Discussions marquées : Refrigerated vehicle

REPOST: Refrigerated vehicles in immunization programmes survey

Dear colleagues,

On behalf of the WHO Performance, Quality and Safety (PQS) Secretariat, we are delighted to invite your response to our survey on the use of refrigerated vehicles in immunization programmes.

Refrigerated vehicles are crucial in the delivery of life-saving vaccines. Programmes that depend on one or a small number of refrigerated vehicles may be seriously impeded if a vehicle breaks down or is unable to maintain the temperature range that is required for the safe storage of vaccines.

The purpose of this survey is to gather information on the performance of refrigerated vehicles that are at least three years old. This information will be used to help PQS develop standards for refrigerated vehicles that meet the needs of immunization programmes. The information you provide will be extremely valuable to WHO PQS and the WHO Expanded Programme on Immunization (EPI). The survey can be accessed by clicking on the following link: https://www.surveymonkey.com/r/PQSrefrigeratedvehicle. The survey will remain open until October 31, 2018.
Please complete this survey for each vehicle that has been in regular use for more than three years for the purpose of carrying vaccines or other temperature sensitive pharmaceuticals. Please provide any available photographs where prompted in specific survey questions, by uploading photos directly to this platform.

Should you require further information on the survey, please contact the PQS Secretariat at mallinsp@who.int.

The survey will take approximately 20 minutes to complete, depending on the extent of your free-text answers.

Kind regards,

WHO PQS Secretariat

When should Ministries of Health use refrigerated vehicles to deliver vaccines?

Dear Colleagues, You are invited to contribute to a new discussion on 'When should Ministries of Health use refrigerated vehicle to deliver vaccines?'. Discussion co-moderated by James Cheyne and John Lloyd: There are at least four good reasons for using refrigerated vehicles to replace the classic pickup trucks loaded with cold boxes: The number of vaccines used in national immunization programmes has roughly doubled over the past 20 years and the number of new vaccine introductions is likely to increasing at a similar rate over at the next ten years. Larger volumes of vaccines will need larger vehicles. Refrigerated vehicles with three or four times the carrying capacity cost about the same as a typical pickup truck including the cost of the cost boxes and ice packs. Refrigerated vehicles eliminate the need to freeze hundreds of ice packs for each trip. Furthermore, continuous temperature monitoring in refrigerated vehicles is likely to reduce the amount of vaccine frozen in transit Larger capacity vehicles are better adapted to make round trips to deliver vaccines to several remote stores, saving both fuel and time. There are also at least four reasons for retaining pickup vehicles that deliver the vaccine in cold boxes and not investing in refrigerated vehicles: Existing delivery routes can continue to be used without the need for new route planning and new training for drivers and heath staff. Refrigerated vehicles can be difficult to maintain and spare parts for both the vehicle and the refrigeration unit are not always easy to source. Even with good maintenance and repair services available a backup refrigerated vehicle is needed to keep the deliveries moving when the first vehicle is being serviced or repaired after an accident. When not needed for vaccine deliveries pickup vehicles can be used more economically for non-vaccine deliveries. The world is not this simple, though.  We would like your thoughts and opinions on when you think refrigerated vehicles can be more effective and also when pickup trucks with cold boxes on the back can be the better option.  Or, of course, we would like to hear of any other options you know about to delivering large volumes of vaccines simply and reliably. Finally, if you are already using refrigerated vehicles, please have a look at WHO’s survey of refrigerated vehicles.  The purpose of the survey is to gather information on the performance of refrigerated vehicles that are three years old or older:   https://www.surveymonkey.com/r/PQSrefrigeratedvehicle The information will be used to help PQS develop standards for refrigerated vehicle meet the needs and operating environments of immunization programmes. Your help will be extremely valuable to WHO PQS and the WHO Expanded Programme of Immunization (EPI). Best regards from John and James.  We are both looking forward very much to debating your thoughts, ideas and suggestions.  Many thanks.

Does your immunization programme use refrigerated vehicles to deliver vaccines?

