by Dr Dhamija

1. C o ld C h a in Is s u e s &
C h a lle n g e s
Dr. Navneet Kumar Dhamija
Assistant Commissioner - Immunization
Ministry of Health & FW, Govt. of India
Mobiles : 8826772555, 9911220066
Office : 23062993, 23062126, 23062728
E-mail : ImmunizationAC@gmail.com

2. Rationale of strengthening
CC&VLM
1. Wide network of cold chain stores : created since
inception of UIP in 1985 and need renovation , up-
gradation and expansion
- GMSDs at Karnal , Mumbai , Kolkata & Chennai
- State Vaccines Store Depots
- Regional / Divisional Vaccines Store Depots
- District Vaccines Store Depots
- CHC and PHC Cold Chain Points
2. Introduction of AD syringes in 2004-05 demands more
dry space and bundling of vaccine and logistics supply

3. Rationale of strengthening
CC&VLM ……..
2. Equipment or management failure at storage levels can
cause destruction or large quantities of vaccines in a
matter of a few hours.
4. Inclusion of additional doses of vaccines in National
Program like Measles 2nd dose and Hepatitis-B
5. Plans need to be based on projected requirements for
next 15-20 years

4. Indicators of Cold Chain
performance
• Direct Indicators:
• Cold Chain Equipment Sickness Reporting
• Cold Chain Equipment Sickness Rate
• Cold Chain Equipment Response Time
• Cold Chain Equipment Down Time
• Proxy Indicators:
• Availability of CCO and CCTs
• Availability of Tool kits and Spare parts
• Effective utilization of cold chain maintenance fund
• % of equipments that have been visited through Preventive
Maintenance

5. Factors affecting Cold chain
performance
• Mode of maintenance (Departmental, AMC or mixed
solution )
• Presence of cold chain technicians in the state ( number
of technicians for number of districts in state )
• Sickness rate of equipments in the state
• Issues pertaining to maintenance of cold chain
• Spare parts availability

6. Cold Chain Sickness Rate( SR)
April 2011
• National : 3.63
• States having with SR less than 2%
– Assam, Chandigarh, Delhi, Goa, Gujarat, Haryana,
HP, Kerala, MP, Maharashtra, Mizoram, Orissa,
Punjab, Tamilnadu, Tripura & West Bengal
• States having SR 2-5%
– AP, Karnataka, Meghalaya, Nagaland, Pondicherry
& Rajasthan
• States with SR > 5%
– A&N Island, Bihar, Jharkhand & UP

7. CCE Sickness rates &
State – specific issues
2010-11
State No. of No. of CCTs Maintenance Sickness Other issues
distts. rate
A & N Island 3 2 (67%) Departmental 9.89 CCO to be posted. As per Ministry’s
record there is no WIC supplied but state
have one WIC in working condition
Andhra 23 22 (96%) Departmental 3.79 Negligible funds spent on HW+CCH Tgs
Pradesh
Arunachal Pr 16 12 (75%) Departmental 1.72 -
Assam 27 13 (48%) Departmental 0.52 Out of 20 Solar Units , 17 at Sites
Only 6 units installed & No reasons …
Bihar 38 6 (16%) OS / AMC 14.2 Posting of CCTs in all districts. WIC
installation site at Saran is not ready.
Civil work not started
Chhattisgarh 18 11 (61%) Departmental 1.20 One WIC lying un-installed for the
last 3 years as site is not ready.
Chandigarh 1 0 Departmental 0.63 CCO to be posted ;
Daman & Diu 2 0 Out sourced 1.89 CCO to be posted
Delhi 9 2 (22%) Departmental 1.3 CCO to be posted
Goa 2 1 Departmental 0 CCO to be posted

8. CCE Sickness rates &
State – specific issues
State No of No of
2010-11
Maintenance Sickness Other issues
districts technicians rate
Gujarat 25 31 (124%) Departmental 1.7 CCO to be posted
Haryana 21 11 (52%) Departmental 1.7 New WIC reached state
But Punchkula site is not ready
Himachal Pr. 12 4 (33%) Mixed 0.5 New WIC and WIF reached in state
but sites are not ready
Jammu & 15 14 (93%) Departmental 1.05 CCO and refrigerator mechanics
Kashmir required to be posted. WIC site at Sri-
Nagar not ready
Jharkhand 24 14 (58%) Departmental 10.2 V-MAT done, follow-up required
Increased Sickness Rate – CONCERN
Karnataka 28 2 (7%) AMC 3.1 CCO visits – storing other vaccines ?
Kerala 26 12 ( 85.7%) Departmental 1.4
Maharashtra 35 20 (57%) Departmental 1.0 -
Manipur 9 6 (67%) Departmental 0 -
Meghalaya 7 5 (71%) Departmental 4.0 -
Madhya 50 34 (68%) Departmental 1.9 Required strengthening of cold chain
Pradesh Training

