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Cold Chain 20011


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by Dr Dhamija

Published in: Health & Medicine
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Cold Chain 20011

  1. 1. C o ld C h a in Is s u e s & C h a lle n g e s Dr. Navneet Kumar DhamijaAssistant Commissioner - Immunization Ministry of Health & FW, Govt. of India Mobiles : 8826772555, 9911220066 Office : 23062993, 23062126, 23062728 E-mail :
  2. 2. Rationale of strengthening CC&VLM1. Wide network of cold chain stores : created since inception of UIP in 1985 and need renovation , up- gradation and expansion- GMSDs at Karnal , Mumbai , Kolkata & Chennai- State Vaccines Store Depots- Regional / Divisional Vaccines Store Depots- District Vaccines Store Depots- CHC and PHC Cold Chain Points2. Introduction of AD syringes in 2004-05 demands more dry space and bundling of vaccine and logistics supply
  3. 3. Rationale of strengthening CC&VLM ……..2. Equipment or management failure at storage levels can cause destruction or large quantities of vaccines in a matter of a few hours.4. Inclusion of additional doses of vaccines in National Program like Measles 2nd dose and Hepatitis-B5. Plans need to be based on projected requirements for next 15-20 years
  4. 4. Indicators of Cold Chain performance• Direct Indicators:• Cold Chain Equipment Sickness Reporting• Cold Chain Equipment Sickness Rate• Cold Chain Equipment Response Time• Cold Chain Equipment Down Time• Proxy Indicators:• Availability of CCO and CCTs• Availability of Tool kits and Spare parts• Effective utilization of cold chain maintenance fund• % of equipments that have been visited through Preventive Maintenance
  5. 5. Factors affecting Cold chain performance• Mode of maintenance (Departmental, AMC or mixed solution )• Presence of cold chain technicians in the state ( number of technicians for number of districts in state )• Sickness rate of equipments in the state• Issues pertaining to maintenance of cold chain• Spare parts availability
  6. 6. Cold Chain Sickness Rate( SR) April 2011• National : 3.63• States having with SR less than 2% – Assam, Chandigarh, Delhi, Goa, Gujarat, Haryana, HP, Kerala, MP, Maharashtra, Mizoram, Orissa, Punjab, Tamilnadu, Tripura & West Bengal• States having SR 2-5% – AP, Karnataka, Meghalaya, Nagaland, Pondicherry & Rajasthan• States with SR > 5% – A&N Island, Bihar, Jharkhand & UP
  7. 7. CCE Sickness rates & State – specific issues 2010-11State No. of No. of CCTs Maintenance Sickness Other issues distts. rateA & N Island 3 2 (67%) Departmental 9.89 CCO to be posted. As per Ministry’s record there is no WIC supplied but state have one WIC in working conditionAndhra 23 22 (96%) Departmental 3.79 Negligible funds spent on HW+CCH TgsPradeshArunachal Pr 16 12 (75%) Departmental 1.72 -Assam 27 13 (48%) Departmental 0.52 Out of 20 Solar Units , 17 at Sites Only 6 units installed & No reasons …Bihar 38 6 (16%) OS / AMC 14.2 Posting of CCTs in all districts. WIC installation site at Saran is not ready. Civil work not startedChhattisgarh 18 11 (61%) Departmental 1.20 One WIC lying un-installed for the last 3 years as site is not ready.Chandigarh 1 0 Departmental 0.63 CCO to be posted ;Daman & Diu 2 0 Out sourced 1.89 CCO to be postedDelhi 9 2 (22%) Departmental 1.3 CCO to be postedGoa 2 1 Departmental 0 CCO to be posted
  8. 8. CCE Sickness rates & State – specific issuesState No of No of 2010-11 Maintenance Sickness Other issues districts technicians rateGujarat 25 31 (124%) Departmental 1.7 CCO to be postedHaryana 21 11 (52%) Departmental 1.7 New WIC reached state But Punchkula site is not readyHimachal Pr. 12 4 (33%) Mixed 0.5 New WIC and WIF reached in state but sites are not readyJammu & 15 14 (93%) Departmental 1.05 CCO and refrigerator mechanicsKashmir required to be posted. WIC site at Sri- Nagar not readyJharkhand 24 14 (58%) Departmental 10.2 V-MAT done, follow-up required Increased Sickness Rate – CONCERNKarnataka 28 2 (7%) AMC 3.1 CCO visits – storing other vaccines ?Kerala 26 12 ( 85.7%) Departmental 1.4Maharashtra 35 20 (57%) Departmental 1.0 -Manipur 9 6 (67%) Departmental 0 -Meghalaya 7 5 (71%) Departmental 4.0 -Madhya 50 34 (68%) Departmental 1.9 Required strengthening of cold chainPradesh Training