Good morning, If your immunization programme uses a refrigerated vehicle WHO needs your insights and experience to help guide and improve the standards of these vehicles. Take this opportunity to share your expertise with the community and contribute to global improvements.  Please post your answers to TechNet-21 to three questions below: Excluding routine servicing, has the vehicle needed to be repaired over the past three years? Inside the refrigerated body have you needed to fit new shelving or change the method of securing the vaccine or pharmaceutical load?  Have there been any problems with the in-cab temperature monitoring of the vaccine storage compartment during the past three years? 'A Yes' or 'No' answer to each question will be very helpful but even more useful for WHO would a sentence or two describing in more detail the problem and the solution you have adopted. These three questions are taken from a more comprehensive survey posted on TechNet-21 at: https://www.technet-21.org/en/forums/discussions/refrigerated-vehicles-in-immunization-programmes If you choose to answer more answers in the survey, that would be best of all, of course! Best regards.  James Cheyne - contractor to WHO.

Take the PQS survey on the use of refrigerated vehicles in immunization programmes

Dear colleagues,

On behalf of the WHO Performance, Quality and Safety (PQS) Secretariat, we are delighted to invite your response to our survey on the use of refrigerated vehicles in immunization programmes.

Refrigerated vehicles are crucial in the delivery of life-saving vaccines. Programmes that depend on one or a small number of refrigerated vehicles may be seriously impeded if a vehicle breaks down or is unable to maintain the temperature range that is required for the safe storage of vaccines.

The purpose of this survey is to gather information on the performance of refrigerated vehicles that are at least three years old. This information will be used to help PQS develop standards for refrigerated vehicles that meet the needs of immunization programmes. The information you provide will be extremely valuable to WHO PQS and the WHO Expanded Programme on Immunization (EPI). The survey can be accessed by clicking on the following link: https://www.surveymonkey.com/r/PQSrefrigeratedvehicle. The survey will remain open until October 31, 2018.
Please complete this survey for each vehicle that has been in regular use for more than three years for the purpose of carrying vaccines or other temperature sensitive pharmaceuticals. Please provide any available photographs where prompted in specific survey questions, by uploading photos directly to this platform.

Should you require further information on the survey, please contact the PQS Secretariat at mallinsp@who.int.

The survey will take approximately 20 minutes to complete, depending on the extent of your free-text answers.

Kind regards,

WHO PQS Secretariat

Refrigerated truck monitoring systems - Measuring interval of logging

Dear Colleagues,
Could you please share any links for documents (regulations or guidelines) where disscussed measuring interval for refrigerated truck monitoring systems (print-paper loggers).
Оr please share practice in your country.
Thank you in advance,
Regards

Refrigerated vehicles and non cold items

Dear Colleagues Is there any guidance (ideally offical and/or anecdotal) on transportation of non cold chain items in refrigerated vehicles? Assuming vehicles have space, (are making journeys less than half full), are there any concerns about transporting non cold chain, vaccine related supplies (syringes etc.) together with vaccines? There are of course programmatic benefits to transporting these items together but can they compromise the cold chain due to their being at ambient temperature? If yes, would leaving them overnight in a cold room alleviate this? (All of this assuming best practices in loading and storing items) Does WHO or any other bodies have formal guidance on this? (I am unable to find this specifically) Are there any general industry guidelines or best practices? Thanks Paul Dowling Vaccine Supply Chain Transiiton Project, Ethiopia John Snow, Inc.

16 Technical Supplements to Annex 9: Model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products are published online

Umit Kartoglu Publié dans :
Dear All,

I would like to share with you the good news of the online publication of the “Technical Supplements to Annex 9: Model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products” (a total of 447 pages). Our dear friend Andrew GARNETT was the series editor for the 16 technical supplements in addition to authoring four and co-authoring one of the supplements. This whole work would have not been possible without him. It was an intense 2-years of work to put these documents together. I miss him dearly…

I would like to thank all authors for bringing these technical supplements to life. I am sure that they will fill a big gap in the management of pharmaceuticals and will be used as reference materials by many individuals, institutions, organizations, agencies and the industry. Please share the links as widely you can.


