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Abbreviation
Description
ACMO
"22*2)&+)!:M*,D!6,7*#&%[email protected]*#,(!!
AD
Auto Disable
ARS
Anti Rabies Serum
ARV
Anti Rabies Vaccine
AVS
Anti Snake Venom
BCG
Bacille Calmette Guerin
CCL
Cold Chain and Logistics
CCO
Cold Chain Officer
CES
Coverage Evaluation Survey
CFC
:M%$($!<%$K($!:&('$+!T(,D(*I,(&+)U!
CHC
Community Health Centre
cm3
:K'*#!:,+)*3,),(!
CMO
:M*,D!6,7*#&%[email protected]*#,(!
0
Degree Celsius
C
DF
Deep Freezer
DH&FW
Department of Health and Family Welfare
DLHFS
District Level Health Facility Survey
DPT
Diphtheria, Pertussis, Tetanus
DRCHO
District Reproductive and Child Health Officer
DT
Diphtheria Tetanus
EPIO
Expanded Program of Immunization Officer
EVSM
Effective Vaccine Store Management
FIC
Fully Immunized Child
HepB
Hepatitis B
ILR
Ice Lined Refrigerator
IPHS
Indian Public Health Standards
KVA
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MDVP
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Abbreviation
Description
MIS
Management Information System
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MOHFW
Ministry of Health and Family Welfare
MOIC
Medical Officer In-Charge
NRHM
National Rural Health Mission
OPV
Oral Polio Vaccine
PHC
Primary Health Centre
PIP
Program Implementation Plan
POL
Petrol Oil and Lubricant
RCH
Reproductive Child Health
RIMS
Routine Immunization Management System
SEPIO
State Expanded Program of Immunization Officer
TA/DA
Travelling Allowance/Dearness Allowance
TT
Tetanus Toxoid
UIP
8+*Q,(2&%!933K+*Y&)*$+!R($I(&3!
UNICEF
United Nations Children’s Fund
VMAT
Vaccine Management Assessment and Training
VVM
Vaccine Vial Monitor
WHO
World Health Organization
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1) Identifying the strengths and good practices of vaccine stores;
2) Train the staff responsible for handling state, intermediate and primary health vaccine
stores in vaccine management practices ;
3) Identify major knowledge gaps;
4) Identify major performance gaps ;
5) Identify resource and training needs;
6) Develop internal capacity of the system to conduct similar self assessment for
remaining districts and repeat the training and assessment periodically.
The VMA was carried out using following steps:
1) Trained the selected staff in conducting the Sites assessment cum training using VMA
Tool during four days workshop held in Guwahati;
2) The state vaccine store was assessed on VMAT criteria using VMA Tool;
3) The assessment covered 11 districts and 2 PHC approximately per district. The
districts were assessed by the team from other districts except for few exceptions;
4) The DIOs and other members of each district participated in assessment carried out
the one day training of cold chain handlers in their own district based on the standard
operating procedures discussed during the program;
5) A three days consultative workshop held at Guwahati to submit and compile the
assessment data;
6) Participants formulated standard operating procedures for district stores and PHC
during the consultative workshop;
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7) Major findings, its cause and solutions were formulated to draw key
recommendations from the assessment exercise;
8) Outcome of the assessment was presented to dignitaries for their perusal and line of
action for implementing the recommendations.
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- ./01)$*21++
The objectives of Vaccine Management Assessment of Assam using the VMAT were to:
7) Identify the strengths and good practices of vaccine stores
8) Train the staff responsible for handling state, intermediate and primary health vaccine
stores in vaccine management practices
9) Identify major knowledge gaps
10) Identify major performance gaps
11) Identify resource and training needs
12) Develop internal capacity of the system to conduct similar self assessment for
remaining districts and repeat the training and assessment periodically
To achieve these objectives, the first step is to train staff of the health department at the state
level and from the districts in the use of the VMA Tool so as to apply it periodically through
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self assessment. This was done in selected districts and in two PHCs of the identified districts
to assess the current status. The analysis of the data defines the future course of action to
improve and ensures quality vaccine management and logistics. With these objectives the
assessment and training exercise was performed from 16 to 28 February 2009. This document
reports on the entire activity starting from induction training till the final outcome of analysis
and recommendations.
