Dear TechNet community, Poor power conditions are a major challenge to maintaining the vaccine cold chain in many LMICs, necessitating the development of specialized CCE such as ILRs and SDD refrigerators to help keep vaccines at safe temperatures in areas with limited or no mains power.  Even in places with an electrical grid connection or a generator, intermittent power can lead to ILRs running out of holdover, and erratic voltages can damage many types of medical devices and equipment. Despite these well-known issues, to date, data on power conditions in LMIC health facilities have been largely anecdotal or small-scale, which impedes evidence-based policymaking.  To quantify power availability and quality challenges, Global Good – in close partnership with Nigeria’s National Primary Health Care Development Agency (NPHCDA) and Kenya’s National Vaccines and Immunization Program (NVIP) – has compiled an analysis of mains power data reported over nearly 18 months by WHO-prequalified ILRs operating in health facilities across Nigeria and Kenya.  We are sharing this analysis in hopes of informing tangible improvements in both the performance and reliability of mains-powered CCE, as well as other priority medical devices and equipment utilized in health facilities within LMICs.

This analysis, co-authored by NPHCDA and NVIP officials, is based on approximately 96,000 facility-days of mains power data collected over a nearly 18-month period from ILRs operating in more than 300 health facilities spanning both countries.  These power data and other information collected by the ILRs belong to the respective countries; Global Good has been granted access to the data to enable collaboration with pertinent national and global stakeholders on tools to better utilize CCE data and make it actionable.  This overview of grid quality realities on the ground shows that multi-day interruptions are common, and that proper protection for medical equipment is essential given the widely varying line voltages experienced at most health facilities.   The initial analysis in this paper focuses on general power availability and quality at health facilities, with a few specific implications for CCE at those facilities including: 68% of the monitored devices in Kenya and 92% of those in Nigeria experienced power outages in excess of 48 hours. Therefore, long holdover times provide additional safety, even at those facilities with generally reliable mains power. Voltages fluctuate significantly, and stabilization can increase the ‘usable power’ availability at many health facilities – only 32% of the devices in Nigeria had access to in-range power (i.e., within 10% of nominal voltage) more than 30% of the time. However, with PQS-defined extended range voltage stabilization (i.e., 110 to 278 V), 58% of devices would have access to ‘usable power’ more than 30% of the time. Damaging high voltage events are common and can persist for hours or days – the graphs below show example voltage profiles from Kenya and Nigeria that would require protection between the socket and CCE (or other medical devices and equipment) to prevent damage to the electronic controls over time. These traces show data measured every 10 seconds, illustrating sustained voltages both above 400 V and below 100 V, and rapid fluctuations in and out of the CCE’s usable voltage range. Additional graphics and discussion are in the full document, and Global Good will continue analyzing data and sharing conclusions as more information is collected.  We hope this analysis will prove valuable for specifications- and standards-setting bodies, equipment designers and equipment purchasers, and we look forward to a vibrant discussion with the TechNet-21 community via this forum. We wish to acknowledge and extend our sincere appreciation to NPHCDA and NVIP for supporting and co-authoring this analysis.  We also want to acknowledge Qingdao Aucma Global Medical Co. for producing the WHO-prequalified ILRs that collected the study data, and eHealth Africa, Caroga Pharma Kenya Ltd, and Fenlab Ltd. for installation and service support in the two countries. The document is also availble here: http://power.2to8.cc/Power_Quality_Challenges_In_Low_Resource_Settings_2019.pdf    Best regards, Jenny Hu Senior Engineering Lead Global Good

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: http://www.who.int/gho/health_equity/assessment_toolkit/en/ To read more about this, please see attachment.

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. Thanks, Celina, on behalf of the BID Initiative team  

A new report has been released that updates information on the occurrence of home-based record (e.g, vaccination cards, child health books) stock-outs. The open access article can be accessed online, and is also attached here. Similar to vaccine stock-outs, disruptions in the supply chain of home-based records (HBRs) are avoidable events that create inefficiencies for immunization service delivery. Several key words there: DISRUPTIONS, AVOIDABLE, INEFFICIENCIES. Following a review of data on HBR stock-outs reported by national immunization programmes, the new report highlights several important themes. First, many programmes confront on-going challenges with ensuring the availability of a durable HBRs in the right place, at the right time and in the right quantity. In 2016, 29 countries reported a national-level HBR stock-out, more than in 2015 or 2014. Second, some programmes appear to not have mechanisms in place to monitor and track the HBR supply chain. During 2016, one-third of countries reporting to WHO failed to report whether a stock-out did or did not occur. Whether countries lack this information; have the information, but not in a readily accessible form for reporting; or are choosing not to report information on supply levels when information exists is unclear. And lastly, HBR financing and printing are complex processes that often involve the national immunization programme and its many partners. In 2016, 44 countries reported two or more HBR funding sources and 22 countries shared responsibility for printing HBRs. It is very possible that these complex financing arrangements may be associated with the occurrence of HBR stock-outs. Immunization programmes are encouraged to take time to evaluate their HBR system along with their partners in the Ministry of Health if immunization and nutrition along with other maternal and/or child health programmes share responsibility. Resources from a prior workshop are available to help guide the evaluation. Let's work together to critically assess the HBR system in each of our countries and identify and implement appropriate, sustainable solutions.

Greetings:   What is the potential and actual role of telehealth for EPI?   Telenetdoctor.com has designed a program that measures the monitoring and preventive care applications between physicians and patients/children.   Appreciate your reply.   Lawrence    

