TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.

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"THE BOOK OF VVM: Yesterday-today-and-tomorrow" is now available for free download

The story of a time and temperature indicator (vaccine vial monitor) that has dramatically changed the course of vaccine management practices as well as shaped the future of cold chain, THE BOOK OF VVM: YESTERDAY-TODAY-and-TOMORROW is now available for free download in ePUB3 and PDF formats. http://kartoglu.ch/vvm We may ask ourselves where humanity might be without some of the greatest inventions that have come to pass. Great ideas have continuously changed the path of human civilization over time with vaccination being widely considered one of the greatest medical achievements of modern civilization. Many commonplace and preventable childhood diseases are now increasingly rare because of vaccines. The concerted human effort to bring the vaccines to the ones who need them at the right time is remarkable. Just one example of the dedication and self-sacrifice involved was the 1925 ‘Serum Run’ between the settlements of Nenana and Nome in Alaska also known as the Great Race of Mercy. This involved a famously grueling winter expedition across the frozen Alaskan interior using dog-sled relays to take diphtheria antitoxin to the beleaguered township of Nome where an outbreak of diphtheria was threatening around 10,000 local Alaskan natives who had no natural immunity to this lethal disease. The epic journey took 20 mushers and about 150 sled dogs just five and a half days to cover the 1,085 km route. This display of bravery and determination was how the small town of Nome and the communities surrounding it were saved from an incipient epidemic. Balto, the lead sled dog on the final leg into Nome, became the most famous canine celebrity of the era. Balto’s statue became a popular tourist attraction both in New York City’s Central Park and downtown Anchorage in Alaska. The vaccine vial monitor (VVM) is one of the most important inventions of the last century; one that has dramatically changed vaccine management practices and continues to shape the cold chain. In 1996, when VVMs started to get to countries with the oral polio vaccine (OPV), I was the health officer for the UNICEF Central Asian Republics and Kazakhstan Area Office. I remember one particularly cold night going to the airport in Almaty at 03.00 am to receive the very first shipment of OPV with VVMs. For years, I was a humble VVM user and advocate in the field. Things started to change when I was hired by the WHO Headquarters ‘Access to Technologies’ team in 2001 and VVM became one of my prime responsibilities. That was at a time when vaccine manufacturers were dragging their feet about incorporating VVM onto vaccines other than OPV. My brief was to overcome this resistance from the manufacturers, an objective that formed the basis for my plans for the historic 2002 VVM technical consultation meeting. In 2007, I immensely enjoyed organizing the event to celebrate the 10th year anniversary of VVM introduction. Visiting Niger, Indonesia, and Vietnam for the shooting of the “Five Senses” video is full of cherished moments. Towards my retirement in August 2018, I conceived the idea of writing this book. I was one of the few people who had witnessed the decades-long programme of VVM development from its birth to its maturity. I had worked with sweat and tears to get VVMs onto all vaccines as well as tirelessly helping vaccine managers and health staff to excel in using the VVMs to their utmost potential. Today, it is a great pleasure to see one of my e-VVM based vaccine management course graduates (2015), Junaidu Adamu Barde from Nigeria, working for the Clinton Health Access Initiative, using the course learning materials to duplicate efforts in his country. I worked on this book from September 2018 to August 2019. I went through every single published and unpublished work on VVMs, watched all available videos about VVMs and the early contending products, talked to key people, some face to face, others over the phone. I visited the U.S., Albania, Burkina Faso, and Sierra Leone. Unfortunately, there were some people I just could not reach despite all my efforts with email and phone messages. And, although I considered myself highly knowledgeable about VVM, I was simply amazed at the volume of new information I discovered and the knowledge I gained. I had originally wanted this book to be a concise, structured, globally-relevant manual that provided comprehensive information on a wide scope of issues; in other words, an ‘A-Z of VVM’. In the event, it turned out to be more voluminous than I thought. I did not want to restrict myself when there are so many clever, dedicated and selfless individuals that have made this near-miraculous innovation a reality and in doing so contributed to saving, literally, the lives of millions. So, I am happy that it became a celebration of all the efforts of individuals, organizations, agencies, donors, and manufacturers involved in the development, scaling, applying, advocating for, enforcing, helping health workers to excel in their practice, and using it. As with my previous books, I have again licensed this work under the Creative Commons (CC) Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The book can be reproduced, remixed, tweaked or built upon non-commercially. I am grateful to Temptime Corporation, and especially to Renaat Van den Hooff and Ted Prusik for sponsoring the creation of this book. I thank Emily Moore for the VVM literature list she put together, it eased my search enormously. I also thank all the individuals I have interviewed for their time and everything they have shared with me. I am thankful to all my colleagues who sent me photographs, and documents. Many thanks to Kadir Abbas for making again an excellent job on the cover and page design, print, and ePUB3 conversion. Gencer Yurttas deserves a special thank you for his immaculate VVM photography. I deeply appreciate Alan Kennedy for his editing work, and Umran and Gokhan Akaalp's help in developing the book’s website. I am grateful to my wife Nellie and daughter Deniz Nala who supported me with love. Deniz Nala was already helping me at the age of 14 measuring VVMs with a spectrodensitometer and entering data into an Excel sheet to calculate optical density differences during a VVM based vaccine management eLearning course. I never imagined that for something only 0.38 cm2 in size that I could write a book of 424 pages. This ‘little big thing’, now reinventing itself with the incorporation of a peak threshold indicator as well as entering the digitized supply chain with the integration of 2D barcodes, never ceases to amaze me. For download please visit http://kartoglu.ch/vvm The book is available both in interactive PDF (32.9 MB) and ePUB3 (24.4 MB) versions. 424 pages...  

