Strengthening the immunization supply chain: A time-to-supply based approach to cold chain network optimization & extension in Madhya Pradesh

Varun Srivastava,Manish Ratna,Arindam Ray,Santosh Shukla,Vipin Shrivastava,Nitin Kothari,Amandeep Gupta,Meenal Kukreja,Harkabir Singh Jandu

doi:10.1016/j.vaccine.2021.09.062

Abstract

Expansion of immunization coverage is dependent in part on delivering potent vaccines in an equitable and timely manner to immunization outreach session sites from Cold Chain Points (CCPs). When duration of travel between the last CCP and the session site (Time-to-Supply) is too long, three consequences may arise: decreased potency due to exposure to heat and freezing, beneficiary dropouts due to delayed session starts, and, increased operational costs for the Health Facility (HF) conducting the outreach sessions. Guided by the Government of India’s recommendation on cold chain point expansion to ensure that all session sites are within a maximum of 60 min from the last CCP, CHAI and the State Routine Immunization Cell in the state of Madhya Pradesh collaborated to pilot a novel approach to cold chain network optimization and expansion in eight districts of Madhya Pradesh. Opportunities for realignment of remote sub-health centers (SHCs) and corresponding session sites to alternative existing CCPs or to HFs which could be converted to new CCPs were identified, and proposed using a greedy adding algorithm-based optimization which relied on health facility level geo-location data. Health facility geo-coordinates were collected through tele-calling and site visits, and a Microsoft Excel based optimization tool was developed.This exercise led to an estimated reduction in the number of remote SHCs falling beyond the permissible travel time from CCPs by 56.89 percent (132 remote sites), from 232 to 100. The 132 resolved sites include 73 sites realigned to existing CCPs, and 59 sites to be attached to 22 newly proposed CCPs. Both the network optimization approach and the institutional capacity built during this project will continue to be useful to India’s immunization program. The approach is replicable and may be leveraged by developing countries facing similar challenges due to geographical, institutional, and financial constraints.

Highlights

The Expanded Programs on Immunization (EPI) rely on well-functioning immunization supply chains to make efficacious and potent vaccines available to children in an equitable, timely, and efficient manner
Recognizing the demand for increased cold chain capacities due to the ongoing COVID-19 vaccine campaigns globally, World Health Organization (WHO) has called upon countries to assess their cold chain inventory and procure additional storage capacity and engage with private sector to address short term gaps while enabling long-term strengthening of the immunization supply chains (iSC) [2]
This paper describes the activities undertaken by the authors in the state for cold chain network optimization and expansion and the results obtained from it

Summary

Introduction

The Expanded Programs on Immunization (EPI) rely on well-functioning immunization supply chains (iSC) to make efficacious and potent vaccines available to children in an equitable, timely, and efficient manner. Settings of developing countries such as India, improvements to the iSC are even more critical, especially in light of new vaccine introductions for COVID-19 and other planned vaccines for diseases such as malaria, typhoid, and cholera, which will place additional burden on the already constrained and fragile supply chains [1]. Recognizing the demand for increased cold chain capacities due to the ongoing COVID-19 vaccine campaigns globally, World Health Organization (WHO) has called upon countries to assess their cold chain inventory and procure additional storage capacity and engage with private sector to address short term gaps while enabling long-term strengthening of the iSC [2].

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Conclusion