Protection of Children against Vaccine Preventable Disease by Strengthening Effective Vaccine Management

Among the factors contributing the child survival in Nepal, successful delivery of vaccines is essential to prevent deaths and disability due to disease. However, the constrains still remains in terms of the scare human resources unable to cope up with the new requirement for temperature sensitive vaccines, and also to the cold chain equipment which needs maintenance and repair on a periodic basis, real time information on the equipment status and stock management of the vaccines.

The Program Cooperation Agreement (PCA) has been developed between UNICEF Nepal and Lifeline Nepal to provide a joint technical assistance to Ministry of Health and Population harnessing the individual capacity on improving the efficiency of supply chain management (SCM), strengthening the vaccine information system (VIM) and human resource for vaccine management (HRVM).

This cooperation was a joint technical assistance to MoHP at one central, 5 regional and 30 district vaccine stores for strengthening the human resource capacity of implementing the standard operational protocol for effective vaccine management, providing technical assistance for scientific delivery and stock management of the vaccines, capacity transfer for cold chain equipment maintenance and repair, optimizing the cold chain space and rooms by auctioning and disposing the old and poor performing equipment. The joint technical assistance will support the central Ministry of Health to develop specification for cold chain equipment and equipment forecast, create a cool chain equipment informational website hub and develop plans for rational equipment replacement and expansion planning and develop infrastructure to improve installation and repair services.

Project Areas: Six regional medical stores and 30 districts

Project Activities:

Formation of Central Level Multi-Stakeholder Effective Vaccine Management Monitoring

Team to plan and review the progress:

The first meeting of multi-stakeholder effective vaccine management monitoring team was conducted in Jan 23, 2014 with chairmanship of LMD director. The participants were Bade Babu Thapa, Chief of Cold Chain and Supply Unit, LMD; Mukunda Raj Gautam, Chief EPI Section of CHD, representatives from UNICEF, WHO and Lifeline Nepal. The meeting decided to have meeting in 3rd or fourth week of each month.

Review meeting of the Multi-stakeholder Effective Vaccine Management Monitoring Team

Meeting is being held each month during PCA period. Until July 2015, seventh meeting is completed. In each meeting program progress were reviewed.

Development of the revised standard operating Procedure for Effective Vaccine Management

2nd Multi-stakeholder Effective Vaccine Management Monitoring Team Meeting held on March 21, 2015 decided to form a working committee with the following personnel:

1) Mukunda Raj Gautam, Chief, EPI Section, CHD, Coordinator

2) Badebabu Thapa, Chief, Cold Chain and Vaccine Supply Unit, LMD, Member

3) Bijaya Kranti Shakya, NTHC, Member

4) Om Prasad Upadhyay, EPISO Cold Chain and vaccine distribution section, LMD, Member

5) Siva Subedi, UNICEF, Member

6) Udev Maharjan, LLN, Member

Development of the training manuals, job aids, quality monitoring checklist for EVM

The working group finalized EVM SOP and developed trainers’ manual and participants’ handbook. Approval of EVP SOP, trainers’ manual and participants’ handbook was proposed to be completed in June 2015. They also developed quality monitoring checklists for each activity.

Central level Training of Trainers on SOP for EVM

Central level TOT on SOP for EVM was conducted on July 18- 23, 2015 with 21 participants. Similarly the regional level TOT was also completed in two batches with 34 participants.

Review and adapt the cold chain equipment specification and forecast for next 5 years at central, regional and district level.

Lifeline Nepal and Cold Chain and Supply expert and biomedical specialists adopted cold chain equipment specification into LMD specification format as suggested by the meeting and the final draft was shared with the concerned officers and the experts. As requested by LMD Director again 1/2 day workshop to review final draft specifications was held on August 28, 2015.

Review and adapt the web-based vaccine status and stock management software

A meeting was held on April 3, 2015 with participation from EPI Section from Child Health Division, Cold Chain and Supply Unit, LMD, WHO to review the existing IMS software implemented by LMD. The meeting suggested adopting IMS software for online reporting of vaccine. The contract was outsourced to Software engineer – Sandesh Maharjan with the deadline to complete by May 10, 2015.

Orientation to the Central level staff on web-based vaccine status and stock management

System for online vaccine reporting was developed and orientation program on it was held on

29th July, 2015. Data entry to test the effectiveness in implementation of the system is going on and LLN is continuously monitoring the effectiveness of the system by collecting the reports from the users of the system.

Support auctioning/disposal of non-functional cold chain equipment at central level

Auctioning process is completed in Pathlaiya cold chain stores. Auctioning process already started in Central cold chain store in Teku. The Tipanni from director general already approved to form auctioning committee.