Dear viewers  All of us are witnessing rapid multidimensional growth of routine immunization in the current decade. Keeping pace with the rapidly expanding / frequently changing schedule itself is a challenge faced by the service providers, more so in the private sector. Pilot study revealed dangerously poor operational knowledge among the Medicos who are the current and would-be programme managers at various levels. This is conspicuously accentuated by the absence of an uniform vaccination schedule and vaccines with no Vaccine Vial Monitor (VVM) in the private sector. We collected vaccination record cards of various private institutions, including Medical Colleges, providing vaccination services and found that no two vaccination cards are mutually matching either with IAP schedule or with National Immunization Schedule (NIS), whether essential vaccines of NIS or optional vaccines. This is creating divided opinion in the community and the caretakers generally have lot of faith and strongly believe what they were advised by the super specialists in the super specialty hospitals at the time of giving birth and insist administration of vaccines as per the vaccination card they have from the private Institution. India gives birth to ~2.7 core (27 million/270 Lakhs) live infants in a year. Even if 10% avail services from the private sector, absolute number is ~27 Lakhs per year in the country. Most of these children are from APL families (Above Poverty Line) – especially of Doctors / Nurses / Engineers / community leaders and the like who are deprived of receiving vaccines with known potency indirectly depicted by the VVM free of cost from the government. Though eligible, many are deprived of Mother and Child Protection Card [Tayi-card] in Karnataka and the vaccination data are not shared with the Government, even on sharing it cannot be “MCTiSed” = uploading to MCTS and making online. Please find the attached with only 3 examples though this number is more than a million for the whole country. This is beyond the scope of “Intensified Mission Immunization (IMI)” as of now. RI should become “peoples’ movement” as aptly iterated by the Honorable Prime Minister, which can address some of these issues to a large extent.           Solutions are with us – the deep lovers of RI, promoters of child health. Shelling out “my-self” from the “APATHY” itself is the first simplest and biggest step followed by empathy for the birthing children / future generation. Doing right things properly at the right time and by the authorized persons itself are the easiest and the most gratifying social service in any field, more so in medical field, that too vaccination – providing quality life-saving services to the newborns and the children. best wishes Holla and the team

This is the fourth topic in my six-part Vaccine Supply Chain Futures series (Please see the attached file for the full text)  focused on the introduction of a system of remote temperature monitoring integrated with equipment maintenance management. Remote temperature monitoring systems represent an opportunity for a system-wide improvement in the performance of equipment maintenance and consequently, more reliable vaccine distribution. Remote temperature monitoring automatically transmits data to a central server where it is analysed and disseminated to managers. This is a significant step forward compared to stand-alone temperature recording in each refrigerator. It replaces manual recording and paper reporting systems that have always suffered from lack of compliance and inaccuracy due to incomplete, delayed and faulty data aggregation. Remote Temperature Monitoring is a means to: Supervise health facilities to maintain correct storage temperatures, Track the efficiency of equipment maintenance at local level, Country wide data on the performance in use of each model will inform the choice of equipment for procurement to maximize reliability, Suitably anonymous versions of the country data will be used at international level to inform equipment manufacturers and regulatory experts on the rates of failure and their principal causes. Please reply to this post with your views and I would be grateful if you could answer just four questions in this SurveyMonkey: https://www.surveymonkey.com/r/L38J79Q I will return the analysis to you at the end of this week and the results will be posted before the TechNet Conference for all five topics. Please see the attached file for the full text. Thank you! 

Improving supply chain data visibility and data use are showing real impact in Tanzania's integrated logistics system. A study has just been published in the peer-reviewed journal Global Health: Science and Practice Global Health: Science and Practice Advance Access articles for September 6, 2017 Original Article Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects Marasi Mwencha, James E Rosen, Cary Spisak, Noel Watson, Noela Kisoka, Happiness Mberesero Abstract | Full Text (PDF) Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs.

Dear viewers Attaining and sustaining very high vaccination coverage is the basic dream of RI lovers of any country to promote child health. An ambitious flagship project "Mission Indradhanush" was launched by India on 25th Dec 2014 with similar dream.  Now, Urban area of Belagavi District will be operating "INTENSIFIED  MISSION INDRADHANUSH (IMI)" from Oct 2017. The district nodal officer on witnessing the dramatic increase and sustenance of immunization coverage (Christmas gift; Peraje Template; Immunogram study; Chikkaballapur Pilot project; Operation SiGMA; MISS Sampaje) and the recommendation by the district supervisor, 2 days training programme was held in the LHV training centre. In this, the participants were oriented as to how to use "EXTENDED  IMMUNOGRAM" as complementary tool in achieving the objectives of Mission Indradhanush. This tool provdes the A) 2 key elements -- IMI Specific Microplan & IMI specific, MCTS theme based highly sensitive / specific duelist B) non ambiguous denominators, scope to record the numerator against the denominator to obtain the critical indicators of IMI. A brief training report is attached for sharing. Hope we will succeed in this endeavor. IMI Team of Belagavi Holla and others        

We are trying to contribute bringing the equity focus on immunisation to the forefront of international and national health policies. In a recent overview of systematic reviews we have been able to identify a large body of evidence on imbalances in access to vaccination according to equity attributes. Yet, the evidence on how to overcome those imbalances and achieve a fairer distribution of health care resources remains astonishingly meagre. Additionally, certain attributes (i.e. religion and minorities, such as those defined by sexual orientation) remain heavily unexplored. Please, help us to build awareness on the need to research on what works to revert the unjust distribution of health care resources. Interested in further reading? Xavier Bosch-Capblanch, Meike Zuske, Christian Auer

Dear colleagues, The Interagency Supply Chain Group (ISG) comprising 15 global agencies, are actively involved in supporting supply chain efforts across all disease areas.The purpose of this group is to provide better coordinated and more effective support to country efforts in ensuring sustainable access to high quality essential health commodities. The group meets quarterly to address priority issues, with technical working groups established for specific focus areas. This includes opportunities to strengthen collaboration at the country level, and leverage institutional support around key technical issues. The ISG has recently published a two-page brochure - find attached - that summarizes a six-country review undertaken by the ISG Secretariat in Senegal, Ethiopia, Tanzania, Zambia, Nigeria and Myanmar earlier this year. The review focused on interagency collaboration in supply chains for essential medicines. For more details, please contact Hitesh Hurkchand of the RMNCH Strategy and Coordination Team at hhurkchand@unicef.org Kind regards, Hitesh Hitesh Hurkchand RMNCH Strategy and Coordination Team UNICEF, New York Phone: +1.212.326.7395 Mobile: +1.917.975.9743 Skype: hitesh_h