2019 Pneumonia & Diarrhea Progress Report Card

The 2019 Pneumonia & Diarrhea Progress Report Card—an annual report developed by the International Vaccine Access Center (IVAC) in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health—is now live. This year’s report card finds health systems are falling short of ensuring the world’s most vulnerable children have access to prevention and treatment services in the 23 countries that together account for 75% of global pneumonia and diarrhea deaths in children under 5. It describes progress in fighting pneumonia and diarrhea in countries with the highest absolute number of deaths and, for the first time, in countries with the highest rates of deaths from these illnesses. While the report card identifies progress—increases in immunization coverage—it also describes a near-universal failure to meet GAPPD targets across 23 countries with the greatest burden of disease. About IVAC The International Vaccine Access Center (IVAC) applies rigorous science to build knowledge and support for the value of vaccines. Based in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, with a team of over 40 physicians and professors, economists and epidemiologists, researchers and advocates, IVAC provides global technical leadership on over 15 vaccine-preventable diseases. IVAC’s approach utilizes leading-edge science, clear communication, productive partnership, and capacity building. By generating, synthesizing, and using evidence to inform decision-making and action, we accelerate equitable and sustainable access to vaccines globally.

VVM

Great achievement for the VVM. Bravo Umit

Is it time to explore a different way of looking at immunization coverage and system strength?

A recent article in Science authored by Michael Mina and colleagues concludes that measles infection reduces antibodies that provide protection against infections thereby reducing the benefits of prior vaccination (https://science.sciencemag.org/content/366/6465/599). Measles vaccination acts as an essential complement to other vaccines; hence, defining system strength by DTP3 or MCV1 coverage appears inadequate. Because coverage can also be seen as a probability, it is possible to multiply DTP3 and MCV1 coverage to obtain the probability that an infant has received both. With this joint coverage approach, there is still a reassuringly high number of countries where coverage exceeds 90%. However, not surprisingly, there are about twice as many countries with coverage less than 70% using the joint methodology than through the use of either DTP3 or MCV1. The use of a joint coverage approach may be better at identifying weaknesses and fragility in immunization systems.

Webinar Invitation: Integrating Drones into Immunization Supply Chains

Hello TechNet-21 members, 

The UAV for Payload Delivery Working Group (UPDWG) invite you to attend a special, one and a half hour webinar, jointly hosted by UPDWG and TechNet-21 on integrating drones into immunization supply chains.  Webinar: Integrating Drones into Immunization Supply Chains When: November 7, 2019 | 10-11:30 AM EST Description: Resilient, high-performing immunization supply chains (iSCs) are the basis for strong primary health care systems and the foundation for reaching global immunization coverage and equity targets. Yet efficient and reliable transportation for immunization products still remains a challenge in many low and middle-income countries. New technologies, such as drones, have the potential to revolutionize traditional modes of transportation but how do you know if these technologies are the right fit for your context?
In this webinar, UPDWG and TechNet-21 will explore when integrating drones (or UAVs) into existing iSCs is feasible and how you can operationalize drones in existing immunization programs. UPDWG Members from UNICEF and VillageReach will share their experiences from Vanuatu and the Democratic Republic of Congo (DRC), in integrating drones transportation into the routine immunization supply chain.  After the presentations, we will open the floor for a panel discussion with VillageReach DRC and former UNICEF Vanuatu staff.  Hosts: 
Olivier Defawe - UPDWG
Daniel Brigden - TechNet-21, The Technical Network for Strengthening Immunization Services

Case Study Presenters: 
Jaime Archundia - UAS Global Lead, UNICEF
Luciana Maxim - Sr. Manager, Research Evidence and Learning, VillageReach

Discussion Panelists: 
Ridwan Gustiana - Health Specialist, Immunization UNICEF (formerly UNICEF Vanuatu) 
Archimede Makaya - Equateur Provincial Coordinator, VillageReach DRC
Dieudonne Nsekela - Program Officer, New Technologies, VillageReach DRC
Christian Vazquez - Civil Engineer, Transportation Engineering (formerly UNICEF Vanuatu)  Registration: https://zoom.us/meeting/register/c638a89ac5516f0d8c34be5db4a05ad8   I hope you can join us for this exciting webinar!    Best,  Gabriella Ailstock Coordinator, UAV for Payload Delivery Working Group (UPDWG) info@UPDWG.org | UPDWG.org

Webinar on PQS cold chain equipment area on TechNet: 17 October 2019

Do you work with WHO PQS-prequalified cold chain equipment – refrigerators and freezers, cold boxes and vaccine carriers, coolant packs, and temperature monitoring devices? If so, you may be interested in the new Cold Chain Equipment (CCE) area of TechNet-21.org, which includes detailed information on all WHO PQS-prequalified products, including installation and maintenance guides, training resources, brochures, videos, photos, as well as product feedback from TechNet members. Next month, TechNet will host a webinar on the new CCE area. We will explain how to use the new area, as well as how PQS manufacturers can manage the information and resources provided for their products. An update on the new WHO PQS website will also be provided. The webinar will take place at 4pm CEST on Thursday, 17 October and will be moderated by Alex Pascutto, TechNet Community Manager. The following experts will also be on the panel: Dan Brigden (WHO EPI) Isaac Gobina (WHO PQS) Matt Morio (PATH) Gemma Huckerby (consultant) Others TBC The link to the webinar will be provided one week before the date. Save the date and please join us!   About the CCE area Every PQS-prequalified CCE product has been given its own page. Each page includes detailed information on that product, including: Product data from the WHO PQS CCE website Resources for the product shared by TechNet members, including technical guidance from WHO, UNICEF, and other partners, installation and maintenance guides, training materials, and manufacturer brochures Videos on the product Feedback from TechNet members on the product PQS manufacturers with a TechNet account can manage some of the information displayed on their product pages, for example by updating the product description, as well as adding product photos and videos. Note: the CCE area features technical information available on the WHO PQS Catalogue website. Please refer to this website for official WHO guidance and the latest information on PQS products.

WHO/UNICEF estimates of national vaccination coverage (WUENIC) study: 'Have your say'

Dear Members of TechNet-21,   Do national coverage estimates affect your work? Do you use estimates to make decisions? Are you interested in contributing to their improvement? If you have answered yes to any of these questions we would love to hear what you have to say about this important indicator.   Supported by WHO and UNICEF, Swiss TPH are conducting a study to explore: 1. the use and usefulness of estimates for decision making, and 2. methodological approaches to improve estimates of national immunization coverage.   Please find attached the WHO/UNICEF WUENIC project introduction letter which includes further details and the link to the online survey (15 minutes). You can also access the survey directly here: https://forms.gle/9dUMZb1zABRdbkmb8   Many thanks for your interest and support, Caitlin & the Swiss TPH study team  

What is the role and use of serosurveys in immunization to deal with hard situation like continued WPV circulation detected in through environmental surveillance in district Lahore Punjab, Pakistan?