  Routine Quality monitoring of regional vaccine stores

A trip to Pokhara regional medical store was made by Lifeline Nepal and Chief of Cold Chain and Supply Unit of LMD for quality monitoring. The temperature for vaccines was well maintained. We could not make further quality monitoring trip due to involvement in supporting MOHP and DOHS in supply chain of vaccine and general logistics. Similarly LLN Cold Chain Supervisors made field visit to 14 districts for the quality monitoring. In 6 regional vaccines stores- Hetuada, Kaski, Butwal, Nepalgunj, Kaliali and Biratnagar the efficiency and effectiveness of the vaccine supply and logistic systems strengthened

 Regional level training of trainers on EVM (Expected Participants from 5 RMS x 3, 5 RHD x 2, 5 RHTC x 3)

Regional level TOT was conducted from August 17- 21, 2015.

Regional level training on establishing EVM quality monitoring

Due to the mega earthquake, the finalization of EVM SOP, participant’s handbook and trainers manual delayed and these activities could not conduct. Planned to conduct in July/August 2015

 Repair and maintenance of cold chain equipment

In Pathlaiya Central Cold Chain Store, there is no dedicated electricity line and 6-8 hours load shedding. However, Pathlaiya Central Cold Chain Store did have two generators to supply power during the load shedding but both of generators non-functional for long time. LLN repaired one of two generators. Now one walk in cooler is functional for twenty-four hours. LLN has been repairing cold chain equipments. Till date altogether 121 cold chain equipment are repaired in the districts given in the table below;

 

 


District
Repaired Number District Repaired Number
Biratnagar 5 Rautahat 1
Teku 1 Jhapa 5
Pathalaiya 5 Morang 1
Dolakha 1 Sunsari 2
Ramechhap 1 Saptari 7
Okhaldhunga 3 Illam 2
Dhadhing 6 Udayapur 4
Kavrepalanchok 3 Siraha 4
Sindhuli 7 Dhanusha 8
Lalitpur 4 Syangja 7
Bhaktapur 1 Bara 2
Sindhupalchok 6 Gulmi 4
Nuwakot 3 Myagdi 3
Gorkha 8 Baglung 1
Makawanpur 2 Palpa 2
Kapilvastu 1 Parbat 5
Tanahu 1 Kaski 2
Chitwan 3 Total 121

 

On-site mentoring to refrigerator technician and EPI person

Second Meeting of Effective Vaccine Management Monitoring Team held on January 25, 2015 decided to hire refrigerator technicians for Biratnagar, Pathlaiya, Pokhara and Butwal Regional cold chain stores where positions of refrigerator technician were vacant. Similarly the meeting also decided to hire cold chain supervisors for Pathlaiya, Central Store Teku and Nepalgunj medical stores where the positions were vacant. The meeting also decided loaders/packers for Central Stores Teku and Pathlaiya. The meeting also decided the qualification of refrigerator technician and cold chain supervisor.

Capacity building of the refrigerator technician on maintenance and electronic temperature monitoring reporting of cold chain equipment

Once refrigerators technician and cold chain supervisors, they have been provided orientation on repair and maintenance and monitoring of report of the cold chain equipment.

 Weekly reporting on the regional vaccine status of stock management from regional level

Routine monthly stock status reporting from the regional level is going on. Once online reporting is initiated weekly reporting will automatically be improved.

 Support auctioning/disposal of the non-functioning cold chain equipment and materials

LLN Auctioning Officer visited Nepalgunj, Butwal, Pokhara, Hetauda and Biratnagar. Auctioning process in each regional cold chain store was discussed and initiated. As per the agreement to submit the list of non functional cold chain equipments in beginning of FY 2072/2073, all submitted the list. Auctioning is completed in Syangja and Argakhachi. Process for Auctioning is going on in Baglung, Sindhuli, Gulmi, Ramechhap, Kathmandu and Dhading. Similarly as requested by Far-Western Regional Health Directors, LLN hire auctioning supervisors and stationed for far-western Region. With new auctioning supervisor’s initiation, auctioning was completed in RMS Dhangadhi and Doti Districts.Based on request, LLN refrigerator technicians from regional cold chain stores visit to district and repair refrigerator. Where, non repairable cold chain equipment was certified for auctioning. Up to now, Technicians are able to repair altogether 93 refrigerator/freezers in different districts.

Collection and update of status and number of cold chain equipment from 30 districts and sub-districts

Inventory of cold chain equipment is prepared by WHO. LLN is updating the cold chain equipment list during auctioning and repairing.

Review existing projected capacity and calculate future cold chain capacity

Calculation of cold chain capacity was completed.

 Dissemination of projected cold chain capacity

The dissemination of projected cold chain capacity was shar

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