Dear TechNet-21 Members, we invite you to follow a moderated discussion just getting started on the International Association of Public Health Logisticians (IAPHL) listserve. You can join the IAHPL, follow the conversation, or sign up for emails here: https://knowledge-gateway.org/iaphl/ We hope you join the conversation! Kevin Pilz on behalf of the IAPHL Team ---------- Forwarded message ----------
From: Kevin Pilz
Date: 2016-10-21 4:38 GMT+02:00
Subject: [iaphl] Our Next Moderated Discussion: Using M&E to Drive Supply Chain Improvement
To: "International Association for Public Health Logisticians (IAPHL)" Dear IAPHL Members, We are happy to introduce the next Moderated Discussion – Using M&E to Drive Supply Chain Improvement. During the next several weeks, a collection of global experts will lead a discussion around how we can better use data from monitoring and evaluation to guide supply chain strategies, policies, decisions, and technical assistance. We are particularly excited because this discussion will directly inform and influence various global efforts, including developing harmonized metrics and universal definitions for key supply chain issues, updating major supply chain assessment tools, and informing approaches to supply chain improvement and strategic planning. The three topics will be: * People and process solutions for improved data-driven decision-making – moderated by Steven Harsono & Michael Krautman of the William Davidson Institute at the University of Michigan; * Using harmonized metrics and definitions to improve country supply chains – moderated by Hitesh Hurkchand of the RMNCH Trust Fund and Lisa Hedman of WHO; and * How can we ensure Supply Chain Assessments are relevant and useful for countries? – moderated by Patrick Lydon of WHO and Kevin Pilz of USAID. For each of these topics, the goal is for all of us to learn from each other and to share our experiences. We are excited to hear from all of you – you are the experts on what is happening in public health supply chains you work in. Now that we are 4,000 strong, let’s show it through this discussion! Special thanks to the experts who have volunteered their time to help plan the session and stimulate the conversation! Please see their bio’s below. We also want to note that introductory and summary emails will be translated to French – thanks to the USAID | DELIVER Project and the William Davidson Institute for that! Stay tuned for the kick-off email this weekend! Kevin Pilz on behalf of The IAPHL Team Biographies of Discussion Moderators: Steven Harsono - Senior Advisor, Healthcare Initiative, William Davidson Institute at the University of Michigan Steven Harsono is Senior Advisor for the Healthcare Initiative at the William Davidson Institute at the University of Michigan. He provides leadership and technical guidance for WDI’s work in improving healthcare supply chain performance in emerging economies. Over the last 10 years, Harsono has worked across the public and private sectors in over 20 countries. He draws on his diverse experiences working with the McDonald’s Corporation on the integration of its global supply chain, pharmaceutical companies improving pricing and access in emerging markets, and Ministries of Health seeking to transform their supply chains. Prior to joining WDI, he worked for Axios International, the Clinton Health Access Initiative, and HAVI Global Solutions. He holds a Bachelor’s degree in economics and international relations from Wheaton College in Illinois and is fluent in French and Bahasa Indonesia. Michael Krautmann - Senior Research Associate, William Davidson Institute at the University of Michigan As a Senior Research Associate for WDI's Healthcare Initiative, Michael has managed and supported a variety of applied research projects to improve health commodity supply chains and market dynamics. His work includes development of forecasting and performance measurement methodologies, supply chain design & modeling, financing policy development, and private sector engagement strategy. Prior to joining WDI, he worked for Lean Care Solutions, a U.S.- and Singapore-based healthcare technology startup. He also served as a Peace Corps volunteer in Zambia, where he helped evaluate clinic-level supply chain practices for a USAID-funded health supply chain project. Michael has Master and Bachelor’s degrees in industrial and operations engineering from the University of Michigan. Hitesh Hurkchand - Public Health Advisor, RMNCH Trust Fund (hosted by UNICEF). Hitesh Hurkchand has over 16 years of experience in international development with a focus on Global Health programs. His health systems experience includes medicines supply, health financing, governance, strategic information, health policy development, general management and capacity building. Hitesh is currently with the RMNCH Strategy and Coordination Team (SCT), a multi-agency secretariat (UNICEF, UNFPA and WHO) hosted by UNICEF in New York. Hitesh supports the implementation of the recommendations of the UN Commission on Life Saving Commodities and coordinates the Global Interagency Supply Chain Group (ISG), an informal group of fifteen development agencies. At the ISG, Hitesh’s role is to provide support, maintain communications and encourage alignment across different agency investments to bring greater impact to individual agency strategies at the global and country level. Some key highlights of the ISG include, an agreement on a set of fifteen key performance indicators for supply chain management, joint efforts to develop the Reproductive Health Traceability and Advisory Group, adoption of global data standards (GS1) to facilitate track and trace of health commodities and products. Hitesh is a native of South Africa! Lisa Hedman - Group Lead for Supply and Access to Medicines, World Health Organization Ms. Hedman is the Group Lead for Supply and Access to Medicines with the World Health Organization (Department of Essential Medicines and Pharmaceutical Policies in Geneva Switzerland). Her work covers leading strategies to advance scientific, regulatory, business and procurement strategies that impact the availability of quality essential medicines. Her experience includes access to medicines in emergencies, innovative supply agreements and procurement and supply strategies for large scale initiatives in multiple countries. Ms. Hedman’s background is in pharmaceutical and health care management. Prior to joining WHO, she also worked with PATH, other non-governmental agencies and donor agencies on procurement and supply chain management initiatives. Patrick Lydon - Technical Advisor, Supply Chain Optimization & Economics, World Health Organization Patrick Lydon has been working for the WHO within the Expanded Programme on Immunization (EPI) team for nearly 18 years. Between 2008-2012 Patrick was key member of project Optimize – a WHO and PATH collaboration on rethinking the vaccine supply chain for the future were he focused on supply chain innovations. With the close of project Optimize, Patrick’s work shifted to lead global partnership coordination on WHO strategies for strengthening immunization supply chain at country level (ex: the WHO/UNICEF Immunization Supply Chain Hub) and on the comprehensive approach to Effective Vaccine Management (EVM). In his spare time Patrick enjoys doing CrossFit, outdoor sports and having a beer on his boat when the weather is nice. Kevin Pilz – Senior Supply Chain Advisor, US Agency for International Development Kevin Pilz is a Senior Supply Chain Advisor at USAID headquarters in Washington, focused on improving access to family planning and reproductive health supplies. Kevin is currently part of the USAID team overseeing an award to Axios International to conduct a complete review and update of USAID’s National Supply Chain Assessment tool. Kevin's areas of expertise include supply chain strategy and implementation, monitoring and evaluation, capacity development, and donor coordination. Kevin previously worked in various other supply chain advisor positions at USAID and as a Senior Advisor to the Director of the Central Medical Stores in Mozambique. Kevin has a Ph.D. from Cornell University in the United States. ---------- Forwarded message ----------
From: Ellen Knowles
Date: 2016-10-21 4:38 GMT+02:00
Subject: [iaphl] Notre prochaine discussion modérée : L’utilisation du Suivi et Evaluation enfin d’améliorer la chaîne d’approvisionnement
To: "International Association for Public Health Logisticians (IAPHL)" Aux collègues de l’IAPHL : C’est un plaisir que nous introduisons notre prochaine discussion modérée : L’utilisation du Suivi et Evaluation enfin d’améliorer la chaîne d’approvisionnement. Pour les trois prochaines semaines, un groupe d’experts internationaux mèneront une discussion sur comment nous pouvons mieux utiliser les données du suivi et évaluation pour guider les stratégies, les politiques, les décisions, et l’appui technique dans la chaîne d’approvisionnement. Nous sommes enthousiastes car cette discussion informera directement et influencera les efforts globaux, y compris l’élaboration des métriques harmonisés et les définitions universelles pour les problèmes clefs de la chaîne d’approvisionnement, la mise à jour les principaux outils de l’évaluation de la chaîne d’approvisionnement, et informer les approches à l’amélioration de la chaîne d’approvisionnement et de la planification stratégique. Les trois sujets à discuter sont:
* Les personnes et les solutions de traitement pour l’amélioration de la prise de décision fondée sur des données : modéré par Steven Harsono et Michael Krautman de l’Institut de William Davidson à l’Université de Michigan. * Utilisation des métriques et définitions harmonisés pour améliorer les chaînes d’approvisionnement au niveau pays : modéré par Hitesh Hurkchand du RMNCH Trust Fund et Lisa Hedman de l’OMS. *Comment pouvons-nous assurer les évaluations de la chaîne d’approvisionnement sont pertinentes et utiles aux pays ? : modéré par Patrick Lydon de l’OMS et Kevin Pilz de l’USAID. Le but serait d’apprendre les uns des autres dans chaque sujet traité et pour que les membres partagent leurs expériences. Nous attendons avec enthousiasme une grande contribution de vous tous pour nous puissions apprendre de vous en tant qu’experts : en chaînes d’approvisionnement de la santé publique. Pour le moment l’IAPHL a 4,000 membres, montrons notre enthousiasme en participant à cette discussion ! Nous remercions particulièrement les experts qui ont offert leur temps pour préparer et organiser la discussion et à stimuler la conversation. Veuillez voir ci-dessous la biographie de chaque modérateur. Il faut noter que ce message d’introduction et les synthèses des discussions à la fin de chaque semaine seront traduits en français. Nous remercions le PROJET USAID | DELIVER et l’Institut William Davison d’avoir traduit. Restez à l’écoute sur le message de lancement ce weekend! Kevin Pilz au nom de l’équipe IAPHL Biographies des modérateurs de discussion Steven Harsono – Conseiller Principal (Senior Advisor), Healthcare Initiative, Institut William Davidson à l’Université de Michigan Steven Harsono est conseiller principal pour l’initiative de soins de santé à l’Institut de William Davidson (WDI) à l’Université de Michigan. Il dirige et assure l’appui technique du travail à WDI pour améliorer la performance de la chaîne d’approvisionnement en économies émergeantes. Au courant de 10 ans, Harsono a travaillé aussi bien dans les secteurs public et privé dans plus de 20 pays. Il tire ses diverses expériences de son travail avec l’entreprise McDonald sur l’intégration de la chane d’approvisionnement, des entreprises pharmaceutiques en améliorant les coûts et l’accès aux marchés émergeants, et des ministères de santé cherchant comment transformer leurs chaînes d’approvisionnement. Avant de joindre le WDI, il a travaillé à Axios International, le Clinton Health Access Initiative, et HAVI Global Solutions. Il a une licence en économie et relations internationales du Wheaton College à Illinois. Il parle couramment français et Bahasa une langue en Indonésie. Michael Krautmann – Chercheur Associé Principal (Senior Research Associate), Institut William Davidson à l’Université de Michigan Michael Krautmann est chercheur associé principal pour l’initiative de soins de santé à l’Institut de William Davidson (WDI) à l’Université de Michigan. Il a geré et soutenu une gamme de projets de recherche pour améliorer les chaînes d’approvisionnement des produits de santé et les dynamiques de marché. Son travail inclut l’élaboration de la prévision et des méthodologies pour mesurer la performance, la conception et la modélisation de la chaîne d’approvisionnement, le financement de l’élaboration des politiques, et la stratégie de l’engagement des secteurs privés. Avant de joindre WDI, il a travaillé à Lean Care Solutions, une entreprise de démarrage de la technologie en soins de santé basée aux Etats-Unis et en Singapore. Il était aussi un bénévole du Corps de la Paix en Zambie où il a évalué les pratiques en chaîne d’approvisionnement au niveau des cliniques pour un projet de la chaîne d’approvisionnement de la santé financé par USAID. Michael est licencié et maitre en ingéniorat d’opération et d’industrie de l’Université de Michigan. Hitesh Hurkchand – Conseiller en Santé Publique (Public Health Advisor, RMNCH Trust Fund (hebergé par Unicef) Hitesh Hurkchand a plus de 16 ans d’expérience en développement international avec un focus sur les programmes de santé globale. Ses expériences aux systèmes de santé incluent approvisionnement des médicaments, élaboration des politiques de santé, gestion générale, et renforcement des capacités. Hitesh travaille avec l’équipe de stratégie et coordination du programme santé de la reproduction maternelle, néo-natale, enfant et adolescent (RMNCH), un secrétariat multi-agences (Unicef, Unfpa et OMS) qui est hébergé par Unicef à New York. Hitesh soutient la mise en œuvre des recommandations formulées par la Commission des Nations Unies sur les produits d’importance à la vie (UNCoLSC) et il coordonne le Groupe de la chaîne d’approvisionnement de l’inter agence globale (ISG), c’est un groupe informel de 15 agences de développement. A ISG, son rôle est de soutenir, maintenir les communications, et encourager l’alignement à travers les différents investissements des agences pour apporter un plus grand impact sur les stratégies de différentes agences au niveau global et pays. Quelques points saillants de l’ISG incluent un accord d’une série des 15 indicateurs principaux de performance sur la gestion de la chaîne d’approvisionnement, efforts conjugués pour développer le Groupe de Conseil et Traçabilité de la Santé de la Reproduction, adoption des standards de données globales (GS1) pour faciliter le suivi et le traçage les produits sanitaires. Hitesh est originaire de l’Afrique de Sud. Lisa Hedman – Chef de groupe, programme d’Approvisionnement et Accès aux Médicaments, OMS Lisa Hedman est chef de groupe pour le programme d’Approvisionnement et Accès aux Médicaments à l’OMS (Département de Médicaments Essentielles et Politiques Pharmaceutiques à Genève, Suisse). Son travail couvre les stratégies de premier plan pour faire avancer les stratégies scientifiques, règlementaires, d’affaires et d’approvisionnement qui ont un impact sur la disponibilité des médicaments essentielles de qualité. Son expérience inclut accès aux médicaments d’urgence, contrat d’approvisionnement innovant, et stratégies d’achat et d’approvisionnement pour les initiatives à grande échelle dans divers pays. Ms. Hedman a évolué dans le domaine de la gestion pharmaceutique et des soins de santé. Avant de joindre l’OMS, elle a travaillé à PATH, dans d’autres agences non-gouvernementales, et agences de bailleurs des fonds sur les initiatives de la gestion de l’achat et de la chaîne d’approvisionnement. Patrick Lydon – Conseiller technique, Optimisation de la chaîne d’approvisionnement et économie, OMS Patrick Lydon travaille à l’OMS sur l’équipe du programme élargi de vaccination (EPI) pour environ 18 ans. Entre 2008 à 2012, Patrick a été un membre clé du projet Optimize, une collaboration entre l’OMS et PATH pour repositionner la chaîne d’approvisionnement dans l’avenir, où il s’est concentré sur les innovations de la chaîne d’approvisionnement. Après la fin du projet Optimize, son travail a évolué à mener la coordination de partenariat global aux stratégies de l’OMS pour renforcer la chaîne d’approvisionnement des produits d’immunisation au niveau pays (e.g. moyeu de la chaîne d’approvisionnement des produits d’immunisation à OMS et Unicef) et sur l’approche compréhensive à la Gestion effective des vaccines (EVM). Pendant son temps libre, Patrick aime faire le CrossFit, les sports en plein air, et boire une bière sur son bateau quand il fait beau. Kevin Pilz – Conseiller Principal en Chaîne d’Approvisionnement, USAID Kevin Pilz est conseiller principal en chaîne d’approvisionnement au siège de l’USAID à Washington où il travaille à l’améliorer d’accès aux produits de la planification familiale et la santé de la reproductive. Il fait actuellement partie de l’équipe USAID qui gère une subvention à Axios International pour mener une révision complète et mettre à jour l’outil national de l’évaluation de la chaîne d’approvisionnement de l’USAID. Ses domaines d’expertise comprennent: stratégie et mise en œuvre de la chaîne d’approvisionnement, suivi et évaluation, renforcement de capacité et coordination des bailleurs. Kevin a travaillé en différentes positions en tant que conseiller en chaîne d’approvisionnement à l’USAID et comme Conseiller Principal au Directeur du Central du magasin d’approvisionnent en Mozambique. Kevin a son PhD de l’Université de Cornell aux Etats Unis.

