Dear Rafael Hernan Rivera
Thank you sir for the response. As you said vaccines need to be staked between 2 to 8 degree C in the cabinet space, need not be as per the gradient. But in the training modules the packings' are kept in tiers as per the gradient and one above the other. To remove OPV / Measles / BCG from the bottom basket, the upper baskets along with all vaccines are to be kept in the room - usually on a cot / table nearby subjecting to TEs. In one of the blocks in North state, outreach session per month in a planning unit was >330. Not so in Karnataka state. Long back in 2011 I posted regarding keeping vaccines in the cabinet space in containers - one per vaccine.
In the planning units in Karntaka, on an average for 25,000 population, annual target of 0-1 year children is not more than 500, monthly not more than 42. No single vaccine vial is required >10-12. A carton has average 50 vials and hence no planning unit will receive vaccines in cartons (original packings'). They receive loose vials. IPV vials have often either 25 or 50 ID doses of 0.1mL per dose. Required vials per month is 2 (50 dose ID) or 4 (25 dose ID). Dummy cartons are not available. Holes are made mainly because the container is made "useless for any other purpose!!"
A couple of years back I shared a ppt on "Utilization of cold space". I wish to share the same with you purely for technical sharing / improving from my side.
In the picture, ice-lining is concealed, extra icepacks are in the chamber as the vaccines quantity is too low e.g 2 vials of IPV for one month.....
Other points I do agree with you but in India to get ILR which is available with public sector is very difficult. Deep freezers are available. Locally made are available but costlier. Hope in the future with PPP, public sector may extend the right equipment blended with proper training of cold chain handlers and extended supportive supervision to the private sector.
regards
Holla