Pakistan is among 2 last countries with Afghanistan that are struggling to eradicate polio from the country. Despite of repeated SIA's (more than 100 rounds) and having good LQAS results showing high coverage, still WPV is being detected (Human Polio cases as well as positive Environmental samples). So, would there be a role and use of serosurveys in this regard? Please look at the attached file from Punjab Pakistan where details can be appreciated in the weekly reports.

Replication of CMEWS for acceleration

Dear viewers We wish to share the attached with End TB stakeholders for dissemination and needful. India is committed, eradicated polio and got the certificate in March 2014. In 2018, declared to End TB [Elimination] by 2025, aims to achieve prevalence rate of ≤65, incidence of ≤44 and mortality of ≤3 per lakh population per year and zero catastrophic cost which looks too ambitious. India also declared to screen below 18 year population both for TB and Leprosy and to put on treatment if required. This will help in minimizing the population infection [reservoir of infection]. In this regard vaccinating with live attenuated vaccine in potent condition without any programmatic error early as possible to the newborns for obtaining “immunogenic scar”, administering tuberculin without any programmatic error for early detection of TB infection, early diagnosis and prompt treatment of all TB cases are mandatory. KVG team proactively and opportunistically discovered several programmatic errors in the administration of tuberculin, shared with stake holders, demosite was established at KVG Medical College, with the support from the government and active participation by the medical colleges in Karnataka rapid replication is happening through CMEW on TST. This is expected to totally eliminate long standing universal operational gaps in administering tuberculin. The attached is the highlights of CMEW held at KVGMCH and KIMS Mangaluru on 15th and 16th October respectively for global sharing. with best wishes Holla n team

Webinar: Analysis of the Situation of Digital Health in Central America: The experience of Central American Health Informatics Network

Webinar organized by Asia eHealth Information Network (AeHIN) in which we shall analyze the current situation of Digital Health in Central America through the accumulated experience of Central American Health Informatics Network (RECAINSA) Speakers: - Joseline Carías Galeano, Coordinator of Communication and Digital Strategy of RECAINSA - Daniel Roberto Otzoy Garcia, Coordinator of RECAINSA  Date: October, 22th 2019  Time: 7 AM Central America Time / 9 AM Washington D.C./ 3 PM Geneva / 9 PM Philippines Time. Register: http://bit.ly/2MP6MHl We thank you for your participation and for sharing with your contacts. Best regards Daniel

Immunization coverage surveys

Reports of Latest surveys in Latina America are available here?

HLN Releases Version 1.21.1 of its Award Winning Open Source Immunization Forecaster

On October 15, 2019, HLN released a new version (v1.21.1) of the Immunization Calculation Engine (ICE). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. This version includes important updates to the DTP Vaccine Group including: Updated HPV rules as per the June 2019 ACIP approved recommendations, including a harmonized recommendation for catch-up vaccination for males and females through age 26 years and recommendation based on shared clinical decision making for individuals aged 27 through 45 years who are not adequately vaccinated. Slight change to the way the dose number included in the vMR output is determined. The full software release is available for download at https://cdsframework.atlassian.net/wiki/display/ICE/Downloads. A revised ICE Implementation Guide is also available. See the feature article about ICE in Open Health News.

New post in RECAINSA's blog

Dear colleagues We have a new post in Central American Health Informatics Network (RECAINSA)!! Abstract: The registration of information about family visit done by primary care level personnel, was carried out for almost 40 years, in the Family Factsheets in cardboard, this resulted in an obsolete and inefficient method in data analysis processes, carrying out statistical balances, timely references, because the information was not encoded, nor available. The aforementioned posed innovative challenge of using information technologies as an enhancer to facilitate education, health promotion and disease prevention, which is why Mobile Family Record (Mobile SIFF) was developed as a work tool that It allows the ATAP (Primary care technicians), to collect the information that is generated in the home visits in an agile, practical and safe way, and also keep track of the activities carried out in the home visit, consultation of promotional material, capture and update of the data of the family record, synchronization with the Integrated Family Record System (SIFF in Spanish) and Integrated Security Module (MISE) currently used by the Social Security Fund of Costa Rica. This intention provided a substantial boost in the issue of eHealth, specifically in mHealth (or health by mobile devices) this because not only a tool is provided to facilitate the processes of providing services digitally. It allows it to be ubiquitous with associated mobility, where information can be accessed from anywhere and from anyone. Complete article (Spanish*): http://bit.ly/2VtSBLO * You can use the translation option located in upper right side of our Web Site, available in English, French and Portuguese. Thanks for reading, feedback and sharing. Best regards Daniel

Development of new technology

I am a refrigeration technician working in Kenya Bomet county under the ministry of heath. I am dealing with vaccine fridges for immunization. I will be in touch with you in new development of cce.

