By -Tesfaye Tsigu
UNICEF has procured, delivered and installed greater than 100k optimal cold chain equipments in low and middle-income countries over the past few years. UNICEF collaborates with GAVI, WHO, Governments and other partners to strengthen the health system of those countries.
Purpose of the research was to assess the impact of health system strengthening on immunization outcome.
Summary: The effect of solar direct derive (SDD) from cold chain equipment on the quality and equity of health facilities’ immunization services is assessed using descriptive and explanatory research design by collecting data using a structured questionnaire from health workers in health centres and health posts of 56 purposely selected health facilities in Ethiopia. Quantitative data were collected from the EPI registry for the year 2014 as a baseline, and a follow-up review was made for the year 2018 performances.
It was found that the new cold chain equipment, SDD refrigerators have a positive and significant effect on improving equity (Penta 3 coverage) and quality (Penta 1 -Measles dropout rate) of the immunization service. This helps to reduce the number of zero dose children.
UNICEF has procured, delivered, and installed greater than 100K Ice lined and Solar Direct Derive refrogerataors through the GAVI CCEOP and COVAX platforms. UNICEF hasl also procured CCEs through other partners support, the UNICEF program and procurement services.
We would like to hear from you about the Country's experience reg the programmatic effect of these cold chain equipment, which are installed in the health facilities.
This research brought some evidence how the optimal CCEs impacts the immunization performance.
Many thanks,Tesfaye
Great initiative and good report.
One clarification regarding fridges?
The report specifically reviews SDD (Solar Direct Drive) technology fridges which have similar eutectic storage capabilities to "temperature hold over" Vaccine Fridges as commonly defined by WHO PQS protocol. Most "Vaccine" fridges today have temperature holdover capability that exceeds 48 hours in the event of no or interupted electricity power supply. These temperature hold over type fridges utilise different sources of energy, solar power being one. Other sources are generated electricity sourced from country power stations or generators. The report specifically shows the benefit of SDD technology yet I get the impression that any form of "Vaccine" fridge with temperature hold over capability would deliver similar results (if central country elecricity supply is available, even with 2 hour power interuptions). SDD type power is based on between 6 and 8 hours of solar generation time / day, implying that 'off time' of between 16 to 18 hours / day when no power can be generated.
Is my assumption correct that a modern 'Vaccine" fridge with temperature holdover would achieve similar results as the implied SDD fridges?
Thanks a lot, Michael, for your message.
I also appreciate you brought this topic forward. As you rightly mentioned, this study mainly focuses on SDD refrigerators, and the evidence generated is also related to it.
The power source as specified in the study is:
1. Approximately only one-fourth of health facilities (23%) have a power source (e.g., electricity, generator, solar or other), and power is interrupted in less than two h/day.
FYI- In Ethiopia, there is more than 3,500 Health center
2. Only 10% of the health posts were least likely to have a power source.
FYI- In Ethiopia, there is more than 16,000 health posts.
Which means access to the on-grid power in Health facilities is the major challenge eventhough the hold over time is long for both ILR and SDD refrigeratrors, as reflected in the WHO PQS.
Hence, In my opinion, the study needs to be replicated in ILR (ice-lined refrigerators) in other low and middle-income countries. Because in addition to the hold over time, other factors must be considered.
TechNet members' comment and opinion is highly apprecaited!
Many thanks, Tesfaye
Thanks for such a great piece of work, Tesfaye!
This is very helpful for similar studies to be conducted in the area aimed at digging out further and learning more on the findings.
Regards,
Agumas,
Vaccine Management Specialsit/ Consultant
EPSS/UNICEF
Dear Tesfaye
The experience of Colombia with SDD has been possitive a lot from 2008, i.e. 15 years ago. In my country there are 128.587 people with electricity between 4 and 12 hours per day only, aproximately the 52% of all territory is off grid and those zones are jungle, mountains with very limited and expensive access.
Before SDD, the Ministry of Health purchased solar refrigerators with deep cycle batteries and charging regulator, but the major cause of fail was those elements. Those batteries at the end was used to fishing by the lead and the useful life was less than 2 years max. Sometimes the charging regulator was bad connected or bad selected and generated a prior damage of the system, etc. Another advantage in the connection of the SDD is the Plug and Play connection, this mitigates mistakes on the installation.
A great advantage of have an SDD in the Health Center in those areas is to take into account all the vaccines for the population on the correct time, I mean, one strategy to have coverage is to do displacements each 3 or 4 months, but this doesn´t guarantees the vaccination properly to the people.
Best regards.
Dear Rafael,
I appreciate for sharing your experience in the context of colombia. This is heplful!
I also share your concern that a good national immunization roadmap is a driver to improve the quality and equity in the immunization program. I agree that the proper use of SDD and other cold chain equipments emanates from this strategy.
# Target to reduce the number of zero dose children.
Many thanks, Tesfaye
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