3 4561)$7$*&#8+9%&:+;7))*#1+<7#7=1:1#$+>88188:1#$+
There are five steps to improve the quality of vaccine and logistics management to increase
Availability, Utilization, Adequate Coverage and Effective coverage in Routine
Immunization services for the beneficiary.
1. Set a quality standard: Establish a national quality standard based on national
programme policy guidelines and national /global standards, as recommended by
WHO and UNICEF.
2. Establish a general approach: Prepare and adopt standard operating procedures
(SOP).
3. Establish standard procedures: Identify the specific task and procedure and assign
these tasks to specific persons responsible for maintenance of cold chain, vaccine and
logistics upkeep.
4. Instruct and train staff on specific tasks of monitoring methods, instructions and
training, equipment servicing and testing to perform them proficiently.
5. Keep good records of temperature charts, VVM training, cold room service report
and cold room specifications.
Steps to improve the quality of vaccine management:
•
Training of trainers, training of field staff
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•
•
•
•
Scope and level of training required at all levels (state, districts and PHC)
Standard Operating Procedures based on standards by WHO/national program
policies
Action plan for system strengthening
Radiation/learning / sharing of good practices across state
? @[email protected]&&B+
The Vaccine Management Assessment Tool (VMAT) is developed by the Vaccine
Management Training Network (VMTN) team to help countries to improve the quality of
their vaccine management system and procedures down to the service delivery level. The
original work on the vaccine-management assessment tool (VMAT) was carried out by WHO
Regional Office for Africa (AFRO) in 2001. After consultations, reviews and field trials it
has developed into today’s document. This is a spreadsheet-based tool that provides a set of
structured questions for the use of national and external assessors. It is designed to be used to
carry out a rapid assessment of vaccine-management procedures in a national store, followed
by a similar assessment of sub national stores (State) and service delivery points (PHCs).
Assessment results are displayed in graphical form and should be supplemented by written
comments. The modules complement the package of guidance, assessment and training
materials developed for the initiative for Effective Vaccine Store Management (EVSM),
which focus on vaccine management at national and sub national (State) primary stores.
The tool is based upon eleven global criteria listed below. The first seven have been derived
directly from Effective Vaccine Store Management (EVSM) initiative. Criteria 8, 9 & 11 are
indigenous part of EVSM but have been identified as separate indicators for assessment at
periphery levels. A criterion 10 on Multi-Dose Vial Policy (MDVP) has been added. Criteria
1 Vaccine arrival Procedures (VAR) is applicable only for state store.
1. Vaccine arrival Procedures
2. Vaccine storage temperatures
3. Cold Chain storage capacity
4. Buildings, cold chain equipment and transport
5. Maintenance of cold chain equipment and transport
6. Stock management
7. Effective vaccine delivery
8. Correct diluent use for freeze dried vaccines
9. Effective VVM use
10. Multi-Dose vial Policy
11. Vaccine wastage control
There are multiple specific questions under each of the above mentioned 11 criterion, which
are applicable to different levels of vaccine supply chain within the rolling down health
system (State, District and PHC) and to which one attributes a mark corresponding to the
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answer: 0 (no), 1 (yes) or n/a (not applicable). The collation of these marks is then integrated
to give an overall score for each criterion on a scale of 0 to 100 %.
Some of the questions under the criterion 1, 2, 5, 6, 7, 8, 9 &11 are critical indicators
designated by CI. These questions are intended to test the most important aspects of vaccinemanagement. For this reason each question attracts a weighted score. A low score against a
critical indicator provides strong evidence that an aspect of vaccine-management is
dangerously weak and that significant improvements are needed.
These collated scores are then used to depict graphically on a spider web the strengths and
weaknesses of a country’s, state’s, district’s or PHC’s vaccine management systems. A
minimum score of 80% is recommended for each criterion as shown by the red polygon in
the graph.
