Baseline Assessment of �Cold Chain Points in Tamil Nadu �2021

©UNICEF/UN0236705/Viet Hung

Background

State wide Census of all cold chain points customized as per state’s immunization ecology

©UNICEF/UN0236705/Viet Hung

Objectives

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To understand

the

Preparedness

of the existing

Cold Chain System

in

Tamil Nadu

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• Cold Chain System
• Equipment

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• Human Resource & Skills

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• Infrastructure

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• Maintenance

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• Temperature monitoring

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• Stock management

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• Vaccine Storage

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• Vaccine Issue, Transport and Disposal

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• Documentation

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‘What’

©UNICEF/UN0236705/Viet Hung

Methodology

‘Where’

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• SVS
• 10 RVS
• 43 DVS
• 2,632 CCPs

© UNICEF/PHOTO CREDIT

Methodology

• Tools
• NCCVMRC and EVM Cold chain supportive supervision tools
• Digitized data collection tool for eliminating human errors
• Bi-lingual checklist
• Quality assurance protocols

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• Training
• Experienced assessors
• Theory & Hands on practical training
• Pilot at 16 CCPs across 15 HUDs

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• First level quality check
• Cross verification with photographic evidences collected on cloud servers
• Data verified by MOIC/NO
• Concurrent monitoring visits to 15% of CCPs

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• Second level quality check
• Excel based quality check dashboard
• Whatsapp based help desk
• 4 rounds of data quality check (Supervisors > Quality Checkers > Data analysts > Technical team)with data

Data Quality and Completeness ensured

‘How’

Findings

Cold Chain Equipment

©UNICEF/UN0236705/Viet Hung

• Electrical
• 3315 ILRs
• 91% Functional
• 3% on Standby

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• 2912 DFs
• 92% Functional
• 3% on Standby

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• 19 WIC
• All Functional

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• 5 WIF
• 3 Functional

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• Non Electrical
• 6470 Cold boxes
• 86% Functional

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• 75412 Vaccine carriers
• 83% Functional

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• SVS
• 2 WIC, 2 WIF, 2 ILR & 11 DF
• RVS

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• Functional WIC at all RVSs

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• DVS
• 4 DVS had functional WIC
• Functional ILRs and DFs at all DVSs

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• CCP
• 99% - Functional ILR
• 95% - Functional DF
• 88% - Functional Large Cold box
• 66% - Adequate vaccine carriers for session sites

Sickness Rate ~2% (MOHFW norm)

Cold Chain Equipment

©UNICEF/UN0236705/Viet Hung

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• 68% WIC

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• 100% WIF

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• 61% ILR

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• 60% DF

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• Over 85% CCE at Vaccine stores

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• 57% of CCE at CCPs

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CFC Free

Share of CFC Free and CFC Cold Chain Equipment

©UNICEF/UN0236705/Viet Hung

Human Resource & Skills

Cold Chain Handlers

• 2182 CCPs had 1 VCCH and 450 CCPs had 2 VCCH
• 95% of VCCH knew all steps of shake test, ice pack conditioning, reading VVM labels and reasons of wastage of unopened vaccine vials

Cold Chain Technicians

• 18 posted
• All equipped with maintenance toolkits
• 64% had adequate set of Spare parts

Medical Officers

• All CCPs headed by a Medical Officer
• 74% were trained in Cold Chain Management

©UNICEF/UN0236705/Viet Hung

Cold Chain Practices

Vaccine management

• 73% CCPs maintained a microplan with complete vaccine & logistic estimates
• 94% CCPs followed EEFO/FIFO while issuing vaccines
• 92% CCPs stored vaccines as per correct temperature protocols
• 85% had legible date and time on open vials

Temperature Monitoring

• 95% CCPs monitored CCE temperature twice daily
• 94% reviewed the temperature records every month
• 96% maintained standard temperature records

Maintenance & Breakdown response

• 79% CCPs follow Daily & Weekly PPM
• 92% CCPs and Vaccine Stores regularly defrosted CCE
• 62% breakdowns were responded within 24 hours
• 80% breakdowns were resolved within 3 days

Documentation

• 90% CCPs documented physical verification of vaccine stocks
• 88% CCPs updated minimum and maximum stocks in last 3 months
• 78% CCPs documented discarded vaccines & diluents

©UNICEF/UN0236705/Viet Hung

Cold Chain Infrastructure

Adequacy of Space at CCPs

• 77% had a dedicated cold chain room
• 70% had adequate space for CCE
• 79% had adequate space for Cold boxes and Vaccine Carriers
• 86% had adequate dry good storage space

Adequacy of Space at Vaccine Stores

• 81% have loading bays accessible to vaccine vans
• 74% have packing area close to cold chain equipment
• 67% had adequate space for CCE
• 60% dedicated area for cold chain equipment repair

Infrastructure Quality

• 82% CCPs and 70% Vaccine stores have walls & roof in good shape
• 89% CCPs and 91% Vaccine Stores have adequate ventilations and lighting

Equipment Infrastructure

• 85% CCPs and 93% Vaccine stores had a separate Stabilizer for each CCE
• 96% CCPs and 95% Vaccine Stores have CCE with intact rubber gasket
• 93% CCPs and 81% Vaccine Stores have intact electrical system

©UNICEF/UN0236705/Viet Hung

Urban Cold Chain Points

• 31% of Cold Chain Points

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• Equipment
• 83% CCPs had 1 ILR and 1 DF
• 848 ILRs – 93 % functional
• 705 DFs – 90% functional
• Sickness rate 2.6%
• 50% DFs and 52% ILRs are CFC Free

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• Infrastructure
• 71% CCPs had dedicated cold chain room
• 84% had intact walls & roof
• 85% had adequate ventilation & lighting
• 9 92% had CCE with intact rubber gaskets

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• Human Resource
• All CCPs had medical officers
• 71% of the medical officers were trained
• 78% had 1 VCCH
• 92% knew about shake test, 93% knew ice pack conditioning & 94% knew how to read VVMs and causes of vaccine wastage

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• Practices
• 60% CCPs had complete microplans
• 68% Daily & weekly PPM by VCCH
• 86% followed regular CCE defrosting
• 67% had breakdown response time within 24 hours
• 71% resolved breakdowns within 3 days

Equipment related issues

• Photo documented cold chain equipment inventory was rationalized with data collated from districts, NCCMIS and eVIN.
• New equipment being deployed based on availability data.

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Human resource and Capacity Building Issues

• Supportive supervision of cold chain points rolled out in April 2022
• Resources being developed on requirements at all levels of the cold chain system.
• 32 Cold chain technicians posted and 5 more underway. First batch of training underway.

Action v/s Challenge

© UNICEF/UNI289867/Shahan

Thank you.