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

Cold Chain Assessment in JharkhandEPI was initiated in India in 1978, and in 1985-86 the Universal Immunization Programmewas launched. To ensure programme implementation, all PHCs in the state were equippedwith an ILR, a DF, and a generator to act as the power supply backup. The DF at the PHClevel is required to facilitate the making of ice-packs, which are used in the vaccine carriersto transport vaccines to health posts and rural areas for the regular weekly immunization programme.However, with 12% (43% including beyond repair) of equipment not functionalthroughout the state, maintaining the cold chain becomes a challenging task. 17% of theequipment has aged and use CFC refrigerants; while 30%of the equipment is beyond repair.Electricity supply to most of the cold chain sites is inadequate or unreliable with persistentlylow voltage, which is insufficient to efficiently run the ILRs (even after taking into considerationnormal hold-over time). The power supply is unable to support use of DFs at 32 PHCs.Generators were supplied to all sites—184 were recorded at sites throughout the state, ofwhich 53 are not working. Availability of funds for fuel is an issue.Provision is now being made for hybrid solar refrigerators, which, if supported by relevanttraining and maintenance and repair, could possibly help towards a long-term and sustainablesolution if the load requirement at the PHC is not too heavy. But the current dual mode solarsystem is NOT suitable for use at any site unless major technical improvements are madewith cost implications.Only 64% of the operational equipment is connected to voltage stabilizers; as a consequenceexposing costly equipment to breakdown due to voltage instability.Supply of vaccine is found to be regular but frequent, probably in order to address the inadequacyof quality storage conditions. There was no report of non-availability of any vaccine atthe PHC level. However, supply of AD-syringes and diluents is not recorded and there is noco-relation maintained between vaccine supply and other consumables required for vaccination.At many PHCs and DHQs, the assessors found excess stock of AD syringes.Transportation of vaccine to the PHCs poses many problems. The vaccine is generallyfetched by the PHC staff from the district store (except during campaign rounds such as thePulse Polio Programme for instance) in preparation for the appointed immunization day (eitherWednesday or Thursday). Most PHCs do not possess a vaccine delivery van, but somehave ambulances, which are frequently no longer functioning. As a general practice, vaccineis either fetched in the ambulance or public transport is used to fetch the vaccine. The Sahebganjdistrict store is an exception, and vaccine is delivered from here to the PHCs on aweekly basis since infrastructure in terms of roads within the district is very poor, and it takesa district store vehicle a full day to deliver vaccine at all the PHCs in the district.The following sub-sections describe in greater detail the findings of the field assessment. Thefindings are followed by recommendations which point towards solutions to strengthen thecold chain in the state.6.1. Cold Chain network6.1.1. Central store site assessmentThe central store, located at Namkum, Ranchi, has 3 WICs and 1 WIF. All the units are operational.The WICs are connected to auto-start generators, but the generators were under repairat the time of the site assessment. One solar hybrid refrigerator has been installed at centralstore as a part of the pilot assessment.A quick evaluation against EVSM criteria reveals that:15