Introduction: Title

1. Selecting sites for storage facilities (Andrew Garnett): Title

2. Design and procurement of storage facilities (Andrew Garnett): Title

3. Estimating the capacity of storage facilities (Andrew Garnett): Title

4. Building security and fire protection (Clare Barker): Title

5. Maintenance of storage facilities (Andrew Garnett): Title

6. Temperature and humidity monitoring systems for fixed storage areas (Jean Bédard): Title

7. Qualification of temperature controlled storage areas (Jean Bédard): Title

8. Temperature mapping of storage areas (Jean Bédard): Title

9. Maintenance of refrigeration equipment (Richard Lawton): Title

10. Checking the accuracy of temperature control and monitoring devices (Claude Haffner): Title

11. Qualification of refrigerated road vehicles (Richard Lawton): Title

12. Temperature-controlled transport operations by road and by air (Kevin O’Donnell and Jim Bacon): Title

13. Qualification of shipping containers (Kevin O’Donnell and Ben VanderPlas): Title

14. Transport route qualification (Kevin O’Donnell, Susan Li, Mark Maurice, Ken Maltas, Sally Eggers, and Andrew Garnett): Title

15. Temperature and humidity monitoring systems for transport operations (Kevin O’Donnell, Patrick McGrath, Umit Kartoglu, and Denis Maire): Title

16. Environmental management of refrigeration equipment (Richard Lawton): Title


All documents can also be reached from http://www.who.int/medicines/areas/quality_safety/quality_assurance/distribution/en/ (scroll down to Technical supplements to WHO Technical Report Series, No. 961, 2011).

Cheers.

UMIT KARTOGLU

Optimize Choices for Vaccine Transport

This post follows another on in-country Vaccine Transport a week ago, inviting discussion of the post and suggesting we discuss a revision of vaccine transport temperatures around a single temperature requirement; +2C to +8C during 48 hours with excursions 100kgs) requires rolling and lifting trolleys which, in turn require smooth floor finishes and preferably no changes in level;
- Large or palletized air-shipment materials may be hard to handle, store and dispose if re-used at sub-national levels.

* Re-use of air-shipment palletized containers is usually associated with storing vaccines on arrival at the central store in their tertiary packing materials. This option is several times more bulky to store than unpacking the vaccine, but is often chosen by countries for ease of handling during reception and despatch.

In the scenarios that were studied in Senegal, the highest-cost option was the Dometic RCW25, the traditional vaccine cold box, due to its small capacity relative to the other potential container options and in most situations, its needless extra cold life performance. Furthermore, the model tested was not ‘freeze-free’ and it is probable that as this type of box reaches the market in freeze-free format the capacity for vaccine will be driven down even further.

John Lloyd
8th December 2014

EVM assessment highlights supply chain improvements in Vietnam

by Nguyen Van Cuong, NEPI, and Vu Minh Huong, PATH

Earlier this year, Vietnam’s National Expanded Programme on Immunization (NEPI) conducted an Effective Vaccine Management (EVM) assessment to evaluate the country’s immunization logistics systems. The results reveal that key improvements have been made since the previous assessment was conducted in 2009.

The EVM assessment and planning tool was developed by the World Health Organization to provide countries with the means to systematically assess their vaccine management processes. This can enable them to identify areas that need to be improved and focus their resources accordingly. An EVM assessment uses a structured questionnaire to evaluate a country’s supply chain at different levels using specific criteria based on good storage and distribution practices. The EVM assessment is just the beginning of a continuous process of improvement, and the assessment tool can also be used as a supervisory aid to monitor and support individual facilities on a regular basis.

The 2009 EVM assessment in Vietnam, conducted by NEPI with the help of project Optimize, highlighted several areas for improvement in the country’s vaccine supply chain. These included recommendations to improve vaccine arrival procedures, prioritize and strengthen standard operating procedures (SOPs) for vaccine management, and put in place a preventive maintenance plan for refrigerators. Since then, NEPI has worked hard to strengthen these areas and the findings of the 2012 EVM assessment indicate that these efforts have paid off. They also demonstrate the effectiveness of the EVM assessment and planning tool as a means for countries to improve their vaccine management practices.



