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 

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  

Dear immunization and health supply chain professionals,

The Effective Vaccine Management (EVM) initiative has evolved significantly from being solely associated with an assessment tool. It has been transformed to help national programmes make major health systems strengthening investments work as intended – to address the underlying systemic bottlenecks to immunization supply chain performance.

In this context, I am pleased to share with you the WHO and UNICEF continuous Improvement Plan (cIP) guidance note – published here in English (and soon to be available also in French):
https://www.technet-21.org/en/library/main/4911-how-to-develop-a-continuous-improvement-plan-cip

--> This document provides detailed guidance on how to plan for continuous ISC improvement: a practical tool for countries to develop improvement strategies, integrate EVM in existing national planning processes, and thus build a robust investment case for immunization supply chains.

The guidance note became possible thanks to cIP champions in a number of countries, who inspired us with their brave efforts and lessons learned. There will be more innovations and lessons as each country works to develop its own cIP. The Guidance note will therefore not remain static but will evolve with these new experiences.

In the coming months, we will launch an interactive process on the TechNet-21 web platform, through moderated discussions on EVM and cIP topics and a country champions group. Please consult the cIP resource page for more information:
https://www.technet-21.org/iscstrengthening/index.php/en/improvement-plans-about

We look forward to your engagement, and in the meantime, I would like to wish you, on behalf of the WHO and UNICEF teams, a good reading.

Warm regard,

Ousmane Dia

Dear TechNet-21 Community, I hope you've had a chance by now to check out the Immunization Costing Action Network (ICAN) website - http://immunizationeconomics.org/ican-home - which launched May 1st and features our immunization delivery systematic review methods and findings, including the Immunization Delivery Cost Catalogue (IDCC). The IDCC contains over 400 immunization delivery unit costs for low- and middle-income countries, pulled from the grey and published literature from January 2005 to January 2017. I hope they will be helpful to you in your work for budgeting, planning, research and advocacy purposes. To update the catalogue with the latest findings, we are currently reviewing published literature from the last year, and need your help in collecting GREY LITERATURE. Reports, unpublished articles, blog posts, theses/dissertations, policy papers, etc. on immunization delivery costs in low- and middle-income countries dated from January 2005 to January 2018 are welcome via this link: https://collaborativedev.egnyte.com/ul/pbf7fBiKXV. The deadline for submissions is June 10, 2018.

Thanks in advance for helping us expand the catalogue! Kelsey Vaughan, on behalf of the ThinkWell team

We are happy to announce the latest version of the Total Cost of Ownership tool for cold chain equipment (v1.5) is now available to download and use. If you have been using an earlier version of the tool, please download the latest version from the link below.   Version 1.5 includes options to add Service Bundle quotes for CCEOP procurement which will overwrite installation cost assumptions.  Version 1.5 also features enhanced warranty comparisons that reflect the value of standard warranties from suppliers over time.  The latest version of the TCO tool contains PQS pre-qualified equipment as of May 2018. Please download the latest version (in English or French) for the most up to date products and pricing. http://www.path.org/publications/detail.php?i=2576  If you have any questions or would like any training/demos please email Matt Morio mmorio@path.org