At B Medical Systems we have received lately more and more complaints about RCW50EG, absorption type vaccine refrigerator / ice pack freezer, that stopped working or never started working correctly. The largest complaint came from the EPI in Kenya with 200 X RCW50EG not working. The RCW50EG and the smaller version of it, the RCW42EG, have always been known as excellent equipment in the cold chain, and never had any issues, therefore initialy we thought it must just have been wrong use, settings or similar issues. Seen the claims we have started investigating where that huge and systematic problem might have come from, and here are the results : during the calendar year of 2011, our supplier of absorption cooling units did change the interior boiler layout of the cooling system in order to increase the efficiency. That would mean as a result less electrical power consumption and as well less gas consumption. It means as well that the cooling system is now more sensitive to the heat applied to the boiler through either the electrical heating element or the gas burner. Therefore, I am explaining hereafter the effects on the different types of operation, and this is valid for every RCW50EG produced as of 2012. You can identify the year of manufacturing with the help of the serial number that is composed by 7 digits, where the first digit is the year- and the 2nd and 3rd are the week of manufacturing: example 2503456 : produced in week 50 in year 2012 1) Operation on LP Gas : The new cooling units will not work properly and mostly not at all with the original burner jet 32, that is producing too much heat. This jet has to be replaced by a jet size 26. This change makes sure the cooling unit operates well on gas. 2) Operation on electricity : We deliver the RCW50EG in a 220V version with a 220V/120W heating element. This setting works well for voltages of 210-230VAC. If the voltage goes higher, it won't work. I am currently in Kenya and we measure constant voltages of 250VAC. In such a case the heater has too much power and overheats the absorption cooling system. We have replaced the heaters in Kenya on several refrigerators with a 240V / 120W version, and now they perfectly well. If you have come around similar problems wih your RCW50EGs, please contact us immediately so that we can help you to solve the problems asap. There are solutions that can be implemented quickly, and B Medical Systems will fully support those activities. In such a case please contact me directly through : gilles.ries@bmedicalsystems.com. Please make sure to report as much details on the problem as you can. If the issue is on electrical operation, please give as much as possible details on the voltage level. PS : we have not heard of any issues with the kerosene version as on these the heat can be adjusted through the flame setting. If anyways you would know about issues on those, please let us know as well. Thanks for letting know and forwarding this message to any of your colleagues or network that may need to get this information. Best Regards Gilles for the B Medical Systems Team