9. CCE Sickness rates &
State – specific issues
2010-11
State No of distts. No. of Maintenance Sickness Other issues
CCTs rate
Orissa 30 22 (73%) Mixed 1.95 Out of 30 Solar Equipments, only 6 installed
No reasons given
Out of 5 WICs , 3 sites to be ready in next 2
years ? Equipments warranty ??
CCO,VLM,CCC,TA,CCs + & SR = increased ?
3 WICs sites not ready & no timeline given
Puducherry 4 6 (150%) Departmental 3.35 CCO to be posted, No measures explained
Rs. 37494/equipment as maintenance cost ?
Punjab 20 14 (70%) Departmental 0.9 New Initiative of CCTs mobility efforts & visits
to every cold chain point once in 3 monthshas
Further brought down SR & monitoring
Strengthening to avoid freezing / PE to be low
Rajasthan 33 35 Departmental 3.1
(106%)
Tamil Nadu 31 16 (52%) Departmental 1.1 Trinuveli site for WIC not ready
Tripura 4 2 (50%) AMC 0.9 -
Uttar Pradesh 70 36 (51%) Departmental 11.0
Uttarakhand 13 4 (31%) AMC 3.65 Incomplete information
West Bengal 18 0 (0%) AMC +OS 0.35

10. Status of Solar Equipment
as on April 2011
S.N. Name of the State No. of No. of Solar No. of Solar No. of solar No. of the Details of Damage, if any.
the Site Equipment Supplied Equipment equipment Site where
where delivered at to be installation
installat Solar Spare Tool the proposed delivered at is complete
ion tobe Equip. Kit site for the and
done installation. proposed Equipments
site of are
1 Arunachal Pradesh 30 30 3 6 6 13 6 No Damage reported
3 by may 1 Charger controller broken
2 Assam 20 20 2 4 17 6
end
3 Chattishgarh 20 20 2 4 14 6 12 1 PV array mechanical damage (PV module type KD
6 by june 1355-IPU) & reported
No Damage 1 Battery
4 Himachal Pradesh 10 10 1 2 4 0
end
5 Jammu & Kashmir 20 20 2 4 3 nos module and one no. Battery found damaged
6 UttarPradesh 20 20 2 4 12 8 8 No Damage reported
7 Madhya Pradesh 20 20 2 4 20 0 8 7 batteries and 3 Arrays
One battery of Nagar PHC and One PV Array of Amravati
8 Maharastra 20 20 2 4 18 2 16 PHC damaged
9 Manipur 20 20 2 4
10 Meghalaya 20 20 0 0 11 9 11 1 charge controller, 1 solar panel
11 Mizoram 10 10 1 2 10 10 10 No Damage reported
12 Nagaland 20 20 2 4 1 19 0 No Damage reported
13 Orissa 30 30 3 6 21 9 6 1 battery damage
2 nos. charge controler, solar panel, compressor
14 Rajasthan 20 20 2 4 20 19 1
charging coil, and 2 nos. batteries.
15 Sikkim 10 10 1 2 10 0 9 One equipments not working, problem not identified
16 Tripura 10 10 1 2 10 0 0 No Damage reported
Total 300 300 28 56 174 81 93

11. Cold Chain training center
SHTO, Pune
• Provides training for cold chain Officers and Technicians on
repair and maintenance of cold chain equipment.
• A total of 1722 technicians and cold chain officers were
trained on various types of cold chain equipment
maintenance and repair between 1983 .
• This centers runs six types of residential training on cold
chain equipment like:
a. Induction training of refrigerator technicians
b. On-job-training on maintenance of WIC/WIF
c. ToT of on-Job training for stabilizers’ repairs
d. On-job training on repair of non-CFC ILR and DF
e. On-Job training of solar equipment maintenance
f. Cold Chain Handlers’ Training

12. State wise No of participants attended
Cold Chain equipment training at SHTO,
Pune
Sr.No. Name of the State to year 2010…. trainee
Since 1983 No. of
1 Andhra Pradesh 107
2 Arunachal Pradesh 27
3 Assam 37
4 Bihar 13
5 Delhi 19
6 Goa 06
7 Gujarat 99
8 Haryana 44
9 Himachal Pradesh 26
10 Jammu & Kashmir 33

13. State wise No of participants attended Cold Chain equipment
training at SHTO, Pune Since 1983 to year 2010….
11 Karnataka 60
12 Kerala 53
13 Madhya Pradesh 152
14 Maharashtra 334
15 Manipur 18
16 Meghalaya 16
17 Mizoram 08
18 Nagaland 09
19 Orrissa 87
20 Punjab 53
21 Rajasthan 104
22 Sikkim 02
23 Tamilnadu 97
24 Tripura 12
25 Uttar Pradesh 178
26 West Bengal 49

14. State wise No of participants attended Cold Chain
equipment training at SHTO, Pune
Since 1983 to year 2010….
27 Andaman & Nicobar Island 08
28 Chandigarh 08
29 Dadra & Nagar Haveli 01
30 Daman & Diu 05
31 Lakshadweep 03
32 Puducherry 03
33 Uttarakhand 06
34 Jharkhand 07
35 Chhattisgarh 21
36 Tanzania 05
37 Nepal 02
Total 1722

15. Challenges in cold
chain
– Low storage capacity in the State warehouses -
Optimizing the stock by keeping in view the
reordering level and the lead time
– Shortage of Staff – CCOs, Refrigerator
Mechanics – Need for hiring and training of staff
and creation of more post as per the state specific
needs in many states

16. Components of Cold chain
& VLM strengthening
 Human Resource
 Infrastructure
 Planning , Monitoring and Supervision
 Periodic Vaccine and Cold chain Assessment using
tools like VMAT/EVSM
 Improved Documentation and Reporting and using
standard practice for vaccine management

17. Human Resource
Strengthening
A. Ideal & Adequate Human resource posted and
Available
State Level:
3. One Cold Chain and Vaccine Manager and for a larger state
an additional Asst Cold Chain Officer and VLM
4. State vaccine store to be managed by trained personnel on
cold chain & vaccine logistics with computer skills.
5. Semiskilled helpers available on 24x7 duty in State Store to
handle emergency, power failure and to coordinate
implementation of contingency plan
6. State Cold chain repair team to resolve major failure in cold
chain system
Similar structure to be replicated at regional and distt.levels

18. Human resource…
B. Capacity Building on CC&VLM
2. Skill based training of cold chain technicians, store
mangers on cold chain and vaccine management
3. Cold chain handlers training at district level by the
trained personnel with practical demonstration
4. Regular reviews of district and block level cold
chain handlers at state and district level
respectively
5. Build capacity of programme managers to do self
assessment using tools like VMAT&EVSM

19. Infrastructure strengthening
 State/Divisional/Regional stores should have
a. Adequate vaccine storage space
b. Dry storage space for storage of AD syringes ,
Immunization cards and other immunization supplies
c. Building to be leakage proof , well ventilated with
telephone, fax and internet connectivity
d. Power back up in the form of auto start generator
e. Temperature monitoring devices like Graphic Chart
Recorder & Acoustic Alarm should be fully functional
f. Working Vaccine Van (Refrigerated /Non refrigerated)
with driver at all levels

20. Infrastructure
strengthening…
 Cold chain storage needs to be extended beyond
block PHC to lower level PHCs, wherever possible
 Preparation of site/s for installation of new WICs and
WIFs
 Segregate all District Vaccine Stores attached to
Divisional /Regional Vaccine store physically along
with all documentation
 Ensuring timely supply of spare parts

21. Planning ,Monitoring &
Supervision
• Each state to have CFC phase out plan & need based
cold chain facility expansion plan for effective
vaccine delivery to outreach session and
monitoring
• Installation of Solar refrigerators for difficult-to-
reach areas without electricity or poor power supply
• Increased field visits of state programme officers for
immunization and cold chain monitoring at District,
Block and other cold chain facilities
• District wise review of vital cold chain performance
indicators

22. Periodic Vaccine and Cold Chain
Assessment –VMAT/EVM
• Build the capacity of departmental staff on Vaccine
Management Assessment.
• Capacity to do self assessment and improve the existing
gaps.
• Identify the gaps and do all possible on-site correction
and provide input for long term planning
• Standard tools available like : EVM ( Effective Vaccine
Management )

23. Population served per cold chain point
Vs Immunization Coverage
Most of the big states with good immunization coverage have one cold chain point for every
Hence there is a need to expand cold chain points
25-40,000 population which facilitate effective vaccine delivery to the session site

24. Why Cold Chain point
expansion ?
• Immunization coverage will increase by increasing
access and utilization
• Making Cold chain point nearer to immunization
sites will improve access which needs to be
supported by micro planning and AVDS
implementation
• Effective supply of vaccine is possible if every cold
chain point serves 6-8 Sub centers or 15-20
immunization sites

25. Requisites for
Cold Chain expansion
• Adequate beneficiary load of the proposed site
• Availability of building
• Availability of power supply
• Dedicated persons to look after the Cold chain point
• Feasibility for electrical /Solar /Hybrid equipment for
expansion

26. Introduction -NCCMIS
• Developed by Cold Chain Training Center, SHTO Pune in
consultation with GOI and with technical support from
UNICEF.
• Field testing of the MIS format completed in 5 states
( UP, Orissa, Haryana, Rajasthan & Karnataka )
• Officers from states will be provided the access to online
database of cold chain equipment in the state.
• Administrator will be at State level

28. Two components of NCCMIS
Static and Dynamic sections as follows:
Static Section :
– Guidance on Cold chain &VM
• GOI guidelines
• Specification of CCEquipments
• CCE allocation to the states
• State wise cold chain performance indicators since
2006
• Spare parts list and code guide and circuit
diagrams
• Report of assessment and studies
• Good practices at the states
• FAQs

29. Two components …..
Trainings on Cold chain &VM
• Courses offered by CCTC- Pune and NIHFW
• Schedule of Training programme of CCTC
• Details of the training programme
( Durations, contents , methodology facilitators)
• Trainees data base since 1992
• Training manuals
• Pool of trainers and their CVs

30. Two components …..
Dynamic Site
• Cold chain data base ,PHC to GMSD
• Cold chain performance indicators
( Sickness rate , Down time , Response Time )
• Maintenance reports of CCEs ,serial numberwise
• Spare parts management ( stock , utiliasataion
pattern )
• Human resource status (Cold chain Officers ,VLM ,
CCTs)
• Tool kits status

31. Cold chain MIS data collection form
• SECTION 1.1: SITE INFORMATION
EQUIPMENT DATA COLLECTION FORM MARCH 2011- FINAL 7 APR 2011.DOC
• Section 1.2 Human resource
• Section 1.3 Vaccine van and generator
• Section 2.1 Cold chain equipment: Ice Lined Refrigerator (ILR)
• Section 2.2 Cold chain equipment : Deep Freezer (DF)
• Section 2.3 Cold chain equipment : Solar Refrigerator( if
applicable )
• Section 2.4: Cold Chain equipment (Non-electrical) consolidated
for whole district
• Section 2.5: Breakdown record of ILR and DF
• Section 2.6: Breakdown record of Solar Refrigerators
• Section 2.7 Cold chain equipment (WALK in Cooler /Walk-in-
Freezer)
• Section 2.9: Breakdown record
• Section 2.10 : RECORD OF BEYOND REPAIR EQUIPMENT

32. 32

33. 33

34. Website address and Contact
person
www.nccvmtc.org
•Immunization Division, MOHFW
Dr.N.K.Dhamija : Asstt. Commissioner-Imm.
Dr.Pradeep Haldar : Asstt. Commissioner-Imm.
Email : riindia2008@gmail.com
•SHTO - Pune
Mr.Yogesh S Bhamare
Electrical Technician,HEMRUnit,SHTO
Email: hemrhqpune@yahoo.co.in, ysbhamare@gmail.com

35. GOI initiatives
• Supply of adequate WIC,WIF, ILRs and DFs and Solar
Equipments
• Supply of Tool Kits and spare parts
• Cold Chain MIS
• EVM training and assessment
• Prototype development for Vaccine stores
• Countrywide training of Cold chain handlers with
structured module
• Temperature monitoring devices in cold rooms
• Regular Qtrly Meetings of CCOs followed after a month
by SEPIOs Meetings on Qtrly Meetings
• Formation of Regional Resource / Working Groups

36. Expectations from SEPIOs
Monitor activities in close
coordination with CCOs
• Monthly Reporting of CC Equipment’ status by e-mail
in prescribed formats
2. Immediate Reporting - in the event of breakdown of
any equipment
4. Monthly Reporting of HR Data and other status by
e-mail as well, in prescribed formats
• Meeting with CCO every month for reporting of Key
Points by CCO
• Scheduling & Monitoring of trainings of HR

37. EXPECTATIONSFROM SEPIOs…..
1. Timely response to requests by authorized personnel at MoHFW
a) Mr. Saumitra Sahar, Section Officer
b) Mr. Eric Beck, Sr. Statistical Officer
c) Dr. Bhrigu Kapuria, Consultant Tech. Officer
d) Er. SK Saxena, Cold Chain Consultant
e) Dr.( Ms.) Hema Gogia, Consultant Tech. Officer
f) Mr. Paritosh Panigrahi, Vaccine & Logistics Consultant
• Take immediate steps to get back the space occupied by
condemned equipments vaccines & other logistics following
state specific procedures
• Repeated Surprise Visits at cold chain points to ensure nothing
except vaccines & diluents are kept in the cold chain equipments
• Ensure proper storage of vaccines in WICs / WIFs & other CCEs
• Ensure “ No expired vaccines are stored in cold chain
equipments ”

38. Resolution
We shall provide safe, secure and
potent vaccines to every mother &
child in India………………………….

39. - Dhamija