Immunization Supply Chain Action Plan

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.  Thanks, Chandralal 

CMEW for sensitizing on TST at JJMMC - Davangere, Karnataka, India

Dear viewers  Last month when the above workshop was conducted at St John Medical College Bengaluru, replication for acceleration was anticipated. KVG team wishes to share the following in brief. Exactly a month back on 04th Sep 2019, St John Medical College Bengaluru, Karnataka, India invited KVG team to conduct CMEW to sensitize service providers [Testers] and specialists who prescribe and read the test for diagnostic purpose in their college. A feedback and a feed forward were shared with SJMC and the higher-ups including global partners of End TB programme through techNet-21. As committed by Dr Balu PS, STF Chair of RNTCP for Karnataka state, Professor and HOD, department of Community Medicine, JJMMC Davangere organized similar programme in their college on 4th Oct 2019; sharing the highlights as continuation of extended success of the vision in mission mode. About the CMEW held at JJMMC Davangere: ~ 2hr CMEW was held on 04th October afternoon. 45 participants from all the key departments attended the programme. Dr Balu PS, STF chair Karnataka, Professor and HOD department of community medicine JJMMC moderated the CMEW. He expressed and wished: “it’s a useful training, do request RNTCP nodal officers to have in u r college;….we also take this opportunity to felicitate holla sir for his contribution towards polio eradication efforts and strengthening Routine Immunization in state of Karnataka”. He thanked Dr Murugesh SB, the Principal for all his support. Dr Mugana Gowda Patil – professor and head of the department of pediatrics and Dr Mohan Maruliah – the Director Bapuji child health institute for participating in the workshop as chief invitees and chair persons. On the spot they committed to administer TST as per CDC / GoI / RNTCP guidelines to support “End TB” timely. Extension of Vision and Mission: Similar vision and mission in administering Newborn BCG vaccine with no programmatic errors under Routine Immunization programme will help the newborns to develop “IMMUNOGENIC BCG SCAR”. According to recent studies, newborn BCG vaccination is ~80% effective in protecting the children from the catastrophic impact of TB and can drastically reduce Mtb population infection (the reservoir of infection). Programmatic errors are bound to occur as >70% birthing are taking place in private birthing institutions and the vaccination commonly yields “ULCEROGENIC SCAR” – soft, shallow, and hyper pigmented which we routinely see in the vaccination clinic which can delay the reduction of “population infection”, retarding the achievement of national and global goals.  Way forward: Conducting similar CMEW in the remaining Medical Colleges of Karnataka followed by hands on intensive training of testers in the follow up supportive supervision visits. In the near future reporting format will be edited to capture core data on TST.  Acknowledgement: We thank all the supporters of “End TB” programme. Same we attched with a few photos. with best wishes and regards to the viewers Holla n Team    

Discussion: The IDEAL-Vietnam project would like global feedback and collaboration on the topic of, “Partnering with Mobile Network Operators for electronic immunization registry application”, after the release of the project’s first case study.

The PATH, Introducing Digital immunization information systems- Exchange and Learning (IDEAL) project, funded by the Bill & Melinda Gates Foundation is excited to release the first lessons learned on transitioning from a paper-based immunization registry to an entirely digital system. The case study reflects necessary partnerships in the development and scale-up of current electronic immunization registry (EIR) in Vietnam, the National Immunization Information System (NIIS). The study describes the benefits and challenges of partnerships between the Ministry of Health, PATH and Mobile Network Operator (Viettel). Both local governments, partnering NGOs and Mobile Network Operators play a vital role in the application of a software-based immunization registry, but as Vietnam’s story demonstrates there is both critical advanced planning and necessary steps to ensure these partnerships are as strong and sustainable as possible, maximizing both resources and time to increase health benefits. The study discusses the development of partnerships that enabled the successful scale-up of Vietnam’s NIIS from a pilot project to a nation-wide application. The World Health Organizations, “A practical guide for engaging with mobile network operators in Health for reproductive, maternal, newborn and child health” was used as a comparative guide in the case study, to relate Vietnam’s experience to existing EIR global resources. The case study highlights the benefits of key partnerships in EIR implementation and drivers for cultivating partnerships from both MNO and MOH perspectives. The report also demonstrates the hurdles that Vietnam experienced, demonstrating when possible, how Vietnam was able to overcome the challenges as the country continues to transition to an entirely digital immunization registry. The first lesson learned case study also serves as a gateway to introduce IDEAL’s new homepage on TechNet-21, where you can find all IDEAL- project reports, announcements and materials in English and Vietnamese. Over the course of the next two years IDEAL-project will explore more lessons learned from Vietnam in the process of moving to completely digital, each zoning-in on an important aspect of the electronic immunization registry process.   IDEAL-Vietnam project would like your feedback on the first case study and first topic of our lessons learned library, “Partnering with Mobile Network Operators”: 1.) What has been some of your countries/organization’s key challenges in the identification, formation, or maintenance of a partnership with a MNO?   2.) What lessons learned or take-away message did you find most valuable for our case study?   3.) What are some lessons learned or take-away messages you think are important to share from your country/organizations experience/partnerships?   4.) What are some other global guidance documents your country/organization have used to determine best practice for forming necessary partnerships for the EIR application?   5.) What aspects from the Vietnam perspective can your own country/organization relate to in regard to the partnerships formed for EIR application? What aspects are less relatable?   6.) If the IDEAL-project could expand/revise this case study in the future what areas would be most helpful to detail further?  

Innovate to sustain; Replicate to Accelerate: MR Elimination

Dear viewrs of techNet community We wish to share the attached wherein a planning unit lead by AYUSH Lady Medical Officer has attained and sustained >95% FIC below one year and DPT 1st booster with OPV and MCV/MRCV. We feel proud to share this as it is attached to our Medical College.  Quote-2012: “With near eradication of poliomyelitis, global immunization commitments have to be in clear focus. Chasing measles outbreaks is costly to families and health systems. It is time to move faster to fill population immunity gaps”. Department of Health and Family Welfare services Dakshinakannada district in collaboration with partner organization (WHO) organized district level workshop on Measles elimination and Rubella control – the need of the year / month / week / day / hour.  Venue – IMA Bhavan, Mangaluru. District Health & FW officer Dr Ramakrishna Rao along with team of resource persons lead by SMO Dr Sathishchandra formally inaugurated the programme. He emphasized that Medical Officers have to identify the gaps in vaccination and close it timely. Team of resource persons spoke on the following topics moderated by SMO who interactively elaborated on strategies of elimination, case based surveillance, outbreak response using “Mentimeter”, case studies and “station approach” for active participatory learning. 1.    Measles and Rubella (MR) Epidemiology 2.    MR elimination strategy 3.    Progress on MR case based surveillance 4.    Modified MR case based surveillance 5. Revised outbreak response 6. HRA prioritization 7. Monitoring Indicators and data analysis 8. Case studies & Station approach Attaining and sustaining ≥95% MRCV two doses is the first of the 5 strategies. Dr Holla shared the following successful models operating in the field since Jan 2013 for attaining the same. Way back in Dec 2012, “Xmas Gift” was posted in the techNet-21 assuring >90% backlog clearance of MCV2 from 6% on 10th Jan 2013 – in just 2 weeks [Peraje Template]. The dramatic and unprecedented result of Peraje Sub-Centre was presented in the Academic Society Meeting in the Medical College on 30th Jan 2013 and ambitiously in the District Task Force [DTF] meeting at Dakshinakannada for replication in all the PHCs of the district. In just 3 months [Jan/Feb/Mar 2013] entire PHC Sampaje reached >95% of Full Immunization of below one year and complete immunization before 2nd year which included 2 doses of Measles. [Immunogram article published]. Measles and Rubella was introduced since Feb 2017. The attached 2 pager with photo will be shared with the viewers for any additional inputs. Way forward: District task force [DTF] to empathetically appreciate the success of PHC Kollamogru and replicate in all the planning units for acceleration. On authorization, KVG team is proactive in accelerating the coverage of MRCV two doses in all the remaining planning units of the district.  Acknowledgement: We thank the organizers for inviting faculty from departments of pediatrics and community medicine of private medical colleges and the management for deputing KVG team. With best wishes Dr Holla n Team                