Economic studies have shown that immunization is an excellent investment, yielding one of the highest returns in health. One dollar spent on immunization is estimated to generate a $16 return on investment. UNICEF considers governments’ budget allocations, whatever their resources, to this life-saving intervention to be states’ foremost commitment to children and the fulfilment of their obligations under the Convention on the Rights of the Child (CRC). Yet, protecting immunization in governments’ budgets has not been systematically addressed in middle-income countries in the Middle East and North Africa (MENA) region. It is to help governments uphold their commitments to the right of every child to be immunized against preventable diseases that UNICEF has undertaken the present financing study. Based on data, research, interviews, lessons learned and good practices in the MENA region, the study provides policymakers, senior officials in ministries of finance and health, and parliamentarians or equivalents with a set of key recommendations to secure necessary government financing for this critical childhood intervention. In focusing on middle-income countries, the study provides a deeper understanding of the situation and dynamics of two critical subgroups: countries with gross national incomes per capita too high to make them eligible for outside financial support, yet who face challenges to meet their immunization goals; and countries eligible for international development assistance, yet who struggle to transition out of aid and co-finance a much greater share of their immunization costs. That means prioritizing health within government budgets, prioritizing immunization within health, and working to make programmes as efficient as possible. Key global players are at the vanguard of the immunization drive, including by making newer vaccines accessible to countries facing resource constraints. Gavi, the Vaccine Alliance, plays a central role in giving eligible countries support to adopt new, life-saving vaccines and improve coverage and equity. At UNICEF, the Supply Division makes every effort to source and supply affordable vaccines, making its procurement services available to countries. Gaining efficiencies and ensuring sustainability are two overarching themes of immunization financing in this report. Where and how countries spend on health is critical: do they allocate funding to ‘do the right thing’ – using budgets to adequately support the highest priority activities in health, such as immunization? And are they ‘doing things right’ – delivering high-quality services and procuring vaccines efficiently? Do budgets include ancillary but crucial allotments for ongoing supervision, training, surveillance, supply and cold chain management, and laboratory control that are prerequisites for effective immunization? This report concludes that in most of MENA’s middle-income countries, prioritizing immunization and making it more efficient is the best way to create room in budgets and to secure more resources. Many of the recommended first steps are information-related: generating and sharing knowledge, equipping policymakers with evidence, and determining the role of social insurance. It is our hope that this report and its recommendations will help UNICEF and partners in the region strengthen their advocacy and support to governments so they live up to their commitments to the CRC and build high-performing immunization systems that are accessible to all.

ThinkWell is currently accepting submissions of GREY LITERATURE about immunization delivery costs in low- and middle-income countries (LMICs). Resources need to be published between January 2005 and January 2018. Please upload your submissions directly to https://collaborativedev.egnyte.com/ul/pbf7fBiKXV. Submitted resources will be considered as part of a systematic review of the current evidence base on immunization delivery costs (IDC) in LMICs, conducted as part of the Immunization Costing Action Network (ICAN), led by ThinkWell and John Snow, Inc. (JSI) to increase the visibility, availability, understanding, and use of data on the cost of delivering vaccines. The three-year project includes this systematic review, country costing studies and a peer learning network and is supported by a grant from the Bill & Melinda Gates Foundation. To access systematic review findings already collected and analyzed, please visit www.immunizationeconomics.org/ican. This initial round of the review considered over 13,000 articles/reports published between January 2005 and January 2017 on the topic. Ultimately, ThinkWell drew from 54 articles/reports on immunization delivery costing data without restricting to a particular vaccine, delivery strategy, type of cost analysis, or setting. Resources available include a standardized and richly annotated Immunization Delivery Cost Catalogue (IDCC) (Excel workbook and web tool) of the data extracted, a summary reporting including immunization delivery unit cost estimates for vaccine delivery through a variety of strategies and in a variety of contexts. and companion interpretive products (e.g., detailed methodology note and user guides). To provide feedback or seek clarification on any of the ICAN resources, please contact ICAN@thinkwell.global.

As more low- and middle-income countries explore opportunities to improve their public health supply chains and diagnostics networks, knowing how best to use unmanned aerial systems (UAS) to improve reach in the last mile is critical. Under the inSupply project, JSI Research & Training Institute, Inc., and our partners LLamasoft, Inc. and the Nichols Group provide objective guidance for countries and public health stakeholders on how to make informed decisions about which health products to prioritize for cost-effective delivery using UAS vs. well-managed traditional modes of last-mile delivery, such as land cruisers and motorcycles.  The analysis took into account geography, UAS characteristics, and characteristics of products and their demand patterns. The paper focuses on examining the cost-effectiveness for each of the following product types: safe blood for transfusion long-tail products (small quantity, unpredictable demand products) program and essential medicines vaccines diagnostic specimens The executive summary is attached and the full white paper can be downloaded here. Please let us know if you have any questions about this white paper or want to know more about our work.

