There are few immunization issues more important than the storage and handling of vaccines. Here’s how Balod district in Chhattisgarh became a model vaccine store.
“This vaccine store is my responsibility. Everyday I log the temperatures of the cold storage at 10am and at 4pm. I also see to it that vaccines are ferried to each of the cold chain points in my area. If the vaccines are spoilt, that’s also my responsibility.” Rajendra Sahare, the district vaccine store manager for Balod, keeps a systematic tally of vaccine stocks at his centre. He manages and sends out over 35,000 doses of vaccines each month to the 29 cold chain points.
Proper vaccine storage and handling is crucial in protecting individuals and communities from vaccine-preventable diseases. From the date it is manufactured till the time it is administered, the quality of a vaccine is the shared responsibility of everyone involved in the chain -- manufacturers, distributors, public health staff and healthcare providers -- but, as Rajendra says, the buck stops with the vaccine store manager.
But nearly 50 percent of Chhattisgarh, where Rajendra works, is covered in forest. Many villages and residential pockets are hard to reach and have extremely poor or no mobile network and internet connectivity. Maintaining an uninterrupted cold chain for vaccines and delivering immunization services here is no easy task.
But 100 km away from Raipur, Chhattisgarh’s capital, the district vaccine store (DVS) of Balod has emerged as a model vaccine store. Situated at the district level, a district vaccine store distributes vaccines and dry stocks like syringes to all the cold chain points within its jurisdiction every month, after receiving these supplies from regional and state vaccine stores.
The district vaccine store in Balod serves 9.2 lakh people, including 18,000 pregnant women and 18,000 babies before their first birthday. Until a year ago, the DVS operated from a single room – a challenge for the smooth management and distribution of vaccines. Now, the old district hospital building has been renovated and upgraded to house the DVS.
Small things have made a big difference. The Balod DVS has today adopted various innovations in the way the store is maintained and managed. It has well-equipped and separate storage rooms for vaccines and dry stocks; a room with workstations allocated for repairs of cold chain equipment by technicians; an ice-pack conditioning centre; movable wooden stands for refrigerators; properly maintained log-books; and well-placed printed communication material for reference. This vaccine store has everything well-organised and systematically in place.
How did this happen? It began with a commitment from the Government of Chhattisgarh to ensure that its vaccine centres were in better shape. With the state health department in the driving seat, UNDP supported the revamp of the DVS by coming up with ideas on how day-to-day difficulties in vaccine management – partly specific to Chhattisgarh’s geography and infrastructural limitations – could be addressed.
Only a year ago, the lack of space made vaccines difficult to store and locate, requiring time and effort to ensure no mistakes were made and vaccine stores were managed efficiently and effectively. With better vaccine storage, all supporting material properly labelled and neatly placed, and with spaces designated for all steps of workflow for vaccine distribution, this DVS is setting an example for several vaccine storage centres in neighbouring districts.
Ravikant Sahu is the vaccine and cold chain manager of the district. He supports Rajendra by keeping a log of the vaccines on his eVIN mobile app (a simple innovation by the Ministry of Health and Family Welfare and UNDP to digitize vaccine stocks and temperatures, helping strengthen the vaccine supply chain). Ravikant and Rajendra keep records of vaccines issued and transported to all the cold chain points in Balod, and prepare a systematic distribution plan accounting for variables like time, distance of the vaccine storage centres and indents received from them, making the vaccine supply chain shorter and vaccines available at all times. Behind them, on the left, is a route map showing cold chain stores across Balod district.
Balod is a triumph of technology, effort and government will. Today, despite the rugged terrain, the logisitical challenges, and the difficult geography, the store is being developed as a skill-development-cum-model-centre for cold chain and vaccine logistics management. The Government of India’s National Health Mission and UNDP support this via exposure visits for teams from other districts for learning and replication. There is also a functional training room used to conduct training sessions for health care workers.
Dr Sirish Kumar Soni, the district immunization officer, holds a training session for cold chain handlers and field staff at the skill centre. “Since the arrival of eVIN, we’ve been able to transform our DVS into a model centre. And this, in turn, has inspired the 222 ANM and 190 health workers in the district to think about ways to improve their own sub-centres.”
Neighbouring districts have organized learning visits to Balod so they can replicate its success. Within the district, health workers are motivated to keep their stores more clean, well-organized, well-maintained. The store also maintains a good collection of reading material and job aids on cold chain logistics maintenance and immunization, encouraging continued learning for staff and visitors.
The Balod DVS is one among many vaccine cold chain points that have undergone a transformation after eVIN was introduced. With digital record-keeping of stocks and storage temperatures for ensured availability and safety of vaccines has come a commensurate upgrade in physical infrastructure to optimize the vaccine supply chain. Using the comprehensive reports and analysis reflected by the eVIN system, programme managers can now assess the functionality of the vaccine storing centres including details of transactions and activity by the centre on the app, health of the cold chain equipment, and availability of electrical power supply. Several new cold chain points have been opened up, while many other non-functional ones have been shut down. Buildings have been renovated and repaired, facilities upgraded at most cold chain points.
Balod, and other vaccine stores like it, exemplify how technology that is contextual, adaptable and responsive for local needs, can bring with it a change beyond the intended immediate solution it is designed to offer .
There are few immunization issues more important than the appropriate storage and handling of vaccines. With more control and agency over monitoring of vaccine temperatures and logs, and therefore a greater investment in the integrity of vaccines, vaccine handlers are looking to optimize every aspect of the supply chain -- to make it stronger, so every pregnant woman, and every child, can be reached in time.