Dear Viewers
Global effort is to close the immunization gap [World Immunization week -2016]. This gap is generally attributed to inadequate coverage: 1 in 5 in the world, 1 in 3 in the country and 1 in 5 in Karnataka are missing routine primary vaccination. This is understandable and measures like meticulous micro-plan, monitoring with supportive supervision, regular programme review, All Time Mission Mode [ATM2izing] regular sessions, using extended Immunogram etc can improve the coverage over a period of time.
National Technical Advisory Group consisting of senior specialists from pediatrics, public health, international development partners etc have developed National Immunization Schedule of our country - compatible with the country specific VPD epidemiology, end game strategy for achieving the global goals and objectives to be achieved by 2020. Private sectors have to proactively involve themeselves to strengthen RI, support the Government and protect the godly under five.
Considerable children both in the rural (~12%) to >25% in the urban area are vaccinated by the private sector at the clinics to tertiary care centers and private Medical Colleges. These children belong to middle to higher socioeconomic class – including doctors & nurses. Children of low socio economic group, migrant population and remote area are blessed and vaccinated by the public sectors who receive essential vaccines of National Immunization Schedule with known potency indirectly depicted by the VVM.
But the children of high economic society are vaccinated but mst likely to remain unimmunized due to various reasons: incompatible immunization schedule, vaccines with no VVM. Four illustrations attached though several thousands / lakhs are suffering from the same in our country.
I am sure that WE CAN CERTAINLY DO A LOT IN THIS REGARD.

