Cold Chain Equipment Planning with CCEM

Cold Chain Equipment Planning with CCEM
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Cold Chain Equipment Planning with CCEM
Vaccine Introduction Timeline
Cold Chain Equipment
Planning with CCEM
Richard Anderson, Sophie Newland, John
Lloyd, David Lubinski, Stefano Malvolti, John
Wecker, Kate Wilson
IVAC VIMS report, March 2010
January 4, 2011
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Cold Chain Equipment Planning with CCEM
Does a country have sufficient cold chain
capacity for new vaccines?
Old vs. New Vaccines
• Preparation for introduction of new vaccines
– Assess cold chain capacity
– Make cold chain capacity visible
– Develop a plan for meeting capacity needs
4,100 doses
Polio and Measles
• Approach
– Inventory of cold chain equipment
– Analytics and modeling
• Software
625 doses
Rotavirus
– CCEM, Cold Chain Equipment Manager
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Cold Chain Equipment Planning with CCEM
Cold Chain Inventory
Cold Chain Equipment Manager
Cold Chain Equipment Planning with CCEM
Inventory Based Cold Chain Capacity Analysis
Health
facility list
Analytics
Demographic
data
Cold Chain Planning
Tool
Reports
Refrigerator
inventory
Equipment
Vaccine
schedule
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CCEM History
CCEM Application
• 2006 CCEM development starts at the TechNet
Consultation in Mexico
• 2007 CCEM piloted in collaboration with Uganda EPI
team, WHO/IST, and UNICEF/TACRO.
• 2009 CCEM migrated to MS Access 2007, with a new
user interface and stability enhancements
• 2010 Release of CCEM at TechNet Consultation in
Kuala Lumpur
• 2011 Cold Chain Planning in Kenya on new national
inventory (tentative)
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• Cold chain inventory
• Analysis and modeling tools
• Components: Catalogs, data entry, reports, forecasting
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Cold Chain Equipment Planning with CCEM
Does the country have sufficient cold chain
space for current vaccines?
What is the impact of the introduction of a new
vaccine on available cold chain capacity?
• Compute capacity
requirements for
each facility
• Compare with
available capacity
• Add a new vaccine to the national schedule
• Identify capacity shortages created by new
vaccine
• Determine facilities that need to add
equipment to meet the shortages
Shortage
Capacity status by facility type
Before PCV7
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After PCV7
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How much would it cost to add equipment to
address capacity shortages?
What is the impact of retiring cold chain
equipment?
• Assign equipment to facilities with insufficient
capacity
• Equipment assigned based on available energy
and cost
• Policies can set equipment options for regions
and facility types
• Remove equipment based on age, type,
energy source, region, and facility type
• Evaluate capacity or energy cost
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How many refrigerators are needed over the
next five years?
• Multiyear planning based on:
– Introduction of Vaccines
– Vaccine Campaigns
– Equipment introduction and removal
• Equipment type, region, facility type, energy source, age
– Population growth
• Products
– Capacity analysis by facility
– Equipment lists for each year
– Comparison across scenarios
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Acknowledgements
Where CCEM is today
• Application and supporting materials available
online at www.path.org.
• Kenya EPI team to deploy CCEM for cold chain
inventory and planning
• Planning for regional technical workshop with
the WHO regional team for ESAR (Feb 2011)
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Cold Chain Equipment Manager
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Kenya Ministry of
Health
Contact Information
Richard Anderson, [email protected]
Sophie Newland, [email protected]
David Lubinski, [email protected]
Software Downloads: www.path.org
http://www.path.org/publications/detail.php?i=1569
[email protected]
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EXTRA SLIDES
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COLD CHAIN INVENTORY ISSUES
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CCEM Core Data Elements
Inventories
1.
• National Inventory
Administrative hierarchy
–
2.
Country, Province, Region,
District, Subdistrict
Facility info
•
•
•
–
3.
– Train enumerators
– Visit each facility,
record information
on paper forms
– Data entry clerks
use CCEM to enter
data
Facilities and vaccine stores
–
Cold chain function
Power sources
Vaccine supply
Demographics:
Population, Live births
Refrigerator Inventory
–
Equipment available at
each facility
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Trade offs for inventory based planning
Inventory Updates
• Advantages
• Current model: update entered manually into
the main application
• Regions may maintain their own databases,
and then merge them with feed forward files
to national database
• Future work
– Improved management with cold chain inventory
• Allocation of equipment
• Matching equipment to available power sources
• Avoiding over allocation of equipment
– Planning at different levels based on data
– Transparency
• Disadvantages
– Initial inventory cost
– Inventory updates
– Transparency
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– Distributed updates to inventory database
– Multiple input mechanisms: web, cell phone
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CCEM with incomplete data
COLD CHAIN CAPACITY ANALYSIS
• Application results depend on data
completeness
• But . . .
