Peru: Cold Chain Peru: Cold