The latest WHO and UNICEF estimates of immunization coverage show that 86% of the world’s children received the required 3 doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) in 2015, a coverage level that has been sustained above 85% since 2010.As a result, the number of children who did not receive routine vaccinations has dropped to an estimated 19.4 million, down from 33.8 million in 2000.However, this progress falls short of global immunization targets (90% or more DTP3 vaccination coverage at the national level, and 80% or more in all districts in all countries) by 2015.
Read the full storyhere, and have a look at thisanimated map to see how global DTP3 coveragechanges from 2000 to 2015.
A short presentation with some highlights is posted here.
Want more detail? All the raw data can be foundhere.

Interesting paper from EMHJ describing systemic bottlenecks and proposes potentialsolutions for routine EPI in Pakistan

Dear Colleagues
With the strategic review of the International Association of Public Health Logisticians (IAPHL) six months in, I would like to provide you with an update of what we've accomplished so far and where we hope to go.
You will find my letter athttp://iaphl.org/news/. Please take a moment to read it and have a wider look around the IAPHL website with recently updatedE-Learning ResourcesandModerated Discussion Summaries.
I would encourage you to ask your health supply chain colleagues to do the same and please provide us with your feedback.
If you would like to become a member, then please go tohttp://iaphl.org/membership/become-a-member/.
Regards,
Andrew





Dr. A.N.Brown PhD, BPharm



Executive Director, International Association of Public Health Logisticians (IAPHL)
+61411137625,andrew_brown@iaphl.org
Skype: Andrew.brown.uc

Greetings TechNet Community, I hope this message finds each of you well and successful in your work. I am the new OpenLMIS Community Manager working with the OpenLMIS Initiativeand Community to develop and share this functional and customizable eLMIS solution. Many of you may be familiar with the open source eLMIS system, OpenLMIS.Currently utilized in five geographies throughout Africa, OpenLMIS is acost-effective and widely customizable eLMIS solution built to address the data visibility challenges of low-resource environments. A non-proprietary solution, the product empowers countries to own, customize, extend, and manage their eLMIS, providing shared investment, shared learning, and reduced up-front development costs. Please visit the OpenLMIS Wikior website for more information. OpenLMIS is currently deployed in Beninthrough AMP, where it supports an informed push system for immunization commodities. One of our colleagues has written an excellent pieceon how OpenLMIS has improved data collection and visibility in Benin –an article I believe would be of great interest to the public health professionals of TechNet. The article may be accessed here: http://www.villagereach.org/2016/03/24/what-do-vaccines-and-vending-machines-have-in-common-using-data-to-improve-vaccine-delivery-in-benin/ Best of luck in your work, and please reach out with any feedback, questions, or discussion. Warm regards, Tenly --- Tenly Elizabeth Snow OpenLMIS Community Manager tenly.snow@villagereach.org CELL: 1.406.544.4856 FAX: 1.206.860.6972 SKYPE: tenly.snow.vr OpenLMIS.org~HingX~OpenLMIS Wiki

Immunizations are among the most successful and cost-effective health interventions ever devised. They have reduced child deaths and disease prevalence radically. They have enabled the eradicationof smallpox, lowered the global incidence of polio by more than 99% and neonatal tetanus by 94%, and achieved dramatic reductions in illness, disability and death from common childhood diseases. However, global mobility and interdependence have increased the vulnerability of people everywhere to the uncontrolled spread of diseases through epidemics. The purpose of GRISP is to reassert routine immunization as the foundation for sustained decreases in morbidity and mortality from vaccine-preventable diseases across the life-cycle of all individuals. GRISP on WHO website GRISP contains two components: nine transformative investments to achieving better immunization outcomes and [hyperlink to the appropriate section below] a comprehensive framework of strategies and practices for routine immunization. [hyperlink to the appropriate section below] Nine transformative investments to achieving better immunization outcomes: these aim to provide overall direction and, if implemented, will transform national programmes and the work of global partners, enabling us to reach the stated DoV goals. These investments are a callto action to governments, donors and partners and should be seen as the highlights and priorities of this document. The nine transformative investments are: Invest in a capable national team – supplied with sufficient resources and authority – to expertly manage each country’s national immunization programme. Invest in tailored strategies that identify undervaccinated and unvaccinated persons and regularly provide them with the vaccines they need. Invest in a coherent planning cycle, with strategic, comprehensive, multi-year and operational annual plans outlining and coordinating strategies and activities, which are monitored quarterly. Invest in ensuring that sufficient and adequately appropriated funds reach the operational level of the programme regularly. Invest in vaccinators and district managers by regularly and systematically building their capacity, strengthening their performance and providing supportive supervision. Invest in modernizing vaccine supply chains and management to ensure that the correct amounts of the right potent vaccines are available at each vaccination session. Invest in an information system that identifies and tracks each person’s vaccination status. Invest in sustainably expanding routine vaccination schedules to cover people’s entire lives. Invest in the shared responsibility for immunization delivery between communities and the immunization programme to reach uniformly high coverage through high demand and quality services. A comprehensive framework of strategies and practices for routine immunization Implementing the strategies and practices within this framework will strengthen routine immunization systems and improve coverage. In addition, the framework organizes them by four main areas of action, enabling a systematic approach to be taken. MAXIMIZE REACH Detect and reach the unreached Design services to reach all equitably Build capacity of vaccinators and managers Ensure vaccine quality and availability Create synergy with special vaccination efforts Integrate immunization services MANAGE the PROGRAMME Secure political commitment and partnerships Plan, budget and mobilize resources Ensure excellence in national leadership Set programme policy and guidance MOBILIZE PEOPLE Engage communities and create demand Mobilize and communicate for vaccination Address vaccine hesitancy & false perceptions MONITOR PROGRESS Monitor programme performance & disease occurrence Evaluate the programme through surveys & reviews

