WHO guidelines recommend supervisory visits to all health clinics once a month. For some countries this is challenging and too expensive to organise for remote areas. The temperature data from the 30DTR devices need to be collected and reviewed in order for the EPI programme to have a realistic overview of the real cold chain capacity of the country.
Trained technicians doing rounds for data collection and routine maintenance
In Mali, where 30DTRs have been deployed throughout the country, a system has been established based on a network of trained staff, equipment, vehicles and data. According to a set schedule for data collection and routine maintenance of the equipment, trained teams of national technicians are downloading temperature monitoring data and maintaining the refrigerators. Each health facility is visited every three months and supervision, maintenance and corrective actions follow a three-month cycle. Although the frequency of data collection and data aggregation has up to three-month delays and the data collected only covers two out of every three months (since the 30DTR device, the FridgeTag2 only keep 60 days of data), this data can provide a reasonable overview of the working status of the refrigerators at the health facility level since current available resources do not allow for more frequent visits. The teams are equipped with tablets and transmit data to a centralized system as it is collected. During the supervisory visits, the technicians perform the following checks, added to their Standard Operating Procedures (SOP):
- The national serial number of the refrigerator and the 30DTR
- The functional status of the refrigerator
- The placement of the 30DTR within the refrigerator
They then download and transmit the collected data to the national logistics team. The files downloaded can be in pdf format and they can be converted to Excel for data manipulation. The pdf report also includes information on the ambient temperature that can be used for root cause analysis. Based on the data collected, the logistics specialist in Mali is able to generate a national scale temperature-based cold chain equipment performance diagnostic, which is used:
(a) as a monitoring and evaluation metric for newly installed refrigerators;
(b) to identify and prioritize existing refrigerators in need of repair or replacement.
This model places a heavy responsibility on the National Logistics team for the review of a huge quantity of data. However it presents the advantage of dealing with the temperature monitoring surveillance and the equipment maintenance and repairs system through qualified technicians who report to the central level and whose temperature and equipment monitoring tasks do not compete with other health delivery assignments.