Joanie Robertson, Supply Chain Manager, Gavi
While significant money is spent by the Gavi Alliance on vaccine grants and on cold chain equipment through grants to strengthen health systems, the responsibility and expense of maintaining that equipment generally falls to countries. Effective Vaccine Management (EVM) results show that equipment maintenance is one of the weakest areas of vaccine management systems. For example, in July 2009, 42% of 179 fridges in one northern Vietnamese province were non-functioning.
Poor cold chain equipment maintenance puts the overall vaccine investment at risk. Even more important, when vaccine is spoiled by improper storage conditions or not available due to non-functioning equipment, immunisation workers in developing countries miss opportunities to reach vaccine coverage goals.
Cold chain equipment management has been one of the agenda items at the 14th TechNet Conference in Bangkok last week. On Wednesday, Dr. Nguyen Van Cuong, the deputy manager of Vietnam’s National Expanded Programme on Immunization (NEPI) shared a strategy Vietnam employed from 2011 to 2014 in order to improve their maintenance program. You can watch his presentation online here.
Cold boxes and fridges help vaccines stay cool and usable. Photo: Gavi/ Dan Thomas.
Vietnam’s strategy was wide ranging, contracting private sector providers to maintain vaccine fridges and other aspects of the cold chain over three years, who were also shadowed by health centre staff so they could learn repairs. Innovative methods were used to verify services provided, such as taking cell phone pictures of technicians with health centre staff to document their visits. At the same time existing NEPI staff were allocated the roles of equipment managers, and cold chain status was included in monthly immunisation reports.
At the end of the 3 years, responsibility for equipment maintenance equipment reverted to local governments and their budgets (provinces and districts). Some provinces continue to use contracted providers for repair services. NEPI estimates the annual system costs to be about 5% the purchase price of the equipment in the system.
Cold chain training in action. Photos: Dr. Nguyen Van Cuong.
Vietnam’s experience shows us how the private sector can be leveraged to build capacity in government systems. NEPI also learned that a cultural shift was needed to elevate the importance of cold chain equipment management for staff. Now cold chain equipment maintenance is part of the regular monthly reporting for all facilities, and equipment maintenance has a regular place on the agenda in quarterly national EPI meetings.
NEPI continues to negotiate with the national government for adequate budget to support this work, but they have clearly shown a creative and innovative approach to strengthening of the government-owned maintenance program. All of which makes a significant contribution to making sure children in Vietnam can get the protection they need against vaccine preventable diseases.