  National and subnational participants from Djibouti, Egypt, Iraq, Jordan, Lebanon, Libya, Sudan and Syria gathered at the Dead Sea, Jordan from 25 to 27 September to participate in a MENA Regional Workshop on Equity-Informed Microplanning. The workshop was organized by UNICEF MENARO in close technical collaboration with GAVI, US CDC, JSI, WHO and EMPHNET. The objective of the workshop was to improve the capacity of national and sub-national level EPI and data managers to analyze immunization data with an equity lens, learn about existing methodologies, tools and Information and Communication Technology applications and exchange ideas and best practices on how to account for special populations such as transient, conflict affected, and urban slums, the non-public sector, immunization during the second year of life, missed opportunities and equity-informed microplanning and resource allocation.   Background:   In the Middle East and North Africa (MENA) region, countries have been faced with enormous threats and challenges due to the proliferation of political conflicts which have led to massive internally displaced people and refugees. Additionally economic austerities and environmental degradations in recent decades have contributed to extensive population movements, such as migration and urbanization. Moreover, health financing has been impacted due to competing priorities and commitments and an increasingly disturbing trend in out of pocket expenditures is observed.   In the meantime, as immunization programs have matured, they have set impressively ambitious goals, for instance to reach the populations that are the hardest to reach and improve coverage across geographic, socio-economic and demographic groups. Yet, current data systems in many countries are not designed with the goals of universal health coverage and equity in mind and often focus on populations already reached by programs.   Consequently, there is often a lack of information about those who are never vaccinated, those who do not complete their vaccinations and those who opt out. Moreover, in many countries microplans are updated or developed without particular focus on equity and where the private and civil society sectors have a major role in providing services, there is a lack of coordination and communication, and the data do not often get reported, recorded and incorporated as part of the country’s planning process. Finally existing plans and tools for registering, recording and reporting coverage do not always take into account immunization during the second year of life and the missed opportunities.  

Dear colleagues,   "Quality Risk Management Mental Modelling: Examples of exposure in everyday life" with 15 chapters, 120 photographs, 89 references, countless tables and graphs, links and QR codes to 13 videos as well as 26 best quotes on risk management is now available in printable interactive PDF and interactive ePUB3 formats from http://kartoglu.ch/qualityriskmanagement/    FREE DOWNLOAD for both PDF and ePUB3 versions.   This book is prepared to help readers to build robust mental models on quality risk management using everyday life examples. Mental models are a set of tools that we use to think. They offer us frameworks that we can use to look at a problem or a process. Mental models help us to shape our behaviour, set an approach to doing specific tasks, as well as explain our own thought process about how the ‘real’ world works. Through mental models, we see the relationships between different steps of a process, causations, and consequences. This book suggests taking a look at some of our daily routines from a risk management perspective in order to better understand the process.   This work comes under a Creative Commons (CC) Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0) and is offered to the global charity that has been initiated by the Creative Commons with the purpose of widening the spectrum of open knowledge and free culture.   Of course, you will undeniably learn a lot by studying risk management publications related to your technical area and excel by practice. But in my experience, one good way to build mental models is to read outside the norm. When I read or listen to something new and different, I always think of how this new information could connect with information I already know, or to my technical expertise. With my involvement in QRM, I have developed a habit of wearing ‘risk spectacles’ wherever I go and in whatever I do. Looking through such spectacles on the things that we typically consider as outside our technical areas reveals a deeper understanding of the issues around the risk management. I often look for answers in unexpected places.   In this book, I invite you to wear my ‘risk spectacles’ at home, outside – on the way to your office, and at work. I hope you enjoy this book that is different from the classic risk management literature.   Kevin O’Donnell, Market Compliance Manager at Health Products Regulatory Authority, Ireland, welcomes the book as a development in the field of quality risk management that focuses on understanding the cognitive processes that relate to risk assessment:   “In this excellent book, Dr. Kartoglu recognises the difficulties and problems in risk assessing and managing complex processes such as pharmaceutical supply chain management. While the application of quality risk management principles to supply chain control has been the subject of much work in recent years, the focus Dr. Kartoglu gives in this work to understanding the cognitive processes that relate to risk assessment, and that relate to how hazards and risks are perceived, render this work an important new approach in this area. He teaches readers how to actually think about hazards, not only in terms of their relationship with harm and risk, but also in terms of how human behaviour and cognitive processes can influence one's perception of those hazards, and the risks they may present. This is a very welcome development in this field, and it has definite relevance to the application of quality risk management principles in efforts to secure the supply chain of vaccines and other important medicines.”   Hope you find it useful.   Happy downloads…   Cheers and all the best,   UMIT

