As Gavi, the Vaccine Alliance was developing the Cold Chain Equipment Optimization Platform (CCEOP), two notable areas in need of improvement in many countries were the long delays in the delivery and installation of cold chain equipment (CCE) at vaccine storage sites and health facilities, as well as the on-going maintenance required of the equipment.
It is similar to buying a new refrigerator. You do not have a truck to transport it to your house and you do not have the technical skills to install it, especially if it has any extra requirements such as solar panels. You pay the experts to do that for you.
That was the thinking behind Gavi’s decision to require CCE manufacturers to install and provide on-going maintenance through local service bundle providers (SBPs) during the warranty period of the equipment procured by countries. This model is adopted from the private sector to respond to an entrenched public health issue. Previously, when Ministries of Health (MoH) procured CCE, their cold chain technicians would install and maintain the equipment, but often with delays in installation due to slow funding flows or lack of vehicle or personnel availability. As a result, CCE could sit in a warehouse for several months before being installed at a facility, essentially wasting precious resources that could instead be used to ensure vaccines were available for all of the children that needed them.
The fact that it takes a lot of headaches out of our mind, we know that this a service that has been paid for and will most likely be rendered at the highest quality that is possible, we do not have to worry about various differing messages or any inconsistencies that may arise… So the peace of mind that is borne by the service bundle associated activities has been quite useful.
– National Partner, Kenya
This is how the CCEOP model solves this problem: the service bundle providers are local companies with equipment maintenance expertise. The manufacturers train the SBPs on the type of CCE that will be installed in that country, and the SBPs in turn receive the equipment at the port, deliver it to the different storage sites and health facilities across the country, install it, and provide on-going maintenance through the life of the warranty. The SBPs also build the capacity of the government technicians to continue maintaining the equipment after the warranty ends.
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Results from the midline assessment of the JSI evaluation of the CCEOP show that the SBP approach is achieving its goal. The SBPs completed the CCE installation on time and according to plan. They have also shown they can be flexible with the inevitable last-minute changes, such as shifting a piece of equipment from one facility to another. The reporting requirements Gavi and UNICEF established also provided great documentation for the installation process and updating the cold chain inventory, an important aspect of managing the system.
I thought [the SBPs] were well organised. They had thought through where they would hold the equipment and how many trucks they would need to get the CCE to the sites. They were very speedy.
– National Partner, Guinea
Of course, with every innovation, there are lessons learned. Some immunisation programme staff feel they have the capacity to do the work using their existing technicians and teams set up to maintain CCE. They also feel the SBP takes away the ownership aspect of being responsible for installation and maintenance; this was exacerbated by the fact that the MoH was not involved in selecting the SBP and the contracting process. Immunisation programme representatives also cited the cost as a drawback, as it does increase the cost of the equipment and reduces the level of funding available for purchasing CCE.
You see the strength of the CCEOP was that the service bundles gave a peace of mind. But at the same time, service bundles have been a weakness in its share of volume. When it comes to [MoH-led equipment] deployments, the cost of it has been a lot better because it has allowed us to procure a lot more equipment, of the same quality and technology as the CCEOP equipment.
– National Partner, Kenya
Gavi is exploring different options for the SBP to reflect the successes of this approach but also to respond to concerns from countries. The approach could allow the Ministry of Health to be fully responsible for all aspects of installation, or it could be a hybrid approach, depending on the type of CCE, or the SBP could be responsible just for transportation.
Whichever SBP model is adopted in the future, bringing in this private sector approach to a public health good has improved CCE installation and documentation process for thousands of pieces of equipment around the world. And that is one component of the system that ensures that vaccines are available for everyone when and where they are needed.