Webinar: HR for SCM – Lets Consider HSCM Career Paths & Professionalization (GHSC-PSM)

Dear SCM Colleagues, The USAID Global Health Supply Chain Program-Procurement Supply Management (GHSC-PSM) project invites you to the fifth in a series of SCM Workforce Development webinars, ‘HR for SCM – Lets Consider HSCM Career Paths & Professionalization’. Are you frustrated with skilled HSCM staff leaving your organization? Do you get frustrated with the lack of health supply chain management (HSCM) job opportunities? Would you like to improve the career pathways for HSCM in your country? Professionalization of the HSCM workforce is often mentioned with an overarching desire to improve competence of HSCM workers and have them engage in a meaningful career, developing and applying their SCM skills to improve the availability of medicines for patients. There are systematic things to consider and apply, that will improve the professionalization of your local and national HSCM workforce. Wednesday the 2nd of October, 8am to 9am EST. At the conclusion of this session participants should be able to: • Explain what professionalization means in the context of HSCM and consider career pathways in this context
• Describe the roles of various SC Professional Associations
• Explore a proposed GHSC-PSM SCM Professionalization Framework
• Consider steps that can be taken to improve the professionalization of SCM cadres in your own country and organizational context The webinar will be facilitated by Dr Andrew N Brown (GHSC-PSM) and Mr Michael Egharevba (GHSC-PSM). Andrew is the GHSC-PSM Workforce Development Specialist Team Lead. He has more than 20 years of experience in pharmaceutical health systems with a specialized focus on human resources development in the health supply chain context of low and middle-income countries. He has extensive experience working with international and national stakeholders to strengthen human resource management systems to effectively develop, recruit, retain, and support the health workforce for increased access to quality health services. Michael is a Workforce Development Specialist within the GHSC-PSM. He has 20 years of experience in pharmaceutical health systems with a specialized focus in health supply chain management, monitoring & evaluation of health indicators in low and middle-income countries. He has extensive in-country experience working with international and national stakeholders to train on various areas of supply chain management, conduct health logistics system design and quantification for health commodities. You can access the webinar through the link below: ......................................................................................................................................... Join Skype Meeting https://meet.lync.com/chemonics-ghsc-psm/abrown/SR5K6HT9 Trouble Joining? Try Skype Web App Join by Phone Toll-free number: +1 (888) 662-4175,,6673602# Toll number: +1 (312) 777-1441,,6673602# Find a local number Conference ID: 6673602 Help 033])!] ............................................................................................................. We look forward to engaging with you in the webinar. Regards, Andrew Dr. Andrew N Brown
Workforce Development Specialist Team Lead for: Workforce Development and Enabling Environment Contractor for USAID Global Health Supply Chain Program Procurement and Supply Management 251 18th Street South, Suite 1200 Arlington, VA 22202 United States
m:+1.571.665.8319 +61.411.137.625
e: abrown@ghsc-psm.org
Skype: andrew.brown.uc

New post in RECAINSA's blog

Dear colleagues We have a new post in our blog and we appreciate your reading, feedback and dissemination in your networks. The Unique Digital Health Record: The Transformation of Health Services in Costa Rica Abstract Manuel Rodríguez Arce, Director of the Unique Digital Health Record Project, EDUS in Spanish, of the Costa Rican Social Security Fund, CCSS, shares the experience of its implementation in Costa Rica using eHealth strategies and the main lessons learned in terms of digital transformation in health of the Costa Rican healthcare model.Link: http://bit.ly/34JaGtz The original language of post is Spanish but you can also read in English, French and Portuguese, using the option "Idiomas" located in up-right position of our Web Site Thanks and best regards Daniel Otzoy

Immunization Data: Evidence for Action findings now available on TechNet-21

The Immunization Data: Evidence for Action (IDEA) report and supporting materials are now available on the TechNet-21 website in English, Spanish and French. The IDEA report, A Realist Review of What Works to Improve Data Use for Immunization: Evidence from low-and middle-income countries, was written by PATH and the Pan American Health Organization (PAHO). It provides the immunization community with clear, proven strategies for improving the quality and use of immunization data. In addition, it outlines how funders, policymakers, and program implementers can incorporate these best practices to improve the efficacy of state, regional, and national immunization programs. The available materials include the full report, an executive summary, the review’s guiding Theory of Change, an evidence synthesis table and a summary of the five top findings. In addition, there is an Evidence Gap Map. For each primary intervention type identified in the IDEA literature review, the gap map visualizes all the pieces of evidence and promising strategies identified. The gap map illustrates where there is greater coverage of evidence and promising strategies as well as where there are gaps in evidence to help inform future research needs. To view the Evidence Gap Map and all the IDEA materials please visit: https://www.technet-21.org/en/topics/idea

