TechNet-21 - Forum

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

Discussions tagged Project / case study

INVITATION - WHO Global Routine Immunization Strategies and Practices (GRISP) Scholar Commencement Event

The World Health Organization Global Routine Immunization Strategies and Practices (GRISP) course team invites you to join our digital (online) Commencement Event to recognize the work and celebrate the achievement of the WHO GRISP Scholars Date: 12 December 2017 Time: 14h00 (2 PM) UTC+1 Geneva (check time) Registration: Training ID: 502-385-612 Contact: During this event: Commencement speakers will address course participants to recognize their work and achievement GRISP Scholar participants will present the action planning they have developed to implement a GRISP transformative investment in their country. Participants will also share their experience and insights gained from connecting with EPI colleagues from over 30 countries through intense dialogue and peer review. You are encouraged to download the invitation and share it with your colleagues and professional networks. This WHO digital course used the Scholar Approach, developed by the University of Illinois College of Education and the Geneva Learning Foundation to support effective learning for global health and humanitarian work. This approach combines community of practice, knowledge co-construction, and peer review to support project-based learning. It was first piloted in 2016 by WHO to support country-level action planning based on the Global Routine Immunization Strategies and Practices (GRISP) guidelines. The GRISP Scholar course will be offered in French in the first quarter of 2018.  

Upgrading supply chain management systems to improve availability of medicines in Tanzania: Evaluation of performance and cost effects

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.

Case Study: Change Management and Motivation for Immunization Training

A case study has been published to share information about some of the change management and motivational strategies deployed by UNICEF and WHO to support high levels of participation in the Immunization eLearning Initiative. The case study can be helpful for learning leaders looking for ways to increase self-paced training participation. The case study document also includes a checklist to help ensure that learning leaders are considering all the key elements of motivation to support successful training participation. We hope you find this resource beneficial. Remember that everyone working in support of Immunization -- including staff, SSAs, consultants, MoH, and other partners -- can now access the Immunization eLearning Initiative courses on UNICEF's online learning portal, Agora at Simply select login, register as a "guest" and search for keyword "Immunization" to locate all the courses. Start and stop without losing progress. Print or download a certificate following successful completion.

Linking the information silos: Tanzania’s HMIS – LMIS data exchange yields lessons for broader interoperability

As supply chain professionals working in the global health sector, we have heard countless requests and statements over the years to integrate data from HMIS and LMIS tools. This is partly to streamline reporting channels and to reduce the reporting burden, and partly to attempt to compare information between the two systems. Often this conversation is burdened by a lack of understanding about how the two data sets differ.

As countries adopt electronic information systems to manage HMIS and LMIS, it is easier to compare service and logistics data, and DHIS2 provides a useful platform for integrating and visualizing these data together.

With funding from the UN Commission on Life-Saving Commodities for Women and Children, JSI, University of Oslo, University of Dar es Salaam, and VillageReach worked with the Ministry of Health, Community Development, Genderly, Elderly and Children in Tanzania to develop an integrated dashboard to look at RMNCH and supply data together. This was achieved by adding a data feed from the eLMIS to DHIS2; two systems that had been deployed nationally in 2013–2014.

Read more about this ground-breaking work and the lesson learned onJSI's The Pump.

Implementing low cost solutions to rabid dogbite victims through research.......

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 is the link......................

Dr. Omesh K Bharti, Simla, HP, India

Third Regional Meeting to Share Lessons Learned in the Development and Implementation of Electronic Immunization Registries

Date:4 - 6 April 2016
Purpose:To share lessons on the planning, development and implementation of Electronic Immunization Registries (EIRs), as well as to socialize a draft document on the planning, design, development and implementation of a national EIR.
Summary:During this two and a half day meeting, participants discussed and shared their experiences and lessons learned regarding the development and implementation of EIRs. Furthermore, the meeting participants reviewed the proposed contents of a draft document under development by PAHO’s Improving Data Quality for Immunization (IDQi) Project.
Besides sharing experiences and discussing needed EIR functionalities, different EIR scopes and options for their development and implementation, meeting participants focused on making EIRs sustainable and useful to improve Immunization Program performance and efficiency, as well as a tool for better accountability. Issues regarding governance, legal frameworks, financial and human resources as well as how EIR and other immunization information systems fit into the countries’ overarching eHealth strategies were emphasized.
As mentioned in the objectives, PAHO is developing a practical guide on the planning, design, development and implementation of an EIR. This document responds to recommendations and regional mandates that support adopting information and communication technologies in health, and particularly EIRs and is drawing from successful experiences and lessons learned from countries of the Region. To this end, this third regional meeting to share experiences was very useful.
Participants:Representatives from 20 countries of the Americas, three from African countries (Gambia, Tanzania and Zambia), World Health Organization (WHO), the Bill and Melinda Gates Foundation, PATH and both the United States’ and European Union’s Centers for Disease Control and Prevention. ‏