– Application can be restricted to geographic levels
or facility levels or regions
– Workarounds available for missing or incomplete
data
– Depending on analysis needs, some data may be
omitted
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Basic capacity calculations
Other approaches to capacity analysis
• For each vaccine:
• Compute capacity requirements based on
population
– Compute number of doses needed
• Covered Populations X Doses reqd X coverage
– Guidelines for number of refrigeration devices for
different facilities types
– Account for wastage
• Divide by (1 – wastage pct)
– Determine weeks of supply
• Historical data
• Sampling based assessments
• Supply interval + Reserve stock period
– Compute doses on hand
• Multiply by weeks of supply divided by 52
– Convert to volume
• Multiply by CCM per dose
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ADDITIONAL USE CASES AND FEATURES FOR
CCEM
Other cold chain tools
• Cold Chain Logistics Planning Tool
– Excel based tool for computing capacity. Same
capacity calculation is used
• EVM: Effective Vaccine Management Initiative
– Country assessment tool including sampling to
evaluate cold chain capacity
• VSSM: Vaccine Supplies Stock Management
– Stock management tool, not for capacity analysis
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Reporting
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CCEM 2.1.5.2
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Forecasting
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Multiyear Scenarios
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CCEM 2.1.5.2
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Multiyear costs
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CCEM 2.1.5.2
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Spanish available
(French in progress)
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CCEM 2.1.5.2
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Equipment Lists and Transactions
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CCEM 2.1.5.2
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Comparing Forecasts
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CCEM 2.1.5.2
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DEVELOPMENT AND DEPLOYMENT OF CCEM
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CCEM History
CCEM roadmap
• 2006. CCEM development starts at the TechNet
Consultation in Mexico City with the idea that an
equipment inventory and planning tool would
support systematic management of the cold chain.
(Dr. Fernando Perez, MOH Peru)
• 2007. In collaboration with Uganda EPI team,
WHO/IST, and UNICEF/TACRO, CCEM is piloted.
• 2009. CCEM is migrated to MS Access 2007, with a
new user interface and deploying software
engineering principles.
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Added functionality
based on Uganda
feedback
CCEM Version 1.0
deployed in Uganda
CCEM Version 1.0
piloted in Uganda
(added functionality)
UNICEF/
PATH
MOU
Panama training
workshop (functionality
and user interface
improvements)
UNICEF/PATH
workshop (added
functionality)
Introduced CCEM
at EPI Managers
Meeting in
Mumbasa
Planned CCEM
Version 2.1 pilot
(country TBD)
Version 2.0
scope review
Developed
CCEM
Version 2.0
scope
CCEM 2.0.7
test
CCEM 2.1
scope and
approach
Developed CCEM
Version 1.0
User Manual
CCEM
testing and
stabilization
CCEM Version
2.1 release
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D
2007
2008
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2010
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Software Development Challenges
WISH LIST FOR COLD CHAIN PLANNING TOOLS
• Challenges and experiences from developing
CCEM are not unique
• Lessons from CCEM
– Developing software is hard!
– Software engineering tools helped
• Issue tracking
• Configuration management
• Test cases
– Absolutely critical to have strong public health input
and domain knowledge
– Important to figure out how to bridge between public
health and computing technology
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TechNet 2010 Consultation, Kuala Lumpur, Malaysia
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Web based inventory tool
Update Mechanisms
• Replace MS Access with a relational database
• Multiple levels of update
– Robust facilities for access and back up
• Provide access to inventory, reporting, and
forecasting through a web application
• Allow standard solutions for updates
• Facilitate sharing of data across multiple levels
of health system
• Access control to limit external viewing of
information
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– Web interface for updates, so internet connected
devices can be used
– Mobile device updates to support reporting from
facilities
• Other mobile tools for cold chain supervision
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Customization
Migration of CCEM 2 to new architecture
• Extensibility for data elements collected and
maintained by countries
• Prior to development, stakeholder buy in and
develop strategy for compatibility with other
tools
• For CCEM, ensure that existing data formats can
be transferred with import / export tools
• Development strategy
– Strong interest in adapting information at the
country level
• Allow additional analytics to be implemented
with a scripting engine
• Tie into a geographic information system
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– Create web based database, which can export to
CCEM
– Migrate analysis and reporting tools to work directly
with the database
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COLD CHAIN MONITORING
FoneAstra
• Attachment to low cost
cell phone to allow
temperature
monitoring
• University of
Washington developed
device
• Regularly report
temperatures by SMS
to server
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Temperature Monitoring
• Receive temperatures
reports by SMS
• Allow monitoring of
large number of
machines
• Receive Alerts
• Identify problem
equipment that is not
triggering alerts
• Field test in Albania
with Optimize
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