Rencontre Scholars ivoiriens et DCPEV à Abidjan le 28 août 2019

Le mercredi 28 août 2019 à 15 heures, s'est tenue à Abidjan une importante rencontre entre les Scholars de Côte d'Ivoire et les autorités du PEV national. L'ordre du jour a porté essentiellement sur la présentation du groupe pays Côte d'Ivoire. La rencontre a vu la présence effective du Professeur EKRA  Daniel, Directeur Coordonnateur du PEV national et d'une dizaine de Scholars venus de tous les coins du pays. Le Team Leader, Kouame Etienne Gata a dans son intervention situé le contexte de la rencontre après avoir remercié l'équipe dirigeante de la DCPEV.  Le Chef d'équipe est revenu dans son exposé sur l'approche pédagogique de l'OMS qui depuis 2016 a recours à la méthode Scholar afin de soutenir le renforcement des capacités des pays pour la vaccination. Cette methode développée par la Fondation Apprendre Genève vise à renforcer les compétences et les actions dans les domaines de la Santé publique et de l'humanitaire. Le groupe pays Côte d'Ivoire à l'instars de nombreux autres pays du monde s'est engagé résolument dans l'aprentissage des cours Scholar et compte aujourd'hui plus de cinquante (50) apprenants que ce soit pour les cours Survey  Scholars,  SPMVS , AMV.    Poursuivant son exposé sur la présentation du groupe Côte d'Ivoire, le Team Leader a montré l'effort de structuration interne qui a été fait et informé le Directeur Cordonnateur du PEV sur la mise en oeuvre de certains projets individuels dans le cadre de l'Accélérateur d'Impact. Il a ajouté qu'un projet collectif conforme au PPac 2019-2020, qui s'intègre dans l'effort plus général de réduction des inégalités et d'amélioration de la couverture vaccinale du pays a été élaboré et attend d'être implémenté après validation et appui de  la DCPEV. Il a été appuyé en cela par le Porte-parole du groupe , M.  AKAFFOU Fulgence qui a décrit l'expérience de mise en oeuvre de son projet individuel. Le Chef d'équipe a avant de clore son intervention,  procedé à la lecture du serment pour l'impact sous les applaudissements de l'assistance. Prenant la parole, le Directeur Coordonnateur du PEV a remercié les participants et décidé d'apporter un appui ferme aux Scholars de Côte d'Ivoire. Il a instruit le Team Leader de faire parvenir à la DCPEV, la liste des Scholars et souhaité la présentation et la validation par sa structure du projet collectif. Le deuxième temps fort de la cérémonie a été marquée par la remise symbolique des Certificats OMS Scholars par le Directeur aux différents Scholars présents. Commencée à 15 h 04 mn, la rencontre a pris fin à 16 h 17 mn avec la prise de photo d'ensemble. Fait à Abidjan le 28 août 2019 Le Team Leader pays Kouame Etienne Gata

CME workshop on Diagnostic role and the Rights to be observed in Tuberculin Skin Test (Mantoux test) at St John Medical College (SJMC), Bengaluru held on 04 Sep 2019.

Dear viewers KVG team wishes to share the following with the viewers and supporters of "End TB Programme" as tuberculin skin test [Mantoux test] is in practice since 1907 however there are many programmatic errors happening at the service delivery point which can be witnessed by anybody anywhere in the country administering tuberculin. Context: The Union Government has rolled out a programme for universal screening of an estimated 250 million children and adolescents below 18 years annually for Leprosy and Tuberculosis (TB) and put on treatment if required. TB kills an estimated 4.8 lakh Indians (sharing 31% of global TB deaths) every year [>1,400 every day]. India has the highest TB burden (27% of the world) with more than a million ‘missing’ cases every year that are not notified – either undiagnosed, unaccountable, inadequately diagnosed and treated in the private sector. (https://indianexpress.com/article/india/govt-rolls-out-scheme-to-screen-all-children-below-18-for-leprosy-tb-5943004/ accessed on 06-09-2019). In this regard Manotux test [TST] has a definite role. Tuberculin Skin Test (TST) is a simple and reasonably reliable method for the detection of infection by Mycobacterium tuberculosis. It is a diagnostic aid for corroborating with clinical findings though not a confirmatory test. Quote: It has to be approached “with respect, administered with care, read with deliberation and interpreted with sentient discrimination.”  Programmatic errors observed during opportunistic proactive supportive supervision: All the 8 rights to be observed before / while and after administering vaccines are applicable to Tuberculin also plus 2 more: a) Do’s and Don’ts for the patient during the reactogenic period of 0 to 48hrs; b) reading the test between 48 and 72 hours without fail. In almost all Medical Colleges visited in 4 states, tuberculin manufactured by “arkray” with different strengths is used: viz. 1TU, 2TU, 5TU and 10TU RT23 in 0.1mL, 5mL per vial providing 50 ID doses of 0.1mL each. Though the test is in practice since 1907, following programmatic errors in various permutation combinations were observed in different thematic areas of administering / reading TST: Cold chain: Stored in domestic refrigerator with vertical door opening horizontally. Often kept in the inner aspect of door abutting freezer compartment, tuberculin getting frequently frozen. Once brought from the main store, kept in the tray at the service point during working hours, often till the last dose in some institutions for couple of months. VVM: In India, tuberculin is not dressed with VVM and hence the potency of the reagent at any time is not known. Pediatric age: No uniformity, ranging from 0 – 5yrs to   0 – 18yrs.     About TU per 0.1mL and the units administered: “Testers” are not aware of number of TU per 0.1mL as a result in one college 10TU per 0.1mL is administered to children and 1TU in 0.1mL to adults. Different colleges are administering different strengths: 2 TU in 0.1mL for all, 5 TU in 0.1mL for all and 10 TU in 0.1mL for all. Quantity / volume: 0.05mL of 2TU in 0.1mL to children, 0.05mL of 5 TU in 0.1mL for children, 0.025mL (one digit from insulin syringe) of 10 TU in 0.1mL for children & or quantity made up to 0.1mL diluting with normal saline were administered. Volume < 0.1mL cannot yield wheal of required diameter of ≥7mm diameter; smaller diameter is like providing "badminton court for playing foot ball". Route: Often administered Sub Cutaneously. Multi dose vial policy: Once the vial is opened (opening date), same vial is used beyond the recommended 30 days till the last dose, with or without cold chain. Opening date and Beyond Useable Date (BUD) are not mentioned on the vial, not in compliance with guidelines. Trained staff: Testers are not “dedicatedly” trained for administering tuberculin, but many regular staff nurses & or lab technicians could administer intradermally correctly. In some institutions “testers” are not “dedicated”, anybody is allowed to administer from nursing students, interns, Post graduates. Wheal: The diameter of the wheal is not measured hence if the wheal is small (≤6mm); there is no repetition of the test immediately. AEFI Kit: Not available at many places. No display of standard operating procedure and job-aid at the service point. 2 step tests in needy circumstances are not in practice. Documentation: No standard documentation hence no indicators can be obtained required for performance review / operational research if any. Instructions to the patient / beneficiary: Explaining the procedure and giving Key messages to the patient are hardly adhered. Reading of the test: Test needs to be read between 48 and 72 hrs unlike many test doses in medical practice which is read ~30 minutes of administering the test dose. In substantial cases results were not read (~30%) defeating the purpose of the test. What we did: Charity should begin at home. We established nursing station for administering tuberculin skin test in the dedicated vaccination clinic in KVG Medical College by the dedicated staff. Developed a Supportive Supervision checklist as per CDC and RNTCP guidelines, used the same in the capacity building of testers and the officers in various Medical Colleges. Regularly shared the observations with DTF, STF, ZTF and NTF. We appraised the visitors to our college. As directed by the State Task Force, in collaboration with DTO, conducted training workshops to the Matron, testers of Medical Colleges of home district at the “Demo-site” of KVG Medical College. As directed by STF, experiences of training workshop presented in the STF meeting at State Institute of Health and Family Welfare on 7th June 2019. Way forward: Conducting similar CMEW in all the Medical Colleges of Karnataka for sensitization followed by intensive training of testers in small batches at the “Demo-site” in KVG Medical College in collaboration with government. Acknowledgement: We thank all the supporters of “End TB” programme.  With regards   