Dear TechNet-21 Community, ThinkWell and John Snow, Inc. (JSI) kicked off a 3-year project in September 2016 – the Immunization Costing Action Network (ICAN) – which is an exciting complement to the Harvard T.H. Chan School of Public Health’s EPIC costing and financing project. Funded by the Bill & Melinda Gates Foundation, ICAN aims to increase the visibility, availability, understanding, and use of evidence on the cost of delivering immunization services. As part of the project, we are embarking on a systematic review of the published and grey literature on the non-vaccine delivery costs of immunization programs in low- and middle-income countries. We’d like to ask for your contribution! Do you know of any grey literature that could feed into our systematic review, including in-progress or unpublished research studies, country reports and meeting/conference presentations, among others, written in English, French or Spanish and developed between 1994 and 2017? Please submit materials to us using the link to our secure file sharing site, Egnyte: https://collaborativedev.egnyte.com/fl/j3DfRJ0Ym3 We expect to produce: 1 A user-friendly unit cost data repository which will grant access to immunization delivery cost evidence. Our repository will be housed on immunizationcosting.org. You’ll be able to slice and dice the data to answer your own cost questions. 2 A publicly accessible library of the published and grey literature collected through the review so you can easily find the references underlying the repository. 3 Companion interpretive products such as how-to guides and webinars to help you navigate the repository, data visualizations to make quantitative data quickly intuitive, and/or analytical fact sheets and narrative snap-shots to help ensure you have a deeper understanding of cost variations and cost drivers across different contexts. 4 Unit cost benchmarks which will allow you to see estimates of the costs per dose, per fully immunized child, per infant in the target population, or per capita across different country contexts, delivery strategies, coverage levels, and platforms for different vaccine schedules and for potential new vaccine introductions. 5 Peer-reviewed papers published in open source journals that report our descriptive, gap, and pooled analyses. Thank you in advance for your contributions to our systematic review. The ThinkWell project team

A new open-access tool, Immunization Financing Resource Guide, is now available for advocates, policymakers, and program managers in low- and middle-income countries. The guide includes 26 briefs, including 8 country case studies, and covers a range of topics such as evaluating the pros and cons of potential sources of financing; understanding and planning for the costs of immunization programs; assessing which vaccines to adopt; getting more value for money through improved purchasing and procurement practices; and building broad political support for these programs. The guide was produced by Results for Development, based on research funded in part by the Bill & Melinda Gates Foundation.

At countries’ request, WHO has worked with UNICEF and PAHO to enhance transparency of vaccine prices, through the creation and maintenance of the Vaccine Product, Price and Procurement Initiative (V3P). Thanks to the hard work of colleagues and partners, last year 51 countries have shared their vaccine price information with the V3P database. Together with the data shared by PAHO and UNICEF, the V3P database now provides visibility to prices accessible to 70% of the world. All the data and analyses are directly accessible on the V3P website. In order to facilitate access to price information, WHO EPI has created the following three documents: -WHO Price report 2016: this is a standalone version of the pricing section (also known as the “GVAP price report͟”) published annually as part of the GVAP Secretariat report. It provides a short overview of vaccine pricing and trends. - V3P price Digest 2016: the price digest is a directory of vaccine prices and is meant to ease access to the price information available on the website. The Digest presents vaccine price data points and ranges from the V3P database per vaccine, with an emphasis on those that are posing the biggest affordability issues. The extracted tables are complemented by procurement and pricing analyses on each vaccine. -Factsheet on vaccine pricing for Gavi transitioning countries 2016: countries have brought to our attention their challenges in accessing information about price commitments by manufacturers for countries transitioning out of Gavi support and for fully self-financing countries. This factsheet aims at clarifying the manufacturers’ price commitments and presents prices accessible to each of these countries. The documents are attached here and available on the V3P repository webpage, at: http://www.who.int/immunization/programmes_systems/procurement/v3p/platform/module2/en/ . Use them and disseminate them broadly to anyone who could benefit from increased knowledge of vaccine prices! Please feel free to share any feedback on these documents to: V3P-project@who.int. Best, Stephanie.