Uganda Equipment Failure Investigation Report

In cooperation with the Uganda Ministry of Health, PATH recently conducted a pilot study to document equipment failures in the Uganda National Expanded Programme on Immunization cold chain. Due to our use of purposeful sampling to locate a subset of failed cold chain equipment in Uganda, conclusions about predicted failures cannot be drawn from our study report. However, after learning of the failures, one manufacturer (B. Medical) has agreed to replace the equipment assessed. The full report can be accessed here: Information from this report has also been added tothe Dulas VC65F revew here:

Impact of tool and the approach – A comparative study amongst 3 PHCs: Guthigar and Kollamogru of Dakshina Kannada Vs Sampaje of Kodagu

Dear viewers The Academic Society Meet scheduled on 23rd March 2016 is held today as the local Govt officials were unable to attend on 23rd March 2016 due to series of IPV & Bivalent switch training. On presenting the comparative study in the Academic Society Meet, we are sharing the same with the TechNet community for needful. Highlights: All 3 PHCs are good performing with >90% vaccination coverage - both primary and booster doses: the key objectives of Mission Indradhanush to be achieved by year 2020. However PHC Sampaje – the RHTC of KVG Medical College is operating Extended Immunogram since Jan 2013. Regular immunization sessions are held in “All Time Mission Mode” [ATM(M)], achieved ≥95% coverage in just 3 months and sustained till date without additional fatigue and budget. In the 2nd phase, Guthigar and Kollamogru PHCs of Dakshina Kannada implemented Mission Indradhanush between Oct 2015 and Jan 2016 for 4 months using GoI guidelines, forms and formats without MI specific tool. Govt expected this to be developed at peripheral level as happened in the past when newer H1N1 vaccine was supplied with guidelines but without micro-plan, declared IRI with guidelines but without specific micro-plan. What is conspicuous: Presence of short life fatiguing forms and formats and absence of long life, capacity building, mission mode generating, self sustainable tool in Guthigar and Kollamogru PHCs. Result: Comparison of critical Indicators of MI revealed that mobilization of due children by Sampaje are significantly higher than the 2 PHCs – Guthigar and Kollamogru who are deprived of proper tool and approach (p

Vaccine cold chain functional inventory and gap analysis: Iran (2011)

Many thanks to Mojtaba Haghgou for sharing this article with the forum.

Vaccine cold chain functional inventory and gap analysis: Looking at all existing cold chain equipment at one go
Ministry of Health and Medical Education, Iran, July 2011

By Dr. Mohsen Zahraei, EPI Manager and Mr. G. Zamani, Vaccine Logistics Manager, Ministry of Health and Medical Education, Iran, Mr. A. Yarparvar, UNICEF Country Office Tehran, Iran, Mr. M. Haghgou, Consultant

Iran delivers children immunization services through an advanced and integrated Primary Health Centre (PHC) system. Forty-six medical universities acting as provincial health authorities implement the health policies set by the Ministry of Health and Medical Education (MOH & ME). With absolutely no foreign assistance, Iran has reached 100% universal child immunization coverage for all vaccines over the last 20 years and this high coverage has been maintained. Polio has been eradicated in Iran and measles is under control.

Since all vaccine cold chain equipment is relatively old and needs to be replaced, in 2010, with financial and technical support from the UNICEF Country Office, the MOH & ME embarked on a project to evaluate the cold chain equipment; make a full functional inventory of all existing equipment; complete a gap analysis; and make a comprehensive plan for renewal of the vaccine cold chain. The findings of this survey will serve as the foundation for the comprehensive plan.

This survey was designed to register all equipment, from vaccine carriers to cold-rooms, back-up generators and vehicles for vaccine transportation at all levels and in all existing and working facilities throughout the country. In order to collect data, two separate questionnaires were prepared, field tested, and staff were trained to use them.