4>B! :(*),(*&! C! _! S&##*+,! &((*Q&%! G($#,7K(,2! &GG%*,2! 3$(,! )$! &! +&)*$+&%! 2)$(,! (,#,*Q*+I!
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The VMA was carried out using following steps:
9) Trained the selected staff in conducting the Sites assessment cum training using VMA
Tool during four days workshop held in Guwahati;
10) The state vaccine store was assessed on VMAT criteria using VMA Tool;
11) The assessment covered 11 districts and 2 PHC approximately per district. The
districts were assessed by the team from other districts except for few exceptions;
12) The DIOs and other members of each district participated in assessment carried out
the one day training of cold chain handlers in their own district based on the standard
operating procedures discussed during the program;
13) A three days consultative workshop held at Guwahati to submit and compile the
assessment data;
14) Participants formulated standard operating procedures for district stores and PHC
during the consultative workshop;
15) Major findings, its cause and solutions were formulated to draw key
recommendations from the assessment exercise;
16) Outcome of the assessment was presented to dignitaries for their perusal and line of
action for implementing the recommendations.
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D($3!,&#M!7*2)(*#)!D$(!&22,223,+)!$D!%$-,(!%,Q,%!2)$(,B!!Vaccine Management Assessment
was carried out at state vaccine store, 11 districts and 22 service delivery points.
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E,? >88188:1#$+&9+$1:61%7$(%1+:7*#$1#7#)1++
The monitoring of temperature at the cold chain storage point and transportation of vaccine is
most essential process to ensure that the cold chain has been maintained. The standard
protocol of temperature monitoring in India at the various levels of cold chain storage points
is explained below.
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The cold chain equipment such as ILR and DF used for storing vaccine are monitored (by
observing and recording temperature) twice daily (morning and evening) by cold chain
handler or store incharge of cold chain point. This process only provides the situational
snapshot at the time of observation. Further, the incorrect methods used for observing or
recording the temperature reduces the effectiveness of this method of temperature
monitoring. To understand this phenomena, two electronic temperature monitoring devices
called Fridge-Tag and Tiny-Tag were introduced in the training program. All the participants
were trained in using the Fridge-Tag during the VMAT training workshop. Following steps
were followed to train the staff:
_
A Video training tool developed by WHO was shown to participants. The video
guides the audience through all the steps of activating the device and reading the
device through history mode.
_
All the participants activated the device themselves during the workshop
The Fridge-Tags were activated during the last day of the training program. Following
activation, all the participants were required to place the Fridge-Tag in the ILRs along with
the DPT vaccine at designated stores from 12th of April till 26 of April (for a period of
fortnight). The Fridge-Tags were then brought back by participants to Guwahati during the
three days consultative workshop from 27 to 29th April 2010. The readings from Fridge-Tag
were read and interpreted by the participants and at the same time it was transferred to an
Excel Worksheet for further analysis. The real time data from the stores provided good
evidence on the performance of cold chain equipment and the degree to which the vaccine
was exposed to extreme temperatures.
To validate the readings from Fridge-Tag and manual temperature records, six number of
Tiny-Tag data loggers were bundled together with Fridge-Tags. Three of those were placed
inside the cold rooms at Goalpara, Dibrugarh and Cachar and other three were issued to
participants from different regions based on following protocol:
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O
Fridge-tag is shipped in “sleep mode”. The device can be activated using the
combination of “read” and “set” button provided on the device. Once activated the
device cannot be stopped. From the time of activation, the device is set to
“monitoring” mode. Pressing the “read” button, which guides user to the history of
Page 56 !
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past 30 days, activates history mode. The device goes back to “monitoring” mode
after 30 seconds of inactivity.
O
Once activated, the device should be kept in ILR, along with vaccine in the vaccine
basket. The health workers should follow these steps to use the device effectively:
O
Check the daily temperature (morning and evening) through this device.
O
Observe the device daily to check if an alarm has occurred. In case the device is
showing the alarm, read the history to note the duration and day of alarm.
O
Carefully interpret the device and note down the date, duration of alarm and type of
alarm and share the readings with Medical Officer or in-charge of cold store and cold
chain technician to diagnose and rectify the problem.
!
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