Happy new year all, We are happy to announce that the latest version of the Total Cost of Ownership tool for cold chain equipment (v1.3) is now available to download and use. The latest version has a few minor changes to the presentation of data as well as the latest PQS pre-qualified equipment as of December 2016. Please download the latest version (in English or French) for the most up to date products and pricing. http://www.path.org/publications/detail.php?i=2576 If you have any questions or would like any training/demos please email Matt Morio mmorio@path.org

Dear colleagues,
Recently, I finished the review of " Guidelines on stock records for immunization programme and vaccines store managers" which come with accompanying CD-ROM - I coudn't find it - including electronic versions of the stock management forms.
With our approach to start a new EPI programe, it will be very helpful if you can provide us with this excel file (Linked to CD-ROM or software copy) .
Best;

Presently the dose of rabies immunoglobulin (RIG) which is an integral part of rabies post exposure prophylaxis (PEP) is calculated based on body weight though the recommendation is to infiltrate the wound(s). This practice demands large quantities of RIG which may be un- affordable to many patients. In this background, we conducted this study to know if the quantity and cost of RIG can be reduced by restricting passive immunization to local infiltration alone and avoiding systemic intramuscular administration based on the available scientific evidence. Two hundred and sixty nine category III patients bitten by suspect or confirmed rabid dogs/ animals were infiltrated with equine rabies immunoglobulin (ERIGs) in and around the wound, the quantity of ERIG used was proportionate to the size and number of wounds irrespective of their body weight. They were followed with a regular course of rabies vaccination by intra-dermal route. As against 363 vials of RIGs required for all these cases as per current recommendation based on body weight, they required only 42 vials of 5ml RIG. Minimum dose of RIGs given was 0.25ml and maximum dose given was 8 ml. On an average 1.26 ml of RIGs was required per patient that costs Rs. 150 ($3). All the patients were followed for 9 months and they were healthy and normal at the end of observation period............here is the link......................

http://www.ncbi.nlm.nih.gov/pubmed/26317441

Dr. Omesh K Bharti, Simla, HP, India
+91-9418120302

http://www.technet-21.org/en/resources/technet-resource-library/

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 publishing of "Theory of Change for Supply Chain Capacity Development" by P. Steele and A. BrownAs we move into the Sustainable Development Goals era and in order to achieve sustainable improvements in the health supply chain,international development organisations will need to think seriously about their investments in capacity-building initiatives and the significant change they desire, as well as the impact of that change and how it will be measured.Pamela Steele Associates Ltd are very pleased to share the news of the publishing of "Theory of Change for Supply Chain Capacity Development" by Pam Steele and Andrew Brown.
The book describes a holistic and practical approach to formulating strategies for strengthening national-level supply chain systems in sustainable manner.
"Theory of Change for Supply Chain Capacity Development" is available through Amazon:https://www.amazon.co.uk/dp/1533018766/ref=cm_sw_r_fa_dp_ymYvxbK748ZT5
You can reach the authors by emailing info@pamsteele.co.uk .

Regards,
Sara A Khan
Strategic Communications OfficerPamela Steele Associates Ltd
e:sara@pamsteele.co.uk | skype:SaraKhanPSAPrama House, 267 Banbury Road, Oxford, OX2 7HT, United Kingdomwww.pamsteele.co.uk | Office: +44 (0)1865 339370 | Fax:+44 (0)1865 339301
Follow us on LinkedIn, Facebook and Twitter @PamelaSteeleLtd.

Pamela Steele Associates Limited (PSA) is a company registered in England& Wales with company number 8531307.

Sharing the news of an article publish in Vaccine on the impact of system design in Niger.

