by Osman Mansoor and Kate Bai, UNICEF; Andrew Garnett, Consultant; and Solo Kone, WHO In December 2011, the United Nations Children’s Fund (UNICEF) hosted a workshop in New York for the Cold Chain and Logistics (CCL) Taskforce. The main focus of the workshop was to review the Effective Vaccine Management (EVM) Assessment Tool and methods. Participants also reviewed a guidance mapping effort for CCL tasks and discussed plans for increasing UNICEF support for CCL as part of a refocus on immunization supported by UNICEF’s new equity agenda. EVM review The EVM Tool, jointly launched by the World Health Organization (WHO) and UNICEF in Cairo, Egypt, in July 2010, provides a standard way to systematically assess the cold chain and logistics (CCL) system and address areas that need improvement. It builds on lessons learned from earlier assessment tools (Effective Vaccine Stores Management and Vaccine Management Assessment) to provide a more comprehensive assessment of the immunization supply chain. The EVM assessment and improvement plan are prerequisites for GAVI Alliance support, and with GAVI funds WHO and UNICEF have supported over 20 national EVM assessments in 2011. The partners aim to complete one in every GAVI-eligible country by 2015. The CCL workshop captured lessons learned and suggestions for improvement from the experience to date. Stakeholders submitted detailed input on the questionnaire, software bugs, language translation, and visual presentation of the tool. Their broader input related to the size and scope of the tool. In addition to the detailed review of the questionnaire, the workshop recommended a range of measures to improve the quality of the EVM assessment, starting with adequate preparations and composing the right team to do the assessment. These suggestions will be captured in a concept note to highlight recommended practices. The workshop also identified the need to improve templates for the EVM assessment and the ensuing improvement plan and to make sure the plan deals with the major issues identified in the review. Participants suggested that a model report based on the best aspects of improvement plans submitted to date would be helpful for countries and lead assessors. The EVM provides an assessment of performance over the past 12 months but can also be used to look forward strategically at how to best meet CCL needs over the next five to ten years. Instead of simply fixing problems in the current system, the EVM focus on CCL can also be used to develop a vision and plan for a future, optimized CCL system. Perhaps the most important discussion was on the need to have an EVM Secretariat support the field work, maintain the EVM database, carry out further data analysis from the EVM results, and update the EVM tools and methods based on feedback from the field. The data from the EVM tools are also a rich trove of data that offer the potential for broader use. CCL guidance mapping One of the tasks the CCL Taskforce has set for itself is to develop a mapping of guidance for each of the tasks the CCL System undertakes. The initial aim is to map existing WHO guidance for each task in a way that is accessible and user friendly, which will provide health workers with simple, clear, and concise guidance for each task. The initial mapping has now largely been completed, and the workshop provided an opportunity for experts to review the content. Based on the reviews received, the guidance will be updated and then tested by potential users before finalization by the CCL Taskforce. The guidance material will then be transferred to TechNet21 where it will continue to develop based on user feedback and new technical developments. UNICEF “scale-up” UNICEF shared its developing plans for scaling up immunization services with participants, with a focus on the CCL aspect of the plan. The workshop supported UNICEF’s proposed approach with its focus on establishing national systems that generate routine data. The initial focus is on systems for managing vaccine stocks, cold chain equipment, and temperature monitoring. UNICEF is building on the work of project Optimize to introduce innovative approaches and has adopted the vision developed by Optimize to “meet the changing needs of a changing world to enable the right vaccines to be in the right place, at the right time, in the right quantities, in the right condition, at the right cost” (“the six rights”). The three systems that generate routine data (stocks, equipment, temperature monitoring) can be relatively easily established, and the data they generate can be used not only to assess system performance but also managerial responses. UNICEF is now developing a paper on monitoring temperatures using 30-day temperature recorders to detect and prevent heat and freeze damage to vaccines. The CCL Taskforce, an interagency collaboration convened by UNICEF of agencies and experts involved in supporting national CCL systems in developing countries. (For more information, including previous meeting reports, see http://www.unicef.org/immunization/index_42071.html) Photo: UNICEF To comment, click reply.