Comparing results of the 2012 and 2009 assessments, we see that the national store has made significant improvements in establishing procedures for vaccine arrival, stock management, and distribution. The national store now meets the 80 percent target in all criteria, compared to just 18 percent in 2009. At the provincial level, results have been improved in most criteria, notably in vaccine management and storage capacity. Many of these improvements are due to the efforts that NEPI has made to strengthen and reinforce SOPs in various functions within the EPI. The EVM assessment has been a useful tool to identify these problems, enabling NEPI to prioritize and direct resources and training to resolve them.

Key recommendations of the 2012 EVM assessment include the following:
? Integrate the EVM assessment tool into regular EPI supervision at all levels, and urge managers to reinforce and regularly review areas identified in the assessment as needing strengthening.
? Improve temperature monitoring by upgrading the monitoring equipment for vaccine refrigerators, cold rooms, and refrigerated trucks at the national, regional, and provincial levels with devices capable of continuous temperature monitoring.
? Work to raise awareness of the importance of preventing vaccines from freezing, retrain staff to use the “shake test” to detect freeze-damaged vaccines, and provide freeze indicators for district-level refrigerators and for transport between province and district.
? At the district level, improve the time it takes to repair broken cold chain equipment.
? Disseminate SOPs widely to all levels so that staff are provided with specific and clear guidelines for vaccine management practices.

For more information, or to request a copy of NEPI’s 2012 EVM assessment report (available in English and Vietnamese), please contact Nguyen Dac Trung (dactrungn@gmail.com).

We encourage your questions or comments. Please click reply at the bottom of the page.

Vaccine cold chain functional inventory and gap analysis: Iran (2011)

Many thanks to Mojtaba Haghgou for sharing this article with the forum.

Vaccine cold chain functional inventory and gap analysis: Looking at all existing cold chain equipment at one go
Ministry of Health and Medical Education, Iran, July 2011

By Dr. Mohsen Zahraei, EPI Manager and Mr. G. Zamani, Vaccine Logistics Manager, Ministry of Health and Medical Education, Iran, Mr. A. Yarparvar, UNICEF Country Office Tehran, Iran, Mr. M. Haghgou, Consultant

Iran delivers children immunization services through an advanced and integrated Primary Health Centre (PHC) system. Forty-six medical universities acting as provincial health authorities implement the health policies set by the Ministry of Health and Medical Education (MOH & ME). With absolutely no foreign assistance, Iran has reached 100% universal child immunization coverage for all vaccines over the last 20 years and this high coverage has been maintained. Polio has been eradicated in Iran and measles is under control.

Since all vaccine cold chain equipment is relatively old and needs to be replaced, in 2010, with financial and technical support from the UNICEF Country Office, the MOH & ME embarked on a project to evaluate the cold chain equipment; make a full functional inventory of all existing equipment; complete a gap analysis; and make a comprehensive plan for renewal of the vaccine cold chain. The findings of this survey will serve as the foundation for the comprehensive plan.

This survey was designed to register all equipment, from vaccine carriers to cold-rooms, back-up generators and vehicles for vaccine transportation at all levels and in all existing and working facilities throughout the country. In order to collect data, two separate questionnaires were prepared, field tested, and staff were trained to use them.

A total of 23,916 facilities at seven levels of PHC service delivery and storage facilities (provincial, district, urban, urban/rural and rural health centres and heath posts and health houses) were visited. Fifty-three items of information on all types of equipment, including capacity and condition of each unit, was collected. The survey also included 18 items of information on logistics required for planning, and staff’s educational level. A total of 269 cold and freezer rooms, 24,784 refrigerators and freezers, 2,948 cold boxes, 20,264 vaccine carries, 60 refrigerated vehicles and 175 back-up generators were registered and detailed information was collected. In addition, the educational background of 413 staff was evaluated.

The collected data were sorted and analysed with a goal-oriented approach. A computer interface was developed for data entry. The collected data from the questionnaires were loaded to the MOH & ME server by staff from all the 46 medical universities at the provincial level.

