lunch, tea + snacks during the workshop
    • Three months of virtual mentorship
    • Does not include: airfare, visa fee or other travel expenses

    SCHOLARSHIP available for Empower Alumni - 50% on Workshop Tuition Fee

    Click here to know more and fill in the Application Form -

    Please feel free to connect with us in case you have any specific questions.



    Ms. Kavya RS  |  Training & Education Coordinator  |  Empower School of Health |  New Delhi . New York  | SkypeID : empower.schoolofhealth  |  + (India) | |

  • WHO PQS is conducting a survey to learn from users of Remote Temperature Monitoring Devices (RTMDs) and inform the future of vaccine cold chain monitoring.

    Have you ever…

    • Received a text, email or notifications from an RTMD?
    • Interacted with RTMD hardware in the field, including responding to alarms?
    • Setup RTMD hardware and/or software?
    • Interacted with an online RTMD web portal?
    • Conducted repairs or service on RTMDs?

    If so, we want YOU to help inform the future of RTMDs!

    Interested? Please send an email to to receive the survey link! 

    Best wishes,

    Denise Habimana

    Vaccine Cold Chain Technologies Program Officer at PATH

Gavi Bill & Melinda Gates Foundation WHO Unicef