For reviewing the performance of a programme it is customary to have a target / expected level of achievement as a denominator before launching a programme. From the numerator collected through formats, indicators were obtained for performance review; for e.g. in NID/SIA’s 0 to 5 yr children are the target children. District Magistrates are used to review against given target. It so happened in the District review meeting following 1st round of Intensification of Routine Immunization (IRI) held in July 2012 that, DC was not able to review the performance without target. And hence, while conducting Mission Indradhanush Simulation study we found the method of estimating expected number of due children which may help the monitors in evaluating/ monitoring/interpreting the programme running in the MI districts. Sharing with technet community for needful. Best wishes Holla

Dear colleagues: The Alliance Data for Management (D4M) working group is developing a guidance package on immunisation supply chain dashboards that includes a menu of primary supply chain performance indicators for countries to select from that meet their needs. The indicators and dashboards are intended for managers at multiple levels of the immunization supply chain and provide visualisation examples and suggested corrective actions for each indicator. This guidance will be endorsed by the Alliance Partners (WHO, UNICEF, Gavi Secretariat, BMGF). We want your input and feedback to inform the guidance and proposed indicator menu to make the guidance document as relevant and useable as possible! Survey will close Monday, June 1 https://www.surveymonkey.com/s/JFRGZXV For those that have already completed the survey, thank you! For others, we thank you in advance for taking time to provide valuable feedback to us.The survey should take less than 15-25 minutes to complete. For further information on the guidance document and how to get involved contact: Jan Grevendonk (grevendonkj@who.int, WHO), Dorthe Konradsen (dkonradsen@unicef.org, Unicef SD) Kaleb Brownlow (kbrownlow@gavi.org, Gavi) or Anna Rapp (anna.rapp@gatesfoundation.org, BMGF). Best, D4M working group

Every quarter, a slide set on introduction status of selected vaccines is updated. The most recent version is available from the web @: http://www.who.int/immunization/monitoring_surveillance/en/ in the right hand column, under the “recent immunization data” menu. If you want to see the worldwide uptake of Hib, PCV, Rota, MCV2, Rubella, YF, JE and HPV, you can either consult the attached or visit the above mentioned website. Comments, suggestions and additional information are welcomed.

An Editorial in Indian Pediatrics the journal of the Indian Academy of Pediatrics has again raised doubts about the usefulness of Hepatitis-B vaccination in India. Results of the pilot study launched in Andhra Pradesh to evaluate the usefulness of the vaccine have been published in the latest issue of Indian Pediatrics. In an accompanying editorial Rajeev Kumar and Jacob Puliyel of the Department of Paediatrics at St. Stephens Hospital say the results are clear evidence that the vaccine has not been very useful. "If the findings of this study are replicated in other areas, it should prompt a re-evaluation of the need for this vaccine in the immunization programme of the country" the editorial says. Twelve years ago the Global Alliance on Vaccines and Immunization (GAVI) provided India with Rs.271.9 million to study Hepatitis B vaccination in India. No study of efficacy was undertaken and universal immunization was introduced in a phased manner. Hepatitis B spreads like AIDS from mother to child or from person to person through contaminated needles or sexual contact. However unlike AIDS, the majority of those who get infected with Hepatitis B clear the organism from their bodies. A few however do not clear the virus and become chronic carriers. Some chronic carriers develop liver cancers or cirrhosis of the liver, 40 years later. Vaccination is meant to reduce the numbers who become chronic carriers and long term problems. The pilot study in rural Andhra Pradesh looked at over 2500 children who were given the vaccine against a similar number who had not received the vaccine and used as control group. The study found that the incidence of chronic carriers was similar, regardless of vaccination status or, in other words, "the vaccination did not reduce hepatitis B carrier rate," defeating the primary aim of the immunization programme, the editorial says. Protective levels of antibodies fell rapidly among the vaccinated and by 11 years only 13% were protected. On the other hand among those not vaccinated, 33% had developed natural immunity by 6 years of age. Kumar and Puliyel note that Hepatitis-B vaccine in now being given as Pentavalent vaccine in combination with DPT and Hib (Haemophilus influenzae type B) vaccines. They say that the efficacy of Hepatitis-B vaccine when given mixed with other vaccines "is likely to be even lower than what was reported in the study that was conducted with Hepatitis-B as a stand-alone vaccine." The link below for full article: http://www.indianpediatrics.net/nov2014/870.pdf

Dear Colleagues, Paper immunization registers and register books are critical components of health information systems (HIS) for immunization programs across the globe. Even as many HIS for immunization programs and other health domains move toward electronic and mobile data collection systems, paper registers continue to be relevant tools in many resource-constrained settings. Registers occupy a particularly unique space in HIS as they serve as an intermediary between individual patient records and aggregate data. For immunization programs, they can be used to track defaulters and to estimate coverage. Registers must meet both the needs of health providers and the needs of administrators and decision-makers. The Bill & Melinda Gates Foundation’s Vaccine Delivery Team engaged the University of Washington’s Global Health Strategic Analysis and Research Training (START) Program in the Paper Health Registers Project in September 2013. With the hypothesis that sub-optimal paper register systems likely detract from patient care and produce poor data quality, the START team investigated five case studies representing innovations in paper health register systems across various health domains and geographies. These cases include: [list] Ethiopia’s Family Folder (FF) is a non-standard register innovation. Developed in 2008, this folder contains key indicators at the household level and contains individual records for each family member, allowing health extension workers easy access to both individual and aggregate data. Ethiopia Case Study Ghana’s Simplified Registers (SR) are a set of five consolidated primary care registers, including maternal and child health and family planning. They were introduced in 2010 as part of the Mobile Technology for Community Health (MoTeCH) initiative. Ghana Case Study South Africa’s 3-Tiered Antiretroviral Treatment (ART) Monitoring Strategy gathers a reduced number of monthly and quarterly data elements to track ART services for all patients receiving HIV treatment in South Africa. This strategy was developed by researchers in South Africa in 2004, and includes a paper tier for facilities with fewer patients and less infrastructure, and non-networked and networked electronic tiers for facilities with many patients. South Africa Case Study Uganda’s Tuberculosis (TB) and Leprosy Program Registers were updated in 2005 to include a mechanism for monitoring TB/HIV cooperative activities. This link allows patients with TB/HIV co-infection to be monitored by the system more easily. This case study focuses on the TB register (rather than the leprosy register), and particularly emphasizes modifications made to record TB/HIV collaborative activities. Uganda Case Study Uruguay’s National Immunization Program Register (SNNI) is a mixed paper and electronic system, in which vaccinators at all public and private vaccination facilities fill out a paper form for each vaccination encounter and submit the form for data entry into an electronic database at the national level. This system was developed in 1987 and is the oldest nominal register in Latin America. Uruguay Case Study While the case studies represent a variety of health domains, many of the lessons learned are applicable to immunization program registers. The full project resulted in five individual case studies detailing each register innovation and a synthesis of the lessons learned from all five cases. The lessons learned demonstrate innovation in register design, human resource models, policymaking, and implementation strategies. This research demonstrates that many stakeholders – including funders, policymakers, public health officials, and health providers – can be a part of strengthening paper register systems to support evidence-based decision-making for improved patient care and accurate reporting. For further information about this work, please contact me at anna.rapp@gatesfoundation.org. Best, Anna Rapp Vaccine Delivery Program Bill and Melinda Gates Foundation

