1. Cold Chain Surveillance Coordinator Provincial EPI cell

2. What is cold chain system • From the manufacture to the recipient, all the steps n people involved in keeping the vaccine in the required temperature is called the cold chain system

3. The cold chain • Vaccines are sensitive biological. • Needs special attention. • Damages by heat – freezing. • Once potency is lost – cannot be regained. • Requires special storage mechanism. • From manufacturer to site of use. • Two major factors. • Staff • Equipment

4. Current vaccine management system

5. EPI cold rooms • Peshawar. • Malakand. • Mansehra. • Kohat. • Bannu. • D.I.Khan.

6. Location of cold rooms

7. Vaccine storage • Ideal temperature (2 to 8 ) so that pneumococcal, penta & TT do not freeze • Polio if needed to be stored for more then 3 months can be stored in – 20. • Thermometers • Dial, cold chain monitor card, mercury • VVM, Shake test

8. Conclusion. • Good installations are available. • Have trained staff posted. • Have the vaccine storage capacity for entire divisions. • Working back up is available in most of the cold rooms. • Stock registered are maintained.

9. Conclusion-2 • Cold rooms remained out of order for considerable time. • No mechanism for local repair. • No allocation for POL of generators. • Did not serve during the past 2 years. • No proper supervision mechanism of concerned staff. • No leave account maintained. • No written job description of staff. • Not trained on storekeeping.

10. Conclusion-3 • No procedures for • Receiving vaccines. • Issuing vaccines. (vit A during NIDs) • No proper vaccine management system. (Frequency & quantity of vaccine) • Vaccine is collected from provincial cold room instead of divisional. • Divisional cold rooms are under utilized. • No allocation for maintenance and repair.

11. Suggestions • Much more is desired to be done. • Vaccine management system. • Date of collection – vaccine stock at different levels. • Regular review/signing of stock registers. • Mechanism for monitoring of the system. • Development of SOPs for various tasks. • Using checklists for various occasions.

12. Suggestions-2 • Ensuring vaccine stock at every level. • Collection of vaccine from divisional, instead of provincial cold room. • Allocation of maintenance and repair funds beyond the PC-1 period. • POL issue for generators to be taken.

13. Suggestions-3 • Training of personnel on storekeeping practices. • Installation of automatic temperature recording equipment. • Developing mechanism for utilization of technical staff. • Provincial cell should deliver vaccine to cold rooms.

14. Proposed vaccine management system • Vaccine should be collected from federal cell on quarterly basis. • Provincial store to supply vaccine to cold rooms. • Divisional cold room have 3 months quota. • Districts will collect vaccine from divisional cold rooms. • District stores – 2 months supply. • EPI centers – 1 month stock.

15. Checklist for receiving vaccine • When Vaccine Consignments Arrive at the Storage Point : • All details of the consignment must be checked. • All detail be recorded in the stock register. • District • Name of cold room/store/health facility • Name of storekeeper/worker • Designation • The type of vaccine • The quantity received (in doses) • The vaccine manufacturer • The batch or lot number. • The expiry date. • The status of the VVM • Balance

16. Issuing vaccine • Record of each consignment leaving the store is appropriate. • All details should be recorded. • The quantity issued. • Batch number. • Expiry dates . • To whom issued. • The remaining balance.

17. While vaccine is in storage • All vaccines must be systematically arranged . • Older stock should normally be distributed first. (FIFO). • Expiry must be checked regularly. • All stocks must be distributed well before their expiry date. • Ensure that no batch or lot remains too long in storage. • Regularly check the integrity of the stocks by reviewing the status of VVM. • Any expired, damaged or vials with VVMs beyond the discard point should not appear in the stock balance.

18. Vaccine demand • Requirement/Target. • Vaccine in balance. • Consumption in previous month (s) • Vaccine received in previous month. • Vaccine issued. • Vaccination coverage.

19. Thank you