TechNet-21 - Forum

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  1. Souleymane Koné
  2. Programme management
  3. Wednesday, 20 January 2016

Abstract from an article written by our EPI Ghana team. Comments are welcome!

For the full article please go to:

Background: WHO and UNICEF supported Ghana to conduct Effective Vaccine Management (EVM) assessments in September 2010 and October 2014 respectively with the view to strengthening vaccine and logistics management for immunization at all levels in the country. In both assessments, temperature monitoring, which is a critical indicator for vaccine potency and immunization programme effectiveness, got very low scores of 50% (2010) and 67% (2014) respectively at the national level and even lower at the regional level. The low scores of temperature monitoring at the national and regional levels in both assessments generated concern and interest for review of the results of the two assessments to determine some of the contributing factors considering Ghana’s advancement in immunization with support of the Gavi Alliance and also with twelve antigens in the routine immunization programme.

Objective: The main objective of the review was to determine causes of the poor performance of the temperature monitoring and to devise strategies to improve on it.

Methods: Desk review of relevant documents including 2010 and 2014 EVM assessment reports, the report of the 2012 comprehensive EPI Review and the status of implementation of recommendations of the 2010 EVM assessment and the 2012 EPI Review was conducted.

Results: The documents review revealed that the 2010 EVM assessment and the 2012 EPI Review recommended installation of continuous electronic temperature monitoring devices in the national and regional vaccine stores but it has not been implemented. The same recommendation has again been made from the 2014 EVM assessment.

Conclusions: There was no significant improvement in the scores of temperature monitoring between the 2010 (50%) and 2014 (67%) assessment because of the failure of the Immunization Programme to implement the recommendations of the previous assessment (2010) and the EPI Review (2012) which called for installation of the continuous electronic temperature monitoring devices in the national and regional vaccine stores. Not until the continuous electronic temperature monitoring devices are installed, the scores of temperature monitoring will forever remain low in any future assessment. The question is why use limited resources to conduct EVM assessment if the recommendations to address key challenges of the immunization programme are not to be implemented? Countries conducting EVM in future should make plans to implement the recommendations from the outcome. This is the only way there can be improvement in the immunization programme. Periodic EVM assessment is essential to keep the supply chain system at the required standard.

Keywords: Effective Vaccine Management (EVM); EPI; Temperature monitoring; Ghana

John Lloyd Accepted Answer
This interesting discussion reveals some weaknesses in EVM but recognises it’s strengths as a supply chain evaluation tool. The news of the current revision of the tool (Ver.2.0) and the way it is used are welcome. But I ask whether we are tackling the EVM needs with a broad enough consultation and as a systematic review of efforts to evaluate and monitor the Supply Chain. EVM is a large and complex tool that was developed with energy and significant resources. As we set off again to revise it we should know the opinions of the users and be confident that the changes are the best ones for the whole system. Do we have such a review and synthesis of EVM in the context of the multiple evaluation and monitoring tools? For example, what do we know of the usefulness of DVD-MT? How do the various management performance indicators developed in the last year fit with the evaluation parameters? Finally, do we have a clear roadmap to introduce rational equipment inventories for SC planning that are updated by managerial transactions, not periodic surveys? We are fortunate that the EVM evaluations are so widely used and that so many efforts are under way to develop supply chain monitoring. Might we not take a step aside and assess what seems to be working well and what we want to see generically in the future? John Lloyd, France
  1. more than a month ago
  2. Programme management
  3. # 1
Boubacar Dieng Accepted Answer

This is very interesting.

I think the EVMA has put a step forward for improving the quality of the CC but the implementation has not been supported as the intervention was by GAVI.

If, in practice, the countries know that a condition is made for monitoring the implementation plan linked to the release of funds by installment then they will do all necessary actions to be up to date and make sure they are not missing the funding opportunity.

The EVM is a quality control measure and has to be continued to make sure that the vaccine administered is at good quality for getting the needed immunity for the child/community.

I think, there is a need to revisit the recommendations and make them more concise for the seek of the implementation which has to be made not beyond two years.

Good discussion

  1. more than a month ago
  2. Programme management
  3. # 2
Patrick Lydon Accepted Answer

Dr. Karan makes a great point. The EVM in many countries was becoming a tick-box exercise. The incentives for Gavi countries especially, was simply a hoop to jump through in order to get Gavi funds for new vaccines or health systems strengthening. The ownership of the process at country level was limited and it was difficult to track improvements. That being said, things are slowly beginning to change. In response to these mounting concerns and convinced by the need to build on the successes the EVM Initiative, WHO and UNICEF have intensified their collaboration in 2015 and united around a joint multi-year workplan resourced by the Bill and Melinda Gates Foundation and the Vaccine Alliance (Gavi). The centrepiece of this collaboration is the implementation of a four-step strategy for continuous immunization supply chain improvements, optimization and innovation in countries. This new comprehensive approach to EVM (or cEVM) and renewed technical assistance framework will ultimately lead to immunization supply chains that are:

  1. Designed to maximize efficiency, effectiveness, agility and responsiveness to the needs of today’s and tomorrow’s immunization programmes;
  2. Robust enough to continually adapt to and comply with WHO and UNICEF recommended vaccine management standards and policies;
  3. Adopting known cost-effective technological and systems solutions that support coverage and equity improvement objectives;
  4. Operated by skilled health care workers managing the supply chain with key performance indicators;
  5. Adequately funded using health system strengthening resources.

A joint statement from WHO/UNICEF will soon be released that will describe in more detail the revised approach to EVM that we hope, will address the concerns raised by Dr. Karan. Watch this space!

  1. more than a month ago
  2. Programme management
  3. # 3

Do we need EVM, Yes we do. It is an opportunity to have an independent overview of the functioning of the LSCM in the country. But the bigger question still remian, how to implement the recommendations from these studies. The major issue is the ownership of the excercise by the countries. It appears that EVM are becoming a tick the box excercise for program managers as they are one of the requirement for getting funding support for new vaccine introduction. The results are hardly made available to the real DECISION MAKERS in the country and the EPI manager struggle to get the right resources for implementing the recommendations. We may need to change our approach of disseminating results of this excercise, which can play an important role in deciding the CC, LSCM needs of the country over a period of time. The ICC has to take up the ownership of the results and get the needed resources (but again the ICC are weak in many countrie, and it is a different question on how to make these bodies functional). The ministries of health and finance have to be engaged at highest levels before starting any of these excercises so that they can lobby for resources which will be needed post these excercises.

  1. more than a month ago
  2. Programme management
  3. # 4
Alex Accepted Answer

This is a great question. As for any report that is produced, we might want to ask ourselves a critical question: Do stakeholders and policy makers with a strong level of influence read it? Moreover, is the report understandable for non technical readers? Do we have global, regional and maybe more important country communications and advocacy strategies in place?

  1. more than a month ago
  2. Programme management
  3. # 5

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