Last week, UNICEF hosted a meeting where experts with a combined 1,000 years of practice in cold chain maintenance discussed some of the current challenges and opportunities related to cold chain maintenance and temperature monitoring at the country level. This blog highlights some of the key themes that came out of the meeting.
Ultimately, preparing for outbreaks begins long before the first case and must entail a strong routine immunization system that provides vaccinations to all target groups, regular communication and education of the public, regular upskilling of health workers, strong surveillance, prepositioning and stockpiling vaccines and appropriate medicines.
Immunization supply chains managers should be thinking about how to use new technology and innovative ideas to deliver more product, faster, and at a lower cost. We aren’t looking for Amazon Prime and delivery in an hour (although that would be nice). What is needed, though, is a reliable and efficient supply chain system that guarantees that all children can be immunized.
Sometimes, simpler solutions like paper cards are more efficient and usable than technology – particularly where they are needed most and where mobile services, electricity, the internet, and computers are not reliably available. Also, often the paper cards – when their value is emphasized and understood – can “live on” longer than the ever-changing and limited archival storage of electronic systems. A combination of both can be very effective.
It takes commitment at all levels – from global, country and community levels to individual health workers and families – to ensure that vaccination works so that vaccines can work.
The economic case is compelling: returns on investment for every child vaccinated are huge. Every $1 spent on vaccines brings a 16-fold return on investment — this climbs to a return of $44 for every $1 spent if we look at all the extended benefits that vaccination brings.
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When we first started this work (in Ethiopia) about seven years ago, when customers came to a warehouse in search of their medicines, the pharmacist had to run down to the warehouse to check if they had an item (it took too long to find the stock card). Now they can access the data the same way as my Walgreens pharmacist can. And they can look to see if the stock is available at any of the other warehouses (even if the nearest location might be a day away).
Providing care for the mother during pregnancy has huge implications not just for her health but also for the child she carries and her community. Many health problems in pregnant women can be prevented, detected and treated during antenatal care by trained health workers.
In Sindh Province, as in the rest of Pakistan, logistics data for the immunization supply chain was sporadically collected and seldom used for years. Stockouts of critical vaccines were commonplace, resulting in poor coverage rates and frequent outbreaks of measles and other vaccine-preventable diseases. In 2013-2014, the federal and provincial governments, supported by JSI, USAID, UNICEF, and WHO, developed and launched a web-based vaccine logistics management information system (vLMIS) to address this problem, and started an ongoing effort to scale up use of the system across the nation.