A total of 23,916 facilities at seven levels of PHC service delivery and storage facilities (provincial, district, urban, urban/rural and rural health centres and heath posts and health houses) were visited. Fifty-three items of information on all types of equipment, including capacity and condition of each unit, was collected. The survey also included 18 items of information on logistics required for planning, and staff’s educational level. A total of 269 cold and freezer rooms, 24,784 refrigerators and freezers, 2,948 cold boxes, 20,264 vaccine carries, 60 refrigerated vehicles and 175 back-up generators were registered and detailed information was collected. In addition, the educational background of 413 staff was evaluated.

The collected data were sorted and analysed with a goal-oriented approach. A computer interface was developed for data entry. The collected data from the questionnaires were loaded to the MOH & ME server by staff from all the 46 medical universities at the provincial level.

This survey is unique in its approach, the number of facilities visited and the amount of data collected and computerized. The principal investigators ensured that the methods used for the survey could be replicated elsewhere. Further, the structure of the report aims at providing a guideline for other countries and programmes to use the same approach. Although the results of the survey is for the national level, each medical university (province) or district will be able to access their own data and use them for their own purpose of analysis for provincial-level programming and planning. The collected data will remain on the portal of the MOH & ME and there is a plan to put in place regulatory frameworks for all medical universities (provinces) to update the data on a regular basis. This will provide an updated profile and a real-time inventory of the cold chain for the whole country.

As a by-product of this survey, an estimation of under-one migrant children covered by the PHC system together with the general population covered by the out-reach teams was obtained for each province and has been presented in the report.

The survey results indicated that most of the equipment is old and needs to be replaced. The investigators were impressed with how the equipment was still being effectively used and maintained and the fact that the full-scale programme was running.

The gap analysis compared the available equipment in good condition with what will be required in 2015 when the new vaccines are introduced into the routine immunization programme. The results from the survey suggested that cold storage capacity at the medical university and district levels was not a problem and that there would be adequate cold storage capacity for 2015 at the provincial and district stores except for a few rather less populated and newly established provinces.

However, there is a shortage of refrigerators, cold boxes and vaccine carriers at almost all levels. There is a need for an estimated 2,670 refrigerators, 2,627 cold boxes and 29,592 vaccine carriers in relation to the requirements in 2015.

Lack of a standard specification and purchasing policy for cold chain equipment, which has resulted in the procurement of diverse equipment, is one of the most important issues that needs to be addressed at the national level in order to harmonize the cold chain inventory.

Transportation does not seem to be a problem at present, though it may become an obstacle in 2015 for safe keeping of vaccines if no action is taken. Although there are 175 back-up generators in the system, the problem of automatic start-up devices is one of the issues that need to be considered.

In addition to developing a functional inventory of the vaccine cold chain equipment and identifying the gap, the survey also addressed issues related to:
• staff educational levels
• store building condition
• communication
• climate data

With regard to the conditions of the store building, it was found that 18 (39%) of the medical university (provincial) stores and 226 (62%) of district vaccine stores need to be made earthquake-resistant or they need major repair and renovation.

It was assumed that all facilities at the six top levels have adequate communication systems. However, no accurate data is available about the health houses (the lowest level of PHC service delivery) communication system. The survey shed light on this issue too. It was found that 50% of all health houses have a landline telephone connection.

Collection of data in relation to climate, which will be useful for selection of appropriate cold chain equipment, was also part of this survey and features in the report.

An accurate under-one population data for every district has been collected and used for estimation of the requirements in 2015. The surveys showed that only 1.4% of the health houses have zero under-one children. Whereas, the majority of the health houses (57%) cover a range between 10 and 50 under-one children. The average number covered by health houses is 22 under-one children per year.

The study also looked at the functioning of all health facilities, vaccine distribution methods, total annual number of vaccine shipments and maximum vaccine stock for each of the seven levels separately and the distance between stores and facilities. These are strategic data probably not accurately and comprehensively available, particularly at the national level, before this survey was conducted. Since the data analysis and report writing took relatively a long time and since the data will remain on the MOH & ME portal and should be updated regularly, developing software to generate reports and support the data analysis is envisaged.

The Iranian Ministry of Health and Medical Education is ready to share the full report with other countries and the principal investigators are ready to assist the other countries if they would like to conduct a similar survey.
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