Since 1998, WHO and UNICEF collect annually data on national immunization systems jointly through the WHO/UNICEF Joint Reporting Form on Immunization (JRF) (http://www.who.int/immunization/monitoring_surveillance/routine/reporting/en/). The Joint Reporting Form annually collects national level data on: • reported cases of selected vaccine preventable diseases, • immunization coverage, • recommended immunization schedules, • supplementary immunization activities, • vaccine supply, and • other information on the structure, policies and performance of national immunization systems. National authorities complete the form using an excel based data-collection tool and submit the data to WHO and UNICEF during the second quarter of each year. By 22 May 2014, 173 (89%) member states reported data for 2013. The WHO vaccine preventable diseases monitoring system has been updated with 2013 data and can be accessed through: • country profiles, (http://apps.who.int/immunization_monitoring/globalsummary) or, • by subject (http://www.who.int/immunization/monitoring_surveillance/data/en/) . The data are provisional and an updated data set with late reports and clarifications from countries, together with summary statistics will be published in July 2014 on the above web pages as well as on the Immunization Summary tablets Application.

The Immunization Summary is an app for visualizing data (tables, graphs, maps) on policies, activities and impact of national immunization systems. These data are reported by WHO & UNICEF Member States annually for incidence, coverage, immunization system indicators and vaccination schedules. The WHO-UNICEF estimates of national immunization coverage constitute an independent technical assessment of coverage. Data are available from 1980 to 2012 (as of July 2013) for 195 countries or territories. Data from 1980 to 2013 will be available in July 2014. Please watch the immunization summary preview at: http://multimedia.who.int/mp4/WHO-TRA_Immunization_surveillance_application_13MAR2014.mp4 Do not Forget to rate the app. Please share with us your comments and suggestions.

Current immunization coverage rates in the WHO European Region are insufficient to ensure herd immunity and stop the spread of vaccine-preventable diseases. In some countries, rates have now fallen well below the WHO-recommended threshold (95%). Across the Region, up to 1 million infants born each year do not receive all their scheduled vaccinations (2012 estimate). To address this situation, a new tool Guide to tailoring immunization programmes (TIP) has been launched. This guide helps national immunization programmes design targeted strategies to improve vaccination levels among babies and young children. It provides tools to identify susceptible populations, determine barriers to vaccination and implement evidence-based interventions. The guide, which focuses on the European region, provides step-by-step instructions on how to segment groups of parents/caregivers on the basis of their children’s vaccination status: fully and timely vaccinated, partially vaccinated or not vaccinated. This segmentation analysis helps to identify susceptible populations that national immunization programmes should target. Through evidence and models, users of the guide will be able to identify and understand what influences parental behaviour regarding vaccination, including how immunization programmes provide services. Further, it will help in the design, implementation, monitoring and evaluation of tailored initiatives to maintain and increase vaccination coverage among targeted groups. It also includes a list of promising practices in immunization programming. After successful pilot-testing in Bulgaria in 2012, the guide is to be rolled out in several countries across the Region; it was launched as part of the activities to celebrate European Immunization Week 2013. Guide to tailoring immunization programmes (TIP) http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/04/guide-to-tailoring-immunization-programmes-launched

Many thanks to Diana Chang Blanc for sharing this information with the readers! The Immunization Summary is an app for visualizing (tables, graphs, maps) data on policies, activities and impact of national immunization systems. The IPAD/IPHONE app can now be downloaded directly from the iTunes app store by typing "immunization summary" in the search field, or by clicking the immunization logo from the right column of our pages (http://www.who.int/immunization_monitoring): which will load your iTunes app store and allow you to download the app (The app size is 61.5 MB). These data are reported by WHO & UNICEF member states annually for incidence, coverage and immunization indicators. The WHO UNICEF estimates of national immunization coverage constitute an independent technical assessment of coverage. The population data are provided by the United Nations' "Population Division. The World Population Prospects - the 2010 revision. New York, 2011." with the exception of the infant and child mortality figures which are provided by WHO's "World Health Statistics 2011, data for 2010." The Gross National Income (GNI) & the Gross Domestic product (GDP) data are taken from "The 2011 World Bank Development Indicators Online". Data are available from 1980 to 2011 (as of October 2012) for 195 countries or territories.

For achieving >90% coverage in the shortest period at the session site level, a one-pager offline tool, which I wish to name as 'IMMUNOGRAM', is adequate. This tool incorporates the basic principle of 'My Village My Home', suitably expanded for IWs (Immunization Weeks) of IRI (Intensification of Routine Immunization) to begin with. This can serve several functions like: 1. 'LODO meter'; 2. 'LODO inhibitor'; 3. 'Herdimmunometer'; 4. Calculation of 'Child specific drop-outs; 5. Interval between subsequent doses, etc. I wish to share the experience with an example of only one session site as a template of evidence. This is scalable. After using this in the field practice area of a poor-performing district with supportive monitoring coverage visibly improved in the study area. Hoping to expand the use of this tool elsewhere also. 11122012-2144_IMMUNOGRAM.doc

In day today life we see so many things happening around us which we can capture and use 'philosophically' in our training programmes. On bringing the two gates closer but not touching each other within a minute the red ants 'constructed' a bridge across a gap of 8 to 10 ants length, a similar gap of 40 to 50 feet we may find it difficult to bridge in the 'ants way'. Reaching the beneficiaries is an important event in the service delivery of any programme. Similarly in a long term programme we may loose interest when only the tail is left.(here it's not the elephant but cat). Learning-from-nature.pdf