Abstract
Objective
To evaluate the potential impact and value of applications (e.g. ordering levels, storage capacity, transportation capacity, distribution frequency) of data from demand forecasting systems implemented in a lower-income country's vaccine supply chain with different levels of population change to urban areas.
Materials and Methods
Using our software, HERMES, we generated a detailed discrete event simulation model of Niger's entire vaccine supply chain, including every refrigerator, freezer, transport, personnel, vaccine, cost, and location. We represented the introduction of a demand forecasting system to adjust vaccine ordering that could be implemented with increasing delivery frequencies and/or additions of cold chain equipment (storage and/or transportation) across the supply chain during varying degrees of population movement.
Results
Implementing demand forecasting system with increased storage and transport frequency increased the number of successfully administered vaccine doses and lowered the logistics cost per dose up to 34%. Implementing demand forecasting system without storage/transport increases actually decreased vaccine availability in certain circumstances.
Discussion
The potential maximum gains of a demand forecasting system may only be realized if the system is implemented to both augment the supply chain cold storage and transportation. Implementation may have some impact but, in certain circumstances, may hurt delivery. Therefore, implementation of demand forecasting systems with additional storage and transport may be the better approach. Significant decreases in the logistics cost per dose with more administered vaccines support investment in these forecasting systems.
Conclusion
Demand forecasting systems have the potential to greatly improve vaccine demand fulfilment, and decrease logistics cost/dose when implemented with storage and transportation increases direct vaccines. Simulation modeling can demonstrate the potential health and economic benefits of supply chain improvements.

Dear friends, Gavi, the Vaccine Alliance is very pleased to present the Cold Chain Equipment ‘Technology Guide’, to support the appropriate selection of modern, efficient and reliable technologies. Download the guide here.
Identifying the most appropriate equipment choices for each health facility is key to help ensure more facilities have adequate cold chain capacity, and that more facilities also have higher performing equipment that stays functional for longer periods of time. This in turn will help increase access to immunisation as well as greater vaccine safety and potency, and contribute to improvements in immunisation coverage and equity.
Developed by technical assistance providers, the Technology Guide offers comprehensive and regularly up-dated information on cold chain equipment and technologies and how to choose the solutions that meet the needs of each health facility. The Technology Guide covers the range of optimised on-grid and off-grid refrigerators and freezers. It also covers other new technologies such as new passive cooling devices and temperature monitoring solutions. The Guide provides clear advice and structured approach to CCE decision-making is intended in particular for use in health facilities and at lower levels of the cold chain.
The Technology Guide is also available as part of the TechNet ‘Cold Chain Equipment Management - Technical Resources’ page here.
The Technology Guide also explains which devices comply with the requirements of the recently launched Gavi Cold Chain Equipment Optimisation Platform. Platform eligible equipment and technologies include innovation that has been achieved via quality assurance provided by WHO Performance, Quality and Safety (PQS) specifications and additionally establishing target product profiles (TPPs) designed to ensure manufacturers also bring the next generation of equipment needed by countries. Click here for more information on the Platform, which is a new form of support to countries to improve access to appropriate and high-performing cold chain equipment.

Outil de calcul du Coût Total de Possession d’équipements de la chaîne du froid
L’outil de calcul du Coût Total de Possession (CTP) d’équipements de la chaîne du froid a été développé afin d’assister les utilisateurs dans leur compréhension du coût d’achat et de maintenance des équipements de la chaîne du froid. L’outil peut être personnalisé pays par pays et calcule les dépenses en capital et en coûts d’opération pour les équipements préqualifié par le département Qualité et Sécurité de l’Organisation Mondiale de la Santé.
Pour accéder le CTP cliquez ici: https://www.path.org/publications/detail.php?i=2576

