Report on Cold Chain Assessment of Jharkhand - 2005 - Nccvmtc.org

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Cold Chain Assessment in JharkhandTotally, 213 sites were visited, which included 190 PHCs, 22 district stores and central store.The teams were advised against visiting two sites: Gawan (Giridih district) and Satgawan(Koderma district) since they were considered potentially unsafe.The forms used to record the findings were countersigned by the staff responsible for handlingthe cold chain. In most cases, the Medical Officer in-Charge (MOiC), or the LadyHealth Volunteer (LHV) or ‘Computer operator’ (an accounts-related post) was interviewed;in the absence of the cold chain in-charge, the Auxiliary Nurse and Mid-wife (ANM) or otherstaff were interviewed. Wherever possible, all staff related to the cold chain were interviewed.Based on the feedback and data collected from the field, a list of recommendations has beendrawn up.A more detailed description of the methodology is given below.4.1. Assessment of siteThe assessment team visited each site in the state to review quality of buildings, equipmentand transport. Sites were assessed to determine adequacy of space, ventilation, space forpacking and loading vaccine for onward despatch, location of burial pit or incineration siteused for the disposal of safety boxes, and availability of staff to monitor cold chain in theevent of power failure.4.2. Assessment of electrical cold chainAll the sites were assessed to evaluate vaccine storage capacity, stacking procedures, capacityto produce ice-packs for regular and campaign programmes and functional status of equipment.The power supply connections, stabilizer support, earthing of equipment, and temperaturelog books were also examined. The equipment was broadly classified into three categoriesnamely: Working (functional), Not Working (non-functional equipment, but could be repaired)and Condemned or Beyond Repair. 5 Maintenance and record keeping procedureswere evaluated.4.3. Assessment of non-electrical cold chain equipmentNon-electrical cold chain equipment includes cold boxes, vaccine carriers, ice-packs andthermometers. All sites were reviewed for their present stock and condition of the equipment.Cold boxes were physically checked for damage to hinges, locks, handles, lids, gaskets andchains and the body itself.4.4. Assessment of power situation and back-up power supply mechanismTo evaluate the power supply situation, the staff at the site were interviewed regarding hoursof assured supply, usage of the generator, fuel purchase, and funds for fuel. The temperaturerecord book was examined to corroborate information. Information garnered on power supplytended to be rather subjective and was frequently not substantiated by the temperature readingsand generator usage recorded.4.5. Assessment of vaccine storage and delivery mechanismStock books used for recording the entry and despatch of vaccines and diluents were checkedto evaluate stock management and record keeping. Vaccine consumption during routine im-5 Beyond repair: extensive damage to the body; rusted, damaged CFC-based compressors; the Voltas maintenancetechnicians have marked the equipment as ‘condemned’.10
Cold Chain Assessment in Jharkhandmunization, entry of recently delivered vials and despatch to PHCs and sub-centres as well asentry of damaged/expired vaccine was also checked. This was co-related with stock and supplyof consumables.The delivery system and the frequency of procurement/delivery were assessed by interviewingthe staff and verifying the indent challans. The vaccine transport mechanism was alsoevaluated.4.6. Assessment of sharp waste disposalSites were assessed for their sharp waste disposal practices. Usage of safety boxes and hubcutters was assessed and some correlation was sought to be made between vials used and thenumber of children vaccinated against the number of safety boxes used. Sharp waste disposallocations were inspected and the waste disposal method recorded.4.7. Assessment of cold chain personnelThe staff responsible for the cold chain operations were interviewed to determine whetherthey had received sufficient training and to assess their understanding of the cold chain andits operation and maintenance, including defrosting cycle, thermostat setting, and cleaning ofequipment. Additionally, information was sought on vaccine handling, shipment and transportation,handling in case of electricity supply breakdown, usage of gensets, record keepingof damaged vaccine, disposal of damaged vials, conditioning of ice-packs, storage of vaccineat different levels within the refrigeration unit, VVM awareness, shake test for the T seriesvaccines, and the use and disposal of safety boxes.4.8. Assessment of cold chain equipment maintenanceThe staff responsible for the maintenance of electrical and non-electrical equipment were interviewedto assess cold chain equipment maintenance practices.Assessors met the staff responsible for maintenance of the electrical cold chain in Jamshedpur,East Singhbhum. They spoke to Mr B.K. Ghosh, the Servicing Manager from Voltas inPatna to discuss the nature and scope of Voltas’s maintenance contract with UNICEF. An unsuccessfulattempt was made to meet one sub-contractor in West Singhbhum, Cool Life, BadiBazar, Chaibasa. Assessors later learnt that this company no longer held the servicing contract.11
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