Dear TechNet21members, This is a call for your help and participation! In November 2009, The Cold Chain and Logistics Taskforce held a workshop to reach a consensus on the approach and key actions needed to address CCL needs. The Guidance Subgroup of the CCL Taskforce was tasked with "collecting and reviewing available guidance to identify overlaps, conflicts and areas where new guidance is needed or current guidance requires updates based on new developments." A large number of guidance resources exist in WHO, UNICEF and elsewhere covering cold chain and logistics (manuals, tools, assessments, reports). We need your help to ensure that right cold chain (CCL) guidance is available at the right level, in user-friendly formats to the managers and health officers who need them. You are invited to share your comments, cold chain logistics guidance materials with Kate Bai ([email@example.com]firstname.lastname@example.org[/email]), especially on the following key areas: a) Please review the draft report on guidance (attached file: Draft Report Review CCL Guidance 1.doc) and tell us if you agree with the analysis and suggested approach for mapping the guidance b) Please look at the spreadsheet that in the first tab maps the CCL roles/functions, and in the second lists the key guidance documents, and tell us:; (See attached file: Cold Chain Logistics Mapping.xls) - What roles/functions we have missed, and what could be better summarized - Any key guidance documents that we have not included; and any that you suggest removing as not being relevant (or out-of-date)c) Please send us good country examples of effective use of guidance, including your thoughts on how best to disseminate guidance d) Are there any relev! ant questions* you would like answered in relation to the CCL guidance? *Below are some of the most frequently asked questions in countries: Which tools/resources do you recommend for.... - cold chain assessment to prepare the country for new vaccines introduction? - inventory of cold chain equipment? the maintenance/upgrade plan for the equipment? - documenting successful experiences, etc, with solar fridges - training all staff in vaccine management? - How can we find the consultants for cold chain and logistics evaluation and support? - When is the best time for an EVM evaluation? There will be a workshop 19-21 October 2010 in UNICEF New York to identify the best and most up-to-date guidance materials, and also identify gaps and areas of controversy that need to be resolved. The workshop will conclude with a plan for dissemination. We need your thoughts and ideas to prepare for that workshop! Many ! thanks for your valuable assistance. We will be sure to report back to you through TechNet21 on the outcome of the meeting that will include all your thoughts and comments. Best, Kate Eun-Hee Bai (UNICEF New York) ##text## ##text##
TechNet-21 - Forum
This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
Excellent point. It may be worth scanning or digitalizing the manual from Zimbabwe for all of us to see. Kits have been discussed recently in a Solution Exchange e-discussion. Supply in a top down or "push" mode results in a degree of apathy at the grassroots. As Mogens says- unless there is an emergency (or an "immunization drive" like Pulse Polio) the vaccine or product that is pushed lies around (in the "pipeline" or expires. While supplies may need to be pushed through the pipeline- it is unproductive to push any item (eg needle cutters or black bags) that is not yet a felt need at the service point. Private agencies and some international groups always have a mobilization and/ or orientation campaign when bringing in a new product. But there are older items (Cetrimide Powder in the RCH Kits) which are mysteries to the field staff. So an indent system helps to let the central planners know what is being used. A purely 'push" system is very wasteful of resources- money, time and material). Prabir
8.10.2010 Dear Technet Editor, I would like to respond to the latest TechNet21 note (Issue 72, dt. 5.10.2010), where Mr. Osman Mansoor calls for participation/guidance on developing the CCL system, but also where Rebeca Field and Robert Steinglass point out that common management problems are much more important now that the vaccines are becoming very expensive (some vaccines costing several dollars per shot!). Rebecca's and Robert's observations were in the back of my mind, when I went through the extensive speadsheet list of key guidance documents available, as per the mapping exercise done by the Cold Chain and Logistics Taskforce. I thus have the following observation in response to Mr. Osman Mansoor's call: As reflected in the spread sheet list, WHO published in 2006 a manual (with electronic software) for proper stock management at primary and intermediary levels, but not for use at the health center level. The WHO manual explains correctly two different kinds of distribution systems: the pull and the push system. Pull system: A distribution system in which the personnel who receive the supplies, determine the quantities to order. Also called as “requisition” system. Push system: A distribution system in which the personnel who issue the supplies, determine the quantities to be issued. Also called an “allocation” system. In the following I presume that in the pull system the "receiver" is the health clinic, i.e. the end user. However, here is the point that I want to make: I cannot find in the above spreadsheet list any manual that describes how to design, implement and train on a simple stock management system suitable and simple enough for use in a pull system at a health center. Such a simple system will be required, when and if it is realized that in order to order correctly (thus avoiding over- and/or under stocking) a stock management system is also required for use by the health center when requisitiong and ordering very costly vaccines by the pull system. The WHO manual mentioned above describes a system suitable only for primary and intermediary levels, as correctly mentioned by the authors, but it is obviously too "heavy" for use by a health center. The WHO approach is thus a top-down one, excluding the end-user level. But a pull system requires that the end-user level is incoroporated. This was done in the Zinbabwe Essential Drugs Program (ZEDAP) in the late 1980s and all 1990s for drugs. Logistically drugs are not different from vaccines. The number of items stocked in an EPI program is typically anything between 30-50. The ZEDAP experience can therefore in my opinion be used as an example. I was fortunate enough to work in the ZEDAP program where training of nurses in simple stock mangement was implemented. The duration of a training course that would take nurses up to the level of being able to go home to their health center and implement a stock management system for ordering, storing and receiving correctly about 150 medical supply items, was one week. A manual was developed as the result of many years work on training of literally thousinds of nurses in Zimbabwe . The manual is therefore in its present shape the results gained from running innumerable training workshops, rewriting the manual several times, and emphazising the essentials and leaving out the unnecesary stuff. I still have copies of the manual developed, if Mr. Osman Mansoor (and/or others) is interested. Below please find a short description of the content: 1. Introduction. 2. How to organize a medical supply store. 3. Stock control. 4. How supplies are ordered. 5. How supplies are stored. 6. What to do, if the intermediary and/or primary level stores are out of stock for an item. 6. Short dated and expired drugs. 8. Issuing drugs. To repeat my point: vaccinec stock management systems for the end user level is required in a pull system. The push system mentioned in the WHO manual is normally only used in a country with no functioning infrastructure, as a consequence of for exampel an emergency. Kits of drugs are distributed. However, typically the health centers end up with too much of some drug itgems and far too little of others. Push systems are therefore abandoned often abandoned very quickly. Best regards, Mogens
Dear Faisal You raise some important issues that need guidance; however, the aim of the Guidance Workshop is more to map the existing guidance according to specific tasks that are needed in the CCL system. What we are seeking to get comments from is the structured approach in the report, and the list of tasks/functions for which we aim to identify the best guidance (the key guidance documents are in the report). Are there any other key documents that we should be including for review? We are particularly seeking country materials such as policies, SOPs, job-aids, etc. Are there any other tasks that are important that have not been included? Thanks Oz
Dear Moderator Kindly add one more comment, this is in relation to the areas which have outside temperatures as low as -30C. These are very poor areas and they have hardly any resources to keep the vaccine storage rooms warm. They tend to put blankets on the ILRs which has no effect. The result is a lot of vaccine is wasted by getting frozen. Out reach activities are impossible to carry. We need to come up with a policy or with equipment that can withhold such extremes of temperatures. The other alteranative could be to halt any vaccination activities for 6 months in these areas and keep all vaccines and diluents in the warmer areas and then do extensive catch ups and out reach/mobile activities in the rest of the 6 months. This is feasible logistically, humanly and supplies wise. This should come as a WHO policy. Pl I have one suggestion on a different topic for which I need comments from experts, In Polio Eradication programs, the Non Polio Entero virus rates in the stool specimens is taken as a proxy indicator of adequate stools and effective reverse cold chain. This indicator becomes all the more important in areas which have 0 polio cases. Now there are areas with in these regions which show very low NPEV rates doubting their reverse cold chain, can we use empty polio vaccine vial with 0 stage VVM in these stool carriers as our monitors of reverse cold chain and their status can be noted by the recieving Labs. If this is possible this could be an effective effecient and logical means of monitoring reverse cold chain. Best regards Dr. Faisal Mansoor Sr. Epidemiologist/National Program Manager NICP-Islamabad. Pakistan mobile +923335254085 office 0092519255780 fax 0092519255710 Residence 0092514415494
Dear Moderator Thanks for sharig the tool. I humbly would like to share my views for consideration, this comes from my experience as EPI Deputy manager and as Focal Person for H1N1 Vaccine in Pakistan Requisitioning: We have been lucky to have support from Jica in our vaccine stock management capacity building. Cascade trainings have been carried out up to the subdistrict level to teach them the concept of Average monthly consumption(AMC), then combining it with factors such as store capacity, frequency of stock orders, regularity of supplies, human resource, buffer stock period etc, we calculate Maximum stock levels and minimum stock levels. Now the requisitioning is based on Max.stock minus the available stock to always keep the stocks between the Max and Minimum levels. Infrastructure: Again using the Japanese 5S concept, we can keep the infrastructure going for years. The 5S are, Sort; our stores are cramped with all kinds of junks. Sorting means separating the useful from unuseful stuff Set; organise the stores in to various compartments, put Bin cards to show the identities Shine: Clean the stores every morning to look spic and span Standardize: Put up written SOPs to ensure the upper three Ss Sustain: Supervise and monitor to sustain the gains so achieved. 3. Fianace: The Budget needs to be ensured for all CCL activities in any EPI plan. This line needs to be added. Pl pass it on Dr Osman Mansoor Best regards Dr. Faisal Mansoor Sr. Epidemiologist/National Program Manager NICP-Islamabad. Pakistan mobile +923335254085 office 0092519255780 fax 0092519255710 Residence 0092514415494
Dear TechNet community Your participatin in this process of developing guidance will be very much appreciated. I post now a 'workflow' of all the tasks and actors in the CCL system for your review and inputs. Dr Osman David Mansoor  Public Health PhysicianSenior Adviser EPI (New Vaccines) United Nations Children's Fund  3 UNPlaza, New York, NY 10017 (room 840)Phone: +1 212 326 7410 (direct) Fax: +1 212 8246460Email: [email@example.com]firstname.lastname@example.org[/email] (image: file:///Users/osmanmansoor/Library/Caches/TemporaryItems/moz-screenshot-1.png)(image: file:///Users/osmanmansoor/Library/Caches/TemporaryItems/moz-screenshot-2.png) (image: file:///Users/osmanmansoor/Library/Caches/TemporaryItems/moz-screenshot.png) ##text##
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