Dear Viewers On this eve of Ugadi and launch of IPV era, also expressed as 3rd phase of Mission Indradhanush(MI) by a few, we wish to share Making of Mission Mode learnt by practically doing and working together with grass-root level service providers since 2012 till date. The tool was born spontaneously through the approach of working together, named as enumeration format during IRI Simulation study. Later, on demand by the Karnataka ANMs Immunogram version was born which revealed very high Full Immunization Coverage (FIC) below one year, low coverage of Measles 2nd dose and HepB birth dose vaccination. It was extended to improve the coverage of Newborn Vaccination (NbV) and replicated in a difficult district - Chikkaballapur. On launching MI, in the first phase, same extended Immunogram tool blended with approach of learning by doing and working together was used, conducted MI simulation study (MISS Sampaje) and learnt 10 new lessons, shared and disseminated. We compared the results of MISS Sampaje with that of 2 planning units who completed MI between Oct 2015 and Jan 2016 with forms and formats. There were significant gaps in the achievement of critical performance indicators – explained to the ANMs of 2 planning units, shared with all and technet viewers as “Impact of Tool and Approach…” ANM Sarala of Guthugar and Srilatha of Sampaje further upgraded the tool to ‘register’ named as “Saral” Immunogram to honor their contribution, includes latest National Immunization Schedule, State specific – incorporating 2 doses of IPV to be administered from April 2016. In this, children of IPV era will be recorded. This can address 5 issues. Expenditure is minimal i.e. less than Rs 2/- per ASHA and AWW and Rs 5/- per ANM for “immunogramming” one year vaccination data. Thus the expenditure is marginalized by the ANMs. ANMs of all 3 PHCs will use this till they receive printed register from the Govt as a temporary measure to protect vaccination data from losing. I express my indebtedness to all the 22 ANMs and the MOs of these 3 planning units for contributing in the “MAKING OF MISSION MODE”: attached for viewers' review and editing please. With regards to all viewers Holla

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

Dear viewers Context: India in collaboration with development partners like WHO/UNICEF/USAID/MCHIP etc has made remarkable advances in the last ten years: introduction of Measles 2nd dose, HepB vaccine including Birth dose vaccine, JE 2 doses, Pentavalent vaccine, year 2012-13 declared as year of Intensified Routine Immunization, India with SEARO declared as Polio Free, launching of Mission Indradhanush – the flagship programme of India. Karnataka Piloted Immunogram in a difficult district in 2013. India is now entering in to a new era of introducing Injectable Inactivated Polio Vaccine under routine Immunization from 1st April 2016 as part of Global Endgame Strategic Plan. India Expert Advisory Group, based on evidences recommends 2 fractional doses of 0.1ml intradermally at 6 and 14 weeks in selected States including Karnataka. Injectable vaccine has VVM on the label and MDVP / OVP is made applicable to minimize wastage, to be operated at all levels. Background: Globally immunization programme is rapidly expanding in covering more beneficiaries from newborn to the old through children, teenagers and pregnant; administering the doses close to the recommended schedule for timely attaining adequate immunity – jointly closing population immunity gap – an aspiration of WORLD; including more and more vaccines in the National Immunization Schedule on the basis of country specific epidemiology of Vaccine Preventable Diseases (VPDs), periodically reviewed and revised / upgraded by the Expert Advisory Group / Committees of the countries, World is convinced about the advantages of vaccination in preventing morbidity and mortality form VPDs like neonatal / puerperal tetanus, crippling polio & post encephalitic residual paralysis of JE, Diphtheria, Whooping cough, measles, childhood tuberculosis, pneumonias, diarrhoea, Varicella, herpes zoster, Ca cervix, HCC, rabies etc. World has witnessed Smallpox eradication, Polio at the verge of eradication, measles under elimination – others declining and under control. But: Expenditure of vaccination is increasing & Vaccine wastage is rising. Hence: Countries all over the world expressed the concern to avoid “preventable wastage without compromising efficacy and safety” [WHO – MDVP 2014]. We wish to share the experiences of practically operationalizing MDVP / OVP guidelines in the attached planning unit - RHTC Sampaje in view of introduction of IPV in the country and the one page jobaid which we made in regional Kannada launguage, the same is now edited with new circular guideline, translated to english as suggetsed by consultants form ITSU also. This may please be edited / corrected further by the viewers. Regards Narayana Holla

