POST 01259E: REPAIR/NON-REPAIR OF COLD CHAIN EQUIPMENT
29 APRIL 2008
Follow up on posts: POST 01258E, 01257E, 01254E
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Nasim Ahmed spells out his observations based on a cold chain survey and inventory and states that there are several factors justifying repair or non-repair. I have requested that the comprehensive cold chain survey carried out in Uganda in 2007 be shared with the TechNet subscribers. Other readers are invited to share outcomes of cold chain inventories/surveys in their countries too.
John Lloyd suggests local repair for minor failures and replacement when the equipment breakdown is major and there is no easy access to repair facilities. But replacement should be backed by environmentally sound scrapping. He also calls for R&D when it comes to reconstituted vaccines and cooling in the field.
Robert Steinglass asks TechNet readers to share their experiences with regard to advantages and disadvantages of contracting with the private sector on repair and maintenance.
Fred Willis cautions that the effects of a 'blanket' policy stating 'Faulty equipment equals Replace' need to be considered and suggests that the economic and environmental criteria suggested by Terry (POST 01258E) be spelt out.
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SEVERAL FACTORS DETERMINE THE REPAIR NON-REPAIR DECISION
I have been reading with interest several postings made on the issue of repairing and non-repairing of cold chain equipment. In the later part of 2007, a comprehensive survey and inventory of all cold chain equipment in Uganda were carried out by physical inspection to each and every health facilities in the country. The exercise was carried jointly by UNICEF, WHO, PATH and MOH Uganda. The CCM tool developed by PATH was used, and report with its recommendation should be available through each of the participating agency.
The finding is so exhaustive that it will provide an insight (into) the basic problem of repair and maintenance of the equipment, the magnitude of non-EPI standard equipment being used in the system for vaccine storage, varied type of equipment used from gas, electric, solar, absorption type, compression type etc, etc. It also highlights the repair, spare parts, maintenance facilities (major and minor) at central as well as in district level.
However several factors are there to justify repair or non-repair of cc equipment particularly in third world countries that heavily depend on donors fund to buy and replace existing equipment. [ol]>Ø we should move away from manual reconstitution at the point of use (R&D on auto-reconstitution and liquid alternatives needed)
Ø we should seek other ways to cool the reconstituted vial of multi-dose vaccine than ice (R&D needed)
Ø we should re-examine the necessity, notwithstanding the current WHO guidance, to pre-cool diluent for single dose reconstituted vaccine presentations (R&D needed)
Until the necessary R&D can be done, we are stuck with the restrictive SOPs that we have.
Interesting debate, thanks!
John Lloyd ([email=Lloyd,%20John%20%[email protected]%5d]Lloyd,%20John%20%[email protected]%5d[/email])
PATH
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SHARE COUNTRY SPECIFIC CC MAINTENANCE EXPERIENCES
Dear Padmini,
At the end of his message, John Potts says, “An alternative to new for busted policy is to have a contract with a local Frig/freezer repair company but this in my experience is also fault with problems and difficulties.”
I believe this is an interesting approach on which TECHNET readers can contribute their experiences so that countries can learn the advantages and disadvantages of contracting with the private sector on repair and maintenance.
Robert Steinglass ([email=Robert%20Steinglass%20%[email protected]%5d]Robert%20Steinglass%20%[email protected]%5d[/email])
IMMUNIZATIONbasics (JSI)
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LET US NOT CONSIDER COLD CHAIN IN ISOLATION
I quite agree with Terry about looking at other considerations before formulating a policy guideline on repair/non-repair of cold chain equipment. I have had opportunity to work in immunization logistics in Kenya, Nigeria, Ethiopia and now back in Nigeria and I know that in many developing countries, some forms of maintenance structures exist at various administrative levels of the healthcare system. In Kenya for instance, we have provincial and district hospital maintenance units that are equipped and staffed (in most cases) to undertake repairs on cold chain equipment. These workshops were set up with the assistance of GTZ in the 1990s and later handed over to the MOH but a good number of them are still functional. Nigeria on the other hand has its challenges mainly rooted in difficulties of coordination across administrative levels of the federal system, apart from poor maintenance culture not only with reference to cold chain equipment. In addition, there will be need to consider the effects of a 'blanket' policy of 'Faulty equipment equals Replace'. Such a policy in my view will, at least in many developing countries, be good for the manufacturers but probably an unnecessary diversion of meagre resources from more pressing immunization/health needs to cold chain procurement.
To conclude, I think Terry's suggestion gives us the best opportunity to approach this in a more rational way. I hope that the environmental and economic criteria suggested by Terry would be expanded to include a look at existing maintenance structures for healthcare systems (both government operated and private) and exploring opportunities for integration. I think this will be a little less expensive than looking at cold chain equipment maintenance and repair in isolation. After all, a cold chain equipment healthcare service delivery equipment...
Fred Simiyu Willis ([email=Fred%20%[email protected]%5d]Fred%20%[email protected]%5d[/email])
UNICEF, Nigeria
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