•Delivery of vaccines and other equipment in good condition to place of use
•And in this context it includes
NATIONAL LEVEL- Indicators are the existence of National Policy Guidelines on:
• Vaccine Management
(FIFO and expired vaccine must be addressed and wastage factors per vaccine-used in Vaccine Management).
• Transport Management
(Guidelines must address availability and utilization - private or public system).
• Cold Chain
(temperature monitoring, VVMs - CCMs & maintenance
• Distribution of vaccines, supplies and consumables. Forecasting, requirements and planning.
NATIONAL LEVEL- Sources
• • • • Guidelines Evaluations, Reviews Assessments Publications/posters, locally produced by MoH, UNICEF,WHO • EPI-Manager and Dept. of Med. Suppl.
RELIABILITY at NATIONAL LEVEL Visit Central Vaccine Store
CHECK vaccines (max 6 months supply) in cold room and freezers
Note Lot/Batch #, exp. date, CCM and VVM status & correct diluents and droppers - daily t°C record
Is the cold storage capacity enough
VAR and/or recording of receipts and despatches(& transits) reserve, min. & max. stocks levels dual refrigeration system (cold room), & stand-by generator and age of system(s) transport (sufficient/lack) - com. channels interruption(s) of services caused by:
Sub-national level INDICATORS Existence of a Monitoring System for monitoring:
• Adequacy of stocks; equipment,supplies & consumables (are reserve, min. and max. levels observed - FIFO principle, expiry date and VVMs) • availability of vehicles for routine and emergency use (preventive maintenance-plan, is the right type of vehicle used for the required job) • operation of cold chain equipment • communications and accessibility between levels
Sub-nat. level SOURCES
Meet with Regional/Provincial/District EPI-Heads Visit Vaccine/Medical Store -could be CR or ILRs & freezers
Guidelines implemented (look around for visible posters/stickers/MEMOs) Stock control books (receipts, dispatches, Lot#, expiry dates and VVMs status) Is there a Cold chain inventory Distribution plan for gas, kerosene & spare parts Observe recommended stock levels, min.- max. FIFO and VVMs (a max. of 3 months supply •
is recommended at thi level
• • •
Discuss accessibility to HFs; road, sea, river, air (take into account the rainy season(s))
Sub-nat. level RELIABILITY Ask’n Check
• Check CC eqpt (dual system & stand-by generator),CHECK monitoring devices (thermometers, t.-records, freeze watch). t°= +2 to +8°C & minus 20°C • Are there spare parts and consumables in stock incl.. for SDL) • Have there been interruptions in immunization services over the past year caused by: • Equipment breakdown and lack of preventive maintenance • LACK of transport (is a vehicle assigned for EPI & Logistics) vaccine distribution and/or pick-up by health facilities • Lack of communications channels to H/Fs or higher levels
Service Delivery Level INDICATORS
• Adequacy of;
• vaccines, equipment, supplies & consumables, incl. Syringes and safety boxes (max 1 month supply of vaccines is recommended at this level) actually, is there a distribution/pick-up plan (if a HF is using gas a min. of 3 cylinders are recommended; 1 in HF, 1 for refill and 1 for the road) transport management monitoring of CC equipment
• • •
SDL SOURCES Check all immunization providers
Condition of CC refrigerator; is PREVENTIVE maintenance carried out ?
• • • Check in CC refrigerator +2to+8°C; vaccines, diluents (incl. VVMs and expiry dates) and IPs for OUTREACH Check monitors; thermometers, temperature records, VVMs Is refrigerator working on electricity, gas, kerosene or solar power (installed correct) Spare parts and gas bottle(s), kerosene, wicks, glasses Sterilization equipment incl. spare safety and pressure valves and gasket(s) Posters/stickers/MEMOs etc. available/visible (IF NOT - “FILING CABINET” and heap of)
• • • •
SDL RELIABILITY Ask: Have there been any interruptions the past year caused by:
• Lack of; vaccines, supplies or consumables, equipment breakdown (lack of maintenance, spares), lack of transport • Is the MDVP observed • Do the health workers have knowledge of VVM (show a dummy VVM)