PATH’s Total Cost of Ownership (TCO) tool for cold chain equipment is now available for download and use. The TCO tool is designed to help countries compare and understand the costs associated with the purchase, installation, and ongoing operation of cold chain equipment. The tool currently covers 82 cold chain equipment devices including all 72 PQS (Performance, Quality and Safety) prequalified devices from the E001 (cold rooms and freezer rooms), E003 (refrigerators and freezers), and the long-term passive devices under E004 (cold box and vaccine carriers) categories. Using local country costs such as labor and energy rates, the TCO tool calculates costs for purchasing and operating cold chain equipment over time through multiple views such as: cost over useful life, cost per liter of storage, and recurring operational costs. Additionally, the tool can incorporate facility segmentation requirements to match equipment and country needs. These features not only allow users to understand cost differentials of one technology versus another (absorption gas refrigerator versus solar direct–drive refrigerator), but they also provide the ability to drill down and compare costs on a model by model basis over a user-defined horizon from 1 to 20 years. The TCO tool can be downloaded from PATH via the following link: https://www.path.org/publications/detail.php?i=2576. After downloading, please check back regularly to ensure you have the latest version/updates. A large thank you to all who have contributed to our efforts developing the tool. The total cost of ownership tool for cold chain equipment was made possible with support from the Bill & Melinda Gates Foundation. Please send any questions or comments to Matt Morio mmorio@path.org.

Health Affairs is a leading journal of health policy thought and research. The peer-reviewed journal was founded in 1981 and explores health policy issues of current concern in domestic and international spheres. It occasionallydevotes issues to the in-depth exploration of particular policy topics. This month it focuses on vaccines.The special issue looks at the Decade of Vaccines, RoI on vaccines, vaccine shortages, etc. Please use the following link to access the articles: http://content.healthaffairs.org/content/35/2.toc

The newly launched Global Financing Facility (GFF) for Every Woman Every Child is a bold initiative coordinating a mix of donor funds, loans, and domestic financing for the purpose of accelerating country efforts to end preventable maternal, child, and infant deaths by 2030. Health supplies and the supply chain systems that deliver them, however, are often afterthoughts in these efforts. “Global Financing Facility: Advancing Smartly Means Keeping an Eye on Family Planning Products and the Supply Chains that Deliver Them,” a new blog post at The Pump, JSI’s online hub for public health news and opinion, focuses on this issue and acts as a reminder that the sort of work performed by the USAID | DELIVER PROJECT is essential in closing the US $33.3 billion annual financing gap for reproductive, maternal, newborn, child, and adolescent health. Read the blog at http://bit.ly/1nlNGK2

In 2015, Peru’s Ministry of Health (MOH), in partnership with the USAID | DELIVER PROJECT, implemented and co-funded a costing study for warehousing and transportation in La Libertad Region. The study helped document, for the first time, the specific warehousing and transportation costs of a sample of 304 preventive and life-saving medicines in La Libertad. After the study, the Minister of Health, the Director of Logistics Unit for Strategic Medicines (DARES), and health region Directors committed to implement the costing methodology in the rest of the country. Learn more about the study at http://bit.ly/1PohZqx(in English and Spanish)

Hi all, I just wrote a blog on PATH's DefeatDD.org called "Getting to 'Mars' with immunization delivery," which I thought might be of interest! I really enjoyed the recent blockbuster movie,The Martian. Andas a vaccine advocate supporting PATH's advocacy for stronger immunization supply chains project, I drewa parallel between the coordination, planning, and logistics that it would take for NASA to get humans to Mars (as portrayed in the movie) and the coordination, planning, and logistics that it takes to deliver lifesaving vaccines to every community around the world. If we want to reach our "Mars" of reaching every child, everywhere with vaccines, we need to focus on supply chain workers (or "astronauts"), high-tech cold chain equipment (spaceships), and data for decision-making (control centers). Hope you enjoy. :) -Laura   Laura Edison, MPH Scientific Communications Associate Vaccine Access and Delivery, PATH

The V3P project aims at collecting, publishing and analysing vaccine product and price information. This year, 40 countries have shared data with V3P. Combining information shared by countries, PAHO and UNICEF, the database provides price information on more than 170 vaccines. If you wonder about the price range of vaccines in various income groups, if you would like to know more about the evolution of vaccine prices overtime, if you are currently working on budgeting and financing and would like to use real and current prices for your analyses: come check out the new V3P price database. To access the database, click on the link to the V3P web platform: www.who.int/immunization/v3p, and then follow “Price database” and “Database reports and analyses”. Please feel free to share any comment or question on V3P and vaccine pricing on this forum or at: v3p-project@who.int.