This survey is unique in its approach, the number of facilities visited and the amount of data collected and computerized. The principal investigators ensured that the methods used for the survey could be replicated elsewhere. Further, the structure of the report aims at providing a guideline for other countries and programmes to use the same approach. Although the results of the survey is for the national level, each medical university (province) or district will be able to access their own data and use them for their own purpose of analysis for provincial-level programming and planning. The collected data will remain on the portal of the MOH & ME and there is a plan to put in place regulatory frameworks for all medical universities (provinces) to update the data on a regular basis. This will provide an updated profile and a real-time inventory of the cold chain for the whole country.

As a by-product of this survey, an estimation of under-one migrant children covered by the PHC system together with the general population covered by the out-reach teams was obtained for each province and has been presented in the report.

The survey results indicated that most of the equipment is old and needs to be replaced. The investigators were impressed with how the equipment was still being effectively used and maintained and the fact that the full-scale programme was running.

The gap analysis compared the available equipment in good condition with what will be required in 2015 when the new vaccines are introduced into the routine immunization programme. The results from the survey suggested that cold storage capacity at the medical university and district levels was not a problem and that there would be adequate cold storage capacity for 2015 at the provincial and district stores except for a few rather less populated and newly established provinces.

However, there is a shortage of refrigerators, cold boxes and vaccine carriers at almost all levels. There is a need for an estimated 2,670 refrigerators, 2,627 cold boxes and 29,592 vaccine carriers in relation to the requirements in 2015.

Lack of a standard specification and purchasing policy for cold chain equipment, which has resulted in the procurement of diverse equipment, is one of the most important issues that needs to be addressed at the national level in order to harmonize the cold chain inventory.

Transportation does not seem to be a problem at present, though it may become an obstacle in 2015 for safe keeping of vaccines if no action is taken. Although there are 175 back-up generators in the system, the problem of automatic start-up devices is one of the issues that need to be considered.

In addition to developing a functional inventory of the vaccine cold chain equipment and identifying the gap, the survey also addressed issues related to:
• staff educational levels
• store building condition
• communication
• climate data

With regard to the conditions of the store building, it was found that 18 (39%) of the medical university (provincial) stores and 226 (62%) of district vaccine stores need to be made earthquake-resistant or they need major repair and renovation.

It was assumed that all facilities at the six top levels have adequate communication systems. However, no accurate data is available about the health houses (the lowest level of PHC service delivery) communication system. The survey shed light on this issue too. It was found that 50% of all health houses have a landline telephone connection.

Collection of data in relation to climate, which will be useful for selection of appropriate cold chain equipment, was also part of this survey and features in the report.

An accurate under-one population data for every district has been collected and used for estimation of the requirements in 2015. The surveys showed that only 1.4% of the health houses have zero under-one children. Whereas, the majority of the health houses (57%) cover a range between 10 and 50 under-one children. The average number covered by health houses is 22 under-one children per year.

The study also looked at the functioning of all health facilities, vaccine distribution methods, total annual number of vaccine shipments and maximum vaccine stock for each of the seven levels separately and the distance between stores and facilities. These are strategic data probably not accurately and comprehensively available, particularly at the national level, before this survey was conducted. Since the data analysis and report writing took relatively a long time and since the data will remain on the MOH & ME portal and should be updated regularly, developing software to generate reports and support the data analysis is envisaged.

The Iranian Ministry of Health and Medical Education is ready to share the full report with other countries and the principal investigators are ready to assist the other countries if they would like to conduct a similar survey.

Cool innovations for vaccine transportation and storage

by Steve McCarney, John Lloyd, and Joanie Robertson, PATH

A group of public- and private-sector partners are collaborating with project Optimize to evaluate a range of innovative transportation and storage containers for heat-sensitive drugs and vaccines that operate in environments with or without access to reliable power. The following is a brief description of each technology, the niche it was designed to fill, and the context in which it will be tested.

Stationary passive coolers

Commune-level passive cooling in Vietnam

Currently in Vietnam, not all commune health centers have the capacity to provide vaccine cold storage for a full month. Vaccines are generally brought in for one- or two-day immunization sessions as part of the monthly national immunization strategy. However, it is important for certain vaccines (such as hepatitis B) to be available throughout the month so that babies can receive necessary vaccinations at birth.

With support from Optimize, the National Expanded Programme on Immunization is evaluating the appropriateness of new small-volume (about 3 to 4 liters) passive cooling devices, creating capacity to store a small number of vaccines all month at the communes. These devices provide approximately one to four weeks of cooling on one “charge” of ice. In this way cooling can be provided with no requirement for a refrigerator or even an on-site energy supply.

It is anticipated that these coolers will improve on-time delivery of hepatitis B birth dose while also decreasing closed-vial wastage. The intervention would not increase cooling energy use at the commune, would be compatible with intermittent power conditions, and would not disrupt the current monthly immunization-day system which is working very well.

Mobile passive coolers

Passive cooling for vaccine transport in Tunisia

To safely transport new vaccines, Tunisia’s EPI program is working with Optimize to evaluate phase change material (PCM) packs as a possible passive cooling storage alternative to ice packs. Similar to ice, solidly frozen PCMs hold more cooling power than when in the melted or liquid phase. PCMs are ideal because they can freeze at a vaccine-safe temperature (e.g., +5°C) and can have direct contact with freeze-sensitive vaccines, allowing the entire box area to be used for vaccine. Traditional cold boxes can substitute PCM packs for ice packs and provide adequate cooling for up to 15 hours in the heat of the Sahara.

Insulated containers on Senegal’s moving warehouses

The Ministry of Health in Senegal is piloting a “moving warehouse” approach. Rather than requiring health post staff to pick up vaccines, antiretrovirals, malaria, and tuberculosis medications, along with associated supplies from a district center, two trucks serve as moving warehouses and distribute supplies from the regional level to health posts in all five districts of the Saint-Louis Medical Region.

Integral to the moving warehouse concept is the use of large rolling insulated containers to transport necessary drugs and vaccines. These containers can be rolled by workers or handled by forklift. With a capacity of 161 liters, the volume of one rolling container is equivalent to eight long-range traditional cold boxes, which saves space in transit and makes it easier to handle larger volumes of bulkier single-dose vaccines. The containers are cooled by PCMs that have been chilled in a refrigerator at safe temperatures for a specified time. The PCM panels are placed in the container, and vaccine can be loaded in direct contact with all inside surfaces of the rolling container. Currently, trucks equipped with these containers are able to keep vaccines at proper temperatures for as long as six days while on the road. And in areas where roads are poor, moving warehouses equipped with passive containers have a lower maintenance burden and higher reliability compared to insulated trucks with active refrigeration.

Active refrigeration

Ice-lined refrigerators in Senegal

Power problems that occur throughout the developing world, including in Senegal, make it challenging to cool vaccines and heat-sensitive drugs with electric refrigerators. In this type of intermittent power setting, conventional practices often rely on diesel generators to back up unreliable grid electricity. However, generators are costly, difficult to maintain, create noise and air pollution, and subject to fuel supply disruptions and diversions.

In Senegal’s St. Louis region, a more reliable and energy-efficient solution for vaccine storage is being demonstrated: the super long-life ice-lined refrigerator (ILR). ILRs provide stability in intermittent power conditions and their cost is minimal in contrast with absorption-type refrigerators powered by electricity, bottled gas, or kerosene. The use of ILRs with longer-than-average holdover times can eliminate the need for backup generators if grid electricity provides at least eight hours of power on average per day. The best-in-class ILR can operate with just four hours of electricity and provide over ten days of holdover to maintain acceptable vaccine temperatures, even in warmer climates. Particularly in settings where electricity is unreliable, the ILR is a safer, more reliable choice for vaccine storage than domestic refrigerators.

Domestic fridge study in Tunisia

Many countries, including the United States, are using untested, unmonitored domestic-style refrigerators for storing vaccine and reporting significant losses due to poor temperature control. The WHO Performance, Quality and Safety (PQS) program has established equipment standards and testing protocols for vaccine refrigerators including electric, ILRs, gas/kerosene, and solar-powered refrigerators. Using these PQS prequalified refrigerators is the recommended approach for purchasing vaccine storage refrigerators.

However, many countries elect to purchase locally available refrigerators because these are usually less expensive, quickly available, employ front opening doors, and are familiar to local service technicians. Unfortunately, few of these domestic-type refrigerators are sufficiently monitored to ensure safe vaccine temperatures.

Monitoring has shown that domestic refrigerators have widely varying temperature performance and can expose the vaccine to freezing temperatures and rapid warm-up after power cuts. The widespread practice of domestic refrigerator use warrants better temperature monitoring to find and isolate problem refrigerators before they damage vaccines.

In Tunisia, Optimize is working with Centre Technique des Industries Mécaniques et Electriques (CETIME), a government-sponsored laboratory, to use WHO PQS protocols to test typical domestic refrigerators that have been used for vaccine storage or are being considered for future purchases.

Domestic refrigerators already in use are also being monitored, and their performance will be evaluated. Evaluation results will help Tunisian decision-makers assess the risk of using domestic refrigerators, and laboratory testing of new models will identify potential risks as well as help to inform solutions for maintaining acceptable temperature control. If no suitable refrigerator or solutions can be identified, decision-makers have evidence to make the case to develop improved models in country or to purchase WHO PQS prequalified refrigerators. The demonstration in Tunisia is intended to convey to all countries using domestic refrigerators that first, they should all be continuously monitored in use; second, they should be tested and their performance confirmed before procurement; and third, they should meet the global WHO/PQS norms for vaccine storage.

To comment, click reply.

Senegal launches demonstration of mobile warehouse

Written by: Madjiguène Ndiaye, SNEIPS; Ibrahima Leye, Consultant; and Mariama Gueye, PATH

On October 27, 2010, the Government of Senegal officially launched a new project to demonstrate the impact of various changes and upgrades to the vaccine supply chain including the use of mobile warehouses to deliver vaccines to the peripheral levels of the health system. The ceremony kicked off phase two of the Senegal demonstration project which is being jointly implemented by the Government of Senegal and Optimize, a joint World Health Organization-PATH collaboration.

Senegal’s collaboration with Optimize was established to demonstrate and validate solutions to meet current and future challenges in managing supply chains for vaccines, medicines, and other health products. While the existing vaccine supply chain is challenged by various technologies, logistic, and management constraints linked to the introduction of the pentavalent (DPT-HepB-Hib) vaccine, these challenges are expected to multiply as newer products such as pneumococcal and rotavirus vaccines become available in the country.

The project builds upon information gathered during a Phase 1 assessment between September 2009 and January 2010. The assessment helped establish a common understanding of the current status of the logistics of vaccination in Senegal and generated baseline data against which new technologies and systems will be measured.

In Phase 2, the partners will use moving warehouses (a truck and a pick-up) to integrate parts of the currently separate vaccine and medical supply chains and distribute supplies directly from the regional level to the peripheral health posts in all five districts of the Saint-Louis Medical Region. The moving warehouse is equipped with web-enabled computer equipment connected to a logistics management information system for sharing information in real time between different levels of the health system. In addition, vaccine storage facilities at the Regional Supply Pharmacy and refrigerators in 15 remote health posts will be retrofitted with solar technology which will decrease energy costs and increase the reliability of refrigeration systems in areas with only intermittent access to electricity. All this will be underpinned by increased advocacy and communication support to ensure successful implementation.

In his speech, Mr. Modou Diagne Fada, Minister of Health and Prevention explained how this initiative falls within Senegal’s integrative framework of strengthening the health system and how it will streamline resources and improve the timely distribution of adequate quantities of vaccines and medicines in the region. An enhanced information system is also expected to improve management, planning, and coordination of orders and deliveries between different levels of the health system. He urged health workers and all stakeholders to make the implementation a success with the hope that it can be replicated in other regions in the country as well as in other African countries.

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