Responsibilities and resources need to be appropriately allocated at each segment of the cold chain.
An efficient Temperature Monitoring system requires significant investment in managerial and process elements. It is a management system based on a network of individuals, tools, processes and resources that can a) detect issues when they occur, b) escalate to a responsible and empowered person who can coordinate the resources to resolve the issue.
Experience has shown that the efficacy of Temperature Monitoring (TM) is dependent on a strong system based on clear accountability (SOPs, job descriptions and supportive management), clear and effective processes (SOPs and training) and a good understanding of the device (through training), that must be built within the Expanded Programme on Immunization (EPI) to ensure that safe and potent vaccines are delivered and administered to children.
| ACCOUNTABILITY + PROCESS + DEVICE = SUCCESS |
Accountability: defines who is responsible for what and is the most essential element for TM.
A TM system can help placing responsibilities to where they should belong, shifting some responsibilities from the health workers to the district managers and regional managers who are more empowered to access resources to solve the more complicated and endemic issues.
As this table illustrates, the most critical responsibilities lie at the district level.
| User level | Responsibilities |
|---|---|
| Health worker |
Routinely monitor the CCE and associated TMD data; Escalate any CCE issue that cannot be resolved; In case of a high risk event, move the vaccines to protect them or quarantine them; |
| District Officer |
Ensure that health workers are properly equipped and trained to carry on their duties; Routinely review TM data records to a) check for issues and b)ensure proper monitoring is occurring; When a CCE issue is escalated, coordinate the necessary resources and responses to resolve it; When vaccines must be moved, help coordinate the shift in location, and other mitigations activities. |
| National EPI |
Ensure that Districts and Health Facilities levels have clear accountabilities and processes for managing TM; Ensure that any necessary resources (TMDs, budget, training) are consistently available to the appropriate levels; On a reasonable basis, review Districts to ensure activities are being carried out appropriately. |
Once accountability is structured, an EPI program can design the processes for those roles, and ensure the resources to carry them out.
Processes: defining what the accountable people are expected to do.
Routine Systems: This is about clarifying the roles for tasks that happen every day/month, regardless of whether an issue arises. This includes:
- Daily monitoring of temperatures;
- Submission and review of monthly summary data;
Responsive Systems: This is about clarifying what to do when an excursion occurs, including:
- Immediate protection of the vaccine (Health Worker)
- Escalation of the issue (Health Worker)
- Accessing technician services for repair (District Officer)
- Testing and disposing of stock (District Officer)
Devices / Resources: what users need to carry out their responsibilities and associated processes.
In practice, that means each segment of the cold chain has:
- Sufficient training to understand and execute their role;
- Sufficient budgetary resources to pay for any services;
- The proper devices to monitor CCE.
It is important to emphasize both the routine and responsive aspects of TMC, and having structured protocols for each.