  9. 9. CCE Sickness rates & State – specific issues 2010-11 State No of distts. No. of Maintenance Sickness Other issues CCTs rateOrissa 30 22 (73%) Mixed 1.95 Out of 30 Solar Equipments, only 6 installed No reasons given Out of 5 WICs , 3 sites to be ready in next 2 years ? Equipments warranty ?? CCO,VLM,CCC,TA,CCs + & SR = increased ? 3 WICs sites not ready & no timeline givenPuducherry 4 6 (150%) Departmental 3.35 CCO to be posted, No measures explained Rs. 37494/equipment as maintenance cost ?Punjab 20 14 (70%) Departmental 0.9 New Initiative of CCTs mobility efforts & visits to every cold chain point once in 3 monthshas Further brought down SR & monitoring Strengthening to avoid freezing / PE to be lowRajasthan 33 35 Departmental 3.1 (106%)Tamil Nadu 31 16 (52%) Departmental 1.1 Trinuveli site for WIC not readyTripura 4 2 (50%) AMC 0.9 -Uttar Pradesh 70 36 (51%) Departmental 11.0Uttarakhand 13 4 (31%) AMC 3.65 Incomplete informationWest Bengal 18 0 (0%) AMC +OS 0.35
  10. 10. Status of Solar Equipment as on April 2011S.N. Name of the State No. of No. of Solar No. of Solar No. of solar No. of the Details of Damage, if any. the Site Equipment Supplied Equipment equipment Site where where delivered at to be installation installat Solar Spare Tool the proposed delivered at is complete ion tobe Equip. Kit site for the and done installation. proposed Equipments site of are 1 Arunachal Pradesh 30 30 3 6 6 13 6 No Damage reported 3 by may 1 Charger controller broken 2 Assam 20 20 2 4 17 6 end 3 Chattishgarh 20 20 2 4 14 6 12 1 PV array mechanical damage (PV module type KD 6 by june 1355-IPU) & reported No Damage 1 Battery 4 Himachal Pradesh 10 10 1 2 4 0 end 5 Jammu & Kashmir 20 20 2 4 3 nos module and one no. Battery found damaged 6 UttarPradesh 20 20 2 4 12 8 8 No Damage reported 7 Madhya Pradesh 20 20 2 4 20 0 8 7 batteries and 3 Arrays One battery of Nagar PHC and One PV Array of Amravati 8 Maharastra 20 20 2 4 18 2 16 PHC damaged 9 Manipur 20 20 2 410 Meghalaya 20 20 0 0 11 9 11 1 charge controller, 1 solar panel11 Mizoram 10 10 1 2 10 10 10 No Damage reported12 Nagaland 20 20 2 4 1 19 0 No Damage reported13 Orissa 30 30 3 6 21 9 6 1 battery damage 2 nos. charge controler, solar panel, compressor14 Rajasthan 20 20 2 4 20 19 1 charging coil, and 2 nos. batteries.15 Sikkim 10 10 1 2 10 0 9 One equipments not working, problem not identified16 Tripura 10 10 1 2 10 0 0 No Damage reported Total 300 300 28 56 174 81 93
  11. 11. Cold Chain training center SHTO, Pune• Provides training for cold chain Officers and Technicians on repair and maintenance of cold chain equipment.• A total of 1722 technicians and cold chain officers were trained on various types of cold chain equipment maintenance and repair between 1983 .• This centers runs six types of residential training on cold chain equipment like: a. Induction training of refrigerator technicians b. On-job-training on maintenance of WIC/WIF c. ToT of on-Job training for stabilizers’ repairs d. On-job training on repair of non-CFC ILR and DF e. On-Job training of solar equipment maintenance f. Cold Chain Handlers’ Training
  12. 12. State wise No of participants attended Cold Chain equipment training at SHTO, PuneSr.No. Name of the State to year 2010…. trainee Since 1983 No. of 1 Andhra Pradesh 107 2 Arunachal Pradesh 27 3 Assam 37 4 Bihar 13 5 Delhi 19 6 Goa 06 7 Gujarat 99 8 Haryana 44 9 Himachal Pradesh 26 10 Jammu & Kashmir 33
  13. 13. State wise No of participants attended Cold Chain equipment training at SHTO, Pune Since 1983 to year 2010….11 Karnataka 6012 Kerala 5313 Madhya Pradesh 15214 Maharashtra 33415 Manipur 1816 Meghalaya 1617 Mizoram 0818 Nagaland 0919 Orrissa 8720 Punjab 5321 Rajasthan 10422 Sikkim 0223 Tamilnadu 9724 Tripura 1225 Uttar Pradesh 17826 West Bengal 49
  14. 14. State wise No of participants attended Cold Chain equipment training at SHTO, Pune Since 1983 to year 2010….27 Andaman & Nicobar Island 0828 Chandigarh 0829 Dadra & Nagar Haveli 0130 Daman & Diu 0531 Lakshadweep 0332 Puducherry 0333 Uttarakhand 0634 Jharkhand 0735 Chhattisgarh 2136 Tanzania 0537 Nepal 02 Total 1722
  15. 15. Challenges in cold chain– Low storage capacity in the State warehouses - Optimizing the stock by keeping in view the reordering level and the lead time– Shortage of Staff – CCOs, Refrigerator Mechanics – Need for hiring and training of staff and creation of more post as per the state specific needs in many states
  16. 16. Components of Cold chain & VLM strengthening Human Resource Infrastructure Planning , Monitoring and Supervision Periodic Vaccine and Cold chain Assessment using tools like VMAT/EVSM Improved Documentation and Reporting and using standard practice for vaccine management
  17. 17. Human Resource StrengtheningA. Ideal & Adequate Human resource posted and AvailableState Level:3. One Cold Chain and Vaccine Manager and for a larger state an additional Asst Cold Chain Officer and VLM4. State vaccine store to be managed by trained personnel on cold chain & vaccine logistics with computer skills.5. Semiskilled helpers available on 24x7 duty in State Store to handle emergency, power failure and to coordinate implementation of contingency plan6. State Cold chain repair team to resolve major failure in cold chain systemSimilar structure to be replicated at regional and distt.levels
  18. 18. Human resource…B. Capacity Building on CC&VLM2. Skill based training of cold chain technicians, store mangers on cold chain and vaccine management3. Cold chain handlers training at district level by the trained personnel with practical demonstration4. Regular reviews of district and block level cold chain handlers at state and district level respectively5. Build capacity of programme managers to do self assessment using tools like VMAT&EVSM
  19. 19. Infrastructure strengthening State/Divisional/Regional stores should have a. Adequate vaccine storage space b. Dry storage space for storage of AD syringes , Immunization cards and other immunization supplies c. Building to be leakage proof , well ventilated with telephone, fax and internet connectivity d. Power back up in the form of auto start generator e. Temperature monitoring devices like Graphic Chart Recorder & Acoustic Alarm should be fully functional f. Working Vaccine Van (Refrigerated /Non refrigerated) with driver at all levels
  20. 20. Infrastructure strengthening… Cold chain storage needs to be extended beyond block PHC to lower level PHCs, wherever possible Preparation of site/s for installation of new WICs and WIFs Segregate all District Vaccine Stores attached to Divisional /Regional Vaccine store physically along with all documentation Ensuring timely supply of spare parts
  21. 21. Planning ,Monitoring & Supervision• Each state to have CFC phase out plan & need based cold chain facility expansion plan for effective vaccine delivery to outreach session and monitoring• Installation of Solar refrigerators for difficult-to- reach areas without electricity or poor power supply• Increased field visits of state programme officers for immunization and cold chain monitoring at District, Block and other cold chain facilities• District wise review of vital cold chain performance indicators
  22. 22. Periodic Vaccine and Cold Chain Assessment –VMAT/EVM• Build the capacity of departmental staff on Vaccine Management Assessment.• Capacity to do self assessment and improve the existing gaps.• Identify the gaps and do all possible on-site correction and provide input for long term planning• Standard tools available like : EVM ( Effective Vaccine Management )
  23. 23. Population served per cold chain point Vs Immunization CoverageMost of the big states with good immunization coverage have one cold chain point for every Hence there is a need to expand cold chain points25-40,000 population which facilitate effective vaccine delivery to the session site
  24. 24. Why Cold Chain point expansion ?• Immunization coverage will increase by increasing access and utilization• Making Cold chain point nearer to immunization sites will improve access which needs to be supported by micro planning and AVDS implementation• Effective supply of vaccine is possible if every cold chain point serves 6-8 Sub centers or 15-20 immunization sites
  25. 25. Requisites for Cold Chain expansion• Adequate beneficiary load of the proposed site• Availability of building• Availability of power supply• Dedicated persons to look after the Cold chain point• Feasibility for electrical /Solar /Hybrid equipment for expansion
  26. 26. Introduction -NCCMIS• Developed by Cold Chain Training Center, SHTO Pune in consultation with GOI and with technical support from UNICEF.• Field testing of the MIS format completed in 5 states ( UP, Orissa, Haryana, Rajasthan & Karnataka )• Officers from states will be provided the access to online database of cold chain equipment in the state.• Administrator will be at State level
  27. 27. Two components of NCCMISStatic and Dynamic sections as follows:Static Section : – Guidance on Cold chain &VM • GOI guidelines • Specification of CCEquipments • CCE allocation to the states • State wise cold chain performance indicators since 2006 • Spare parts list and code guide and circuit diagrams • Report of assessment and studies • Good practices at the states • FAQs
  28. 28. Two components ….. Trainings on Cold chain &VM• Courses offered by CCTC- Pune and NIHFW• Schedule of Training programme of CCTC• Details of the training programme ( Durations, contents , methodology facilitators)• Trainees data base since 1992• Training manuals• Pool of trainers and their CVs
  29. 29. Two components …..Dynamic Site• Cold chain data base ,PHC to GMSD• Cold chain performance indicators ( Sickness rate , Down time , Response Time )• Maintenance reports of CCEs ,serial numberwise• Spare parts management ( stock , utiliasataion pattern )• Human resource status (Cold chain Officers ,VLM , CCTs)• Tool kits status
  30. 30. Cold chain MIS data collection form• SECTION 1.1: SITE INFORMATION EQUIPMENT DATA COLLECTION FORM MARCH 2011- FINAL 7 APR 2011.DOC• Section 1.2 Human resource• Section 1.3 Vaccine van and generator• Section 2.1 Cold chain equipment: Ice Lined Refrigerator (ILR)• Section 2.2 Cold chain equipment : Deep Freezer (DF)• Section 2.3 Cold chain equipment : Solar Refrigerator( if applicable )• Section 2.4: Cold Chain equipment (Non-electrical) consolidated for whole district• Section 2.5: Breakdown record of ILR and DF• Section 2.6: Breakdown record of Solar Refrigerators• Section 2.7 Cold chain equipment (WALK in Cooler /Walk-in- Freezer)• Section 2.9: Breakdown record• Section 2.10 : RECORD OF BEYOND REPAIR EQUIPMENT
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  33. 33. Website address and Contact•Immunization Division, MOHFWDr.N.K.Dhamija : Asstt. Commissioner-Imm.Dr.Pradeep Haldar : Asstt. Commissioner-Imm.Email :•SHTO - PuneMr.Yogesh S BhamareElectrical Technician,HEMRUnit,SHTOEmail:,
  34. 34. GOI initiatives• Supply of adequate WIC,WIF, ILRs and DFs and Solar Equipments• Supply of Tool Kits and spare parts• Cold Chain MIS• EVM training and assessment• Prototype development for Vaccine stores• Countrywide training of Cold chain handlers with structured module• Temperature monitoring devices in cold rooms• Regular Qtrly Meetings of CCOs followed after a month by SEPIOs Meetings on Qtrly Meetings• Formation of Regional Resource / Working Groups
  35. 35. Expectations from SEPIOs Monitor activities in close coordination with CCOs• Monthly Reporting of CC Equipment’ status by e-mail in prescribed formats2. Immediate Reporting - in the event of breakdown of any equipment4. Monthly Reporting of HR Data and other status by e-mail as well, in prescribed formats• Meeting with CCO every month for reporting of Key Points by CCO• Scheduling & Monitoring of trainings of HR
  36. 36. EXPECTATIONSFROM SEPIOs…..1. Timely response to requests by authorized personnel at MoHFW a) Mr. Saumitra Sahar, Section Officer b) Mr. Eric Beck, Sr. Statistical Officer c) Dr. Bhrigu Kapuria, Consultant Tech. Officer d) Er. SK Saxena, Cold Chain Consultant e) Dr.( Ms.) Hema Gogia, Consultant Tech. Officer f) Mr. Paritosh Panigrahi, Vaccine & Logistics Consultant• Take immediate steps to get back the space occupied by condemned equipments vaccines & other logistics following state specific procedures• Repeated Surprise Visits at cold chain points to ensure nothing except vaccines & diluents are kept in the cold chain equipments• Ensure proper storage of vaccines in WICs / WIFs & other CCEs• Ensure “ No expired vaccines are stored in cold chain equipments ”
  37. 37. Resolution We shall provide safe, secure and potent vaccines to every mother &child in India………………………….
  38. 38. - Dhamija