Tracking the Cold Chain: Improving Vaccine Systems in India

Tracking the Cold Chain: Improving Vaccine Systems in India
Photo: Prashanth Vishwanathan/UNDP India

At a two-day training in Madhya Pradesh, healthcare workers were introduced to eVIN,  an electronic vaccination intelligence network system that will enable healthcare workers to effectively manage vaccine logistics and have real-time information on availability of vaccines. The electronic vaccine tracking system has been developed as part of a UNDP partnership with the Ministry of Health and Family Welfare, which aims to improve vaccine coverage in India.

 

Highlights

  • Healthcare workers were introduced to eVIN, a new electronic vaccination intelligence network system rolled-out in Madhya Pradesh
  • eVIN will help healthcare workers better understand, where vaccines are stored; whether they are in adequate quantities, and confirm that they are stored at the recommended temperatures
  • Since 2014, UNDP has partnered with the Ministry of Health and Family Welfare in support of the government’s universal immunization programme. The partnership is supported by GAVI, the Vaccine Alliance
  • By 2016, EVIN will be operational in 160 districts across three states - Madhya Pradesh, Rajasthan and Uttar Pradesh

Rewa District, Madhya Pradesh: 
 

“Har mata swasth rahe, har balak swasth rahe, yeh prarthna hamari, Sankalp sabhi ka ho”….

(Let every mother be healthy let every child be healthy, this is our prayer, let this be our Goal!)


A trainer begins the morning session with this song, encouraging participants of this district level training workshop to repeat after him. Participants at this workshop are cold-chain handlers, i.e. health care staff entrusted with vaccine logistics and cold chain management at primary health centres across the country. They are being trained on eVIN,  a new electronic vaccination intelligence network system being launched in Rewa district in the central India state of Madhya Pradesh.


Cold chain handlers are at the frontline of India’s efforts of improving the vaccination coverage of the country’s infants. Currently, 65 percent of children are fully immunized in the country and India aims to  immunize 27 million new children each year. This enormous effort depends on ensuring a consistent supply of vaccines, stored at  recommended temperatures, right from the manufacturer down to the mother and child.

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Many of India’s states including Madhya Pradesh, fall below the national average of full immunization.  The challenge of delivering full immunization is compounded by significant inequities in vaccination coverage, which often differs widely depending on individual, family, demography and social characteristics. Many states also face the task of ensuring an effective cold chain infrastructure, i.e. ensuring vaccines are stored at the optimal temperature and managing vaccine storage and delivery systems.

Since 2014, UNDP has partnered with the Ministry of Health and Family Welfare in support of the government’s universal immunization programme. The partnership is supported by GAVI, the Vaccine Alliance. A key component of this support is to design and implement eVIN, that will enable real-time information on cold chain temperature and vaccine stocks and flows at all points of the cold chain, from the dispatch of vaccines from the state offices, to the Primary Health Centres where auxiliary mid-wives administer the vaccines. By 2016, the system which has just been introduced in Madhya Pradesh,  will reach out to 160 districts in Madhya Pradesh, Rajasthan and Uttar Pradesh.

Excitement at the potential of the new electronic system is palpable in Rewa, where close to 50 cold chain handlers,  gathered at the district headquarters to participate in a two-day training, introducing them to eVIN and guiding them on data entry for accurate and immediate information on vaccine delivery and stock. The unique electronic system will help healthcare workers better understand, where vaccines are stored; whether they are in adequate quantities, and confirm that they are stored at the recommended temperatures.

At the district level, vaccines are stored in dedicated cold storage facilities at primary health centres. Each cold chain handler packs the vaccines in vaccine carriers and transports them to different routine immunization  sites in villages and cities. As and when required, the healthcare worker administers the vaccines to children. Vaccine tracking happens at two points, once in the morning, before the load is dispatched to the point of routine immunization, and second on return. Until the eVIN system was introduced in Rewa, the tracking process was undertaken manually.  

Now, cold chain handlers use a mobile phone application, to note the stocks at the end of the day. The data feeds directly into a central server, where there is real-time information on how many vaccines have been administered and how many remain in storage. The possibilities are endless. Having this data on-hand immediately, means that policymakers can understand the progress being made to ensure  immunization coverage of India’s future generations, and importantly to ensure that cold chain points do not run out of vaccines.

58 year old Devi Prasad Sharma is a cold chain handler working with a community health centre in Gangeo village. He is responsible for ensuring medical care for over 240,000 people. “I was worried that I wouldn’t be able to use the smart phone. But after the training, I’m more confident.” Pointing to the screen he says, “Work is easier, and the numbers are at my fingertips!” Many of the healthcare workers like 65 year old Suryawati Mishra had never touched a smartphone before.

Last month, Akhilesh Soni, a cold chain handler from Raipur Karchulyan distributed more than 7,500 vaccines to 29 centres, reaching out to over 250,000 people. “All my life, I have had to first write down the data in the register, double-check and then again write another final entry. Now with the phone, it’s so much simpler!”  

In Rewa Tuesdays and Fridays are designated as routine immunization days. At 7 am in the morning, Akhilesh packs vaccines in ice boxes for that are carried by health care worker to designated vaccination sites.  Sushil Tripati, takes his vaccine carrier  to Juginahai a village 15 kilometres away.  As Sushil enters with the vaccines into the health center, 30 year old Bharati Singh, an auxiliary nurse midwife, walks through the village calling out to mothers to bring their children for immunization. “Earlier we used to face a lot of resistance to vaccination, because people worried about the fever that sometimes follows. Now people are more willing.” On that day. 15 children and pregnant mothers were given routine immunization, for many of them, it was their last shot before being fully immunized.

At the end of the day, Sushil returns with the unused vaccines, and Akhilesh enters the stock information on the phone application. Information flows are accurate and immediate, meaning that planning for India’s infants became just a bit easier in one district in Madhya Pradesh. 

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