Together, developing quality, reliable immunization products that meet every need

  The WHO PQS product feedback cycle Did you know that at the heart of WHO Performance, Quality & Safety (PQS) is a crucial performance monitoring and feedback mechanism? This mechanism makes it possible for PQS to enforce and improve product standards and make sure that products and devices procured for use in immunization programmes are suitable, quality and reliable. This cycle of feedback and improvement is powered by the input of EPI programmes and product manufacturers. In-field insights - such as reports of product life cycle performance or defects and faults - help WHO PQS develop new or review existing product specifications to maintain a robust prequalification process and, ultimately, help EPI programmes safeguard and deliver precious potent and safe vaccines. Envisioning the future WHO PQS also gathers up-to-date insights about the evolving requirements of product users’ operating environments, with which PQS can help shape the design of novel product features. Desired future product features are incorporated into PQS target product profiles (TPPs) as aspirational targets for manufacturers’ product development. Recent examples of technical advancements thanks to PQS TPPs include remote temperature monitoring devices, and solar power energy harvesting capabilities. Both of these advances answer current needs of product technicians and other health centre staff, reinforcing abilities to deliver reliable vaccination services. Five minutes to fruitful feedback! So, calling all product users and product manufacturers to help improve performance and drive innovation of immunization products and devices! Tell us about any product defects as they happen, and take a moment to imagine your dream-features for any PQS products: submit your feedback with this simple form: http://apps.who.int/immunization_standards/vaccine_quality/pqs_catalogue/feedbackform.aspx or click the link and bookmark the feedback form today!  

Drones for Health, exploring immunization supply chain solutions in DRC

Dear TechNet Community, I have an exciting milestone to share on behalf of the VillageReach Drones for Health team: Since 2015, VillageReach has collaborated with stakeholders at local, regional and global levels to support supply chain solutions, including exploring the use of unmanned aircraft systems (UAS) for health to speed up deliveries and to reduce costs in logistically challenging, low-resource environments. In the Democratic Republic of Congo (DRC), we are working with the Government and Gavi on a phased approach to test and integrate drones into the existing immunization supply chain in Équateur, a large and logistically challenging province in northwestern DRC. The aim is to integrate a new transportation solution to supply vaccines more quickly and efficiently to the most inaccessible health centres in the province. VillageReach with Swoop Aero, national and provincial government stakeholders in DRC hit an exciting milestone – repeated, safe transport of vaccines and other products, via drone, in Equateur province. In summer 2019, Swoop Aero conducted a series of test and demonstration drone flights to deliver vaccines, syringes, medicines and other supplies from Mbandaka town to the village of Widjifake, which is 3 hours away by road, but 20 minutes by drone. Flights were conducted across the Congo River, forests and the populated area of Mbandaka. In just 5 days, Swoop’s drones conducted 50 flights to and from the health centre, covering a total of 2000 km in the air and transporting over 25 kg of health products for Widjifake and three other neighbouring health centres. The results from DRC will help to inform programming and decision making regarding the next phase, including the integration of UAVs in the routine vaccine transport system to deliver immunization products in the Équateur. Through collaboration with governments, the private sector and non-governmental organizations, VillageReach is an expert in managing proof-of-concept flights that can further guide the decision to invest in the implementation of integrated supply chains. I welcome and feedback or questions from those who are working with or interested in using drones for immunization delivery. If you would like any more information, do not hesitate to reach out. Best, Gabriella Ailstock VillageReach, Drones for Health Team https://www.villagereach.org/work/drones-for-health/

Continued Medical Education Workshop for sensitizing on Tuberculin Skin Test

Dear viewers in view of the following context we [KVG team] wish share the attached. Context: The Union Government has rolled out a programme for universal screening of an estimated 250 million children and adolescents below 18 years annually for Leprosy and Tuberculosis (TB) and put on treatment if required. TB kills an estimated 4.8 lakh Indians (sharing 31% of global TB deaths) every year [>1,400 every day]. India has highest TB burden (27% of the world) with more than a million ‘missing’ cases every year that are not notified – either undiagnosed, unaccountable, inadequately diagnosed and treated in the private sector. (https://indianexpress.com/article/india/govt-rolls-out-scheme-to-screen-all-children-below-18-for-leprosy-tb-5943004/ accessed on 06-09-2019). In this regard Manotux test [TST] has a definite role. Tuberculin Skin Test (TST) is a simple and reasonably reliable method for the detection of infection by Mycobacterium tuberculosis. It is a diagnostic aid for corroborating with clinical findings though not a confirmatory test. Quote: It has to be approached “with respect, administered with care, read with deliberation and interpreted with sentient discrimination.” All the 8 rights to be observed before / while and after administering vaccines are applicable to Tuberculin also plus 2 more: a) Do’s and Don’ts for the patient during the reactogenic period; b) reading the test between 48 and 72 hours without fail. In almost all Medical Colleges visited in 4 states, tuberculin manufactured by “arkray” with different strengths is used: viz. 1TU, 2TU, 5TU and 10TU RT23 in 0.1mL, 5mL per vial providing 50 ID doses of 0.1mL each. Though the test is in practice since 1907, many programmatic errors in various permutation combinations were observed in different thematic areas of administering / reading TST.  What we did: Charity should begin at home. We established nursing station for administering tuberculin skin test in he dedicated vaccination clinic in KVG Medical College. Developed a Supportive Supervision checklist as per CDC and RNTCP guidelines, used the same in the capacity building of testers and the officers in various Medical Colleges. Regularly shared the observations with DTF, STF, ZTF and NTF. We appraised the visitors to our college. As directed by the State Task Force, in collaboration with DTO, conducted training workshops to the Matron, testers of Medical Colleges of home district at the “Demo-site” of KVG Medical College. As directed by STF, experiences of training workshop presented in the STF meeting at State Institute of Health and Family Welfare on 7th June 2019. Way forward: Conducting similar CMEW in all the Medical Colleges of Karnataka for sensitization followed by intensive training of testers in small batches at the “Demo-site” in KVG Medical College. Acknowledgement: Thanks to the supporters of End TB programme. Please find the attached for additional inputs from the viewers. with regards Holla n team      

Information System Analyst Consultancy

The Comprehensive Family Immunization Unit (FPL/IM) at the Pan American Health Organization, (PAHO/WHO) is looking to hire a Systems Analyst/ company that will gather systems requirements for the development of a regional web-based solution to collect, analyze and consolidate case-based data from all geographic levels for surveillance of vaccine-preventable diseases and that it meets the needs of various type users at regional, national and sub-national level. The candidate should have proven experience in writing technical requirement and presenting to vendors. The incumbent should perform interviews to stakeholders in Washington, DC, as well in some countries. In addition, the consultant should lead on an international workshop with countries users to consolidate requirements. The documentation should be written in English. The consultant require to communicate with Spanish speakers. The length of the consultancy is 4 months. See attached TOR If interested, please send your CV to ortizcla@paho.org ;ojedapao@paho.org. 

Immunization Supply Chain Leadership Webinar Series

See the attached announcement for details on the upcoming webinar series. Register in advance for the Strategic Planning for Immunization Supply Chain webinar on September 17th using this link: https://jsi.zoom.us/webinar/register/WN_ZC6udeUSREuv-2kvxTNX1w After registering, you will receive a confirmation email containing information about joining the webinar. A link to register for each subsequent webinar will be emailed to you in advance of each webinar. Please address any questions to Barbara Lamphere at barbara_birch_lamphere@jsi.com.

Telemedicine and Teleeducation Strategies from the community base: The experience of TulaSalud in Guatemala.

Dear colleagues We have a new post in our blog and we appreciate your reading, feedback and dissemination in your networks.  Abastract
Isabel Lobos and Noé Quiroa share the experience of TulaSalud in Guatemala and tell us how intervention in community context using digital health strategies has contributed to the reduction of maternal mortality in places where it has been implemented, demonstrating that planning and design of solutions, including community-based experiences, could have a great impact for prevention and timely care of morbidity and mortality in rural, indigenous and excluded areas in low-income countries. Ful blog post: http://bit.ly/2LfLL8Z The original language of post is Spanish but you can also read in English, French and Portuguese, using the option "Idiomas" located in up-right position of our Web Site. Thanks and best regards Daniel Otzoy

WHO Guidelines on the international packaging and shipping of vaccine

Dear Sir/Madam, Kindly be informed that the revised Guidelines on the international packaging and shipping of vaccines has been published on the WHO website for public consultation. https://www.who.int/immunization_standards/vaccine_quality/vaccines_packaging_guidelines2019/en/ We would appreciate your comments not later than 30 September 2019. Thank you and best regards,

Learning's from Duelist PHC Kollamogru

Dear viewers The following illustration emphasizes the importance of keeping vaccination data up to date on a regular basis and to explore the measures to promote EIR.  PHC Kollamogru is one of the 3 planning units attached to KVG Medical College Sullia located in the interior hilly area with sparse population, rich with forest, rubber plantation, coconut trees, plantains etc. It has a population of 9692, five sub-centers, an estimated 130 pregnant women, 117 below one year children [birth rate 12/1000 per year], 521 under five years residing in 2084 houses  [child house ratio of 0.25  & people @4.6 per house]. This PHC is enumerating / line listing vaccination data in the “Extended Immunogram” since April 2013 coinciding with introduction of Pentavalent in the National Immunization Schedule [NIS]. Proactively, on updating vaccination data as a routine, we prepared the duelist for the month of August 2019. With the introduction of RCH Portal, ANMs became busy in entering data to RCH portal, poor connectivity drastically retarded the process and resulted in the following: Provisional duelist had 62 children – 53% of annual target, about 10% more than Expected Due Children (EDC). [Calculating EDC: A child has to visit 5 times as per present NIS in India for completing FIC below one year and booster before 2nd year excluding newborn vaccination. i.e. 117×5=585 visits. 585÷12= ~49; 41.88% of annual target  of 117. Since vaccination is done once a month in the outreach and once a week at the PHC, EDC will be a little more than 42% of annual target]. On updating the data, the list got shortened to 47 by 24.2% [40.17% of annual target – more specific]. Data of 9 children (19.1%) yet to be fed to RCH portal hence not in Electronic Immunization Register [EIR]. EIR has ~20% less data than in manual register. On 29th August 2019 dose wise mobilization of children is given in the table below: Dose 1st dose 2nd dose 3rd dose MR1 Booster MR2 Total FIC   Due in Aug 7 9 3 10 24 53 10 Vaccinated in Aug 4 8 3 8 10 33 8 Following is the table with dose wise due children prepared on updating the data in the Extended Immunogram master register at the PHC for the month of September 2019. We wish to study the proportion of mobilization Dose 1st dose 2nd dose 3rd dose MR1 Booster MR2 Total FIC   Due in Sep 10 10 7 6 23 56   Vaccinated in Sep               In this list 15 children of 56 (26.78%) are yet to be entered in to RCH portal. At any given time, in the existing situation and process, EIR is having about 25% less data than actual and hence the indicators are not reliable for performance review to guide the programme. So what: An expert team has to genuinely study and explore as to how to make the RCH Portal very useful for the grass root level workers and managers at all levels. All PHCs can easily replicate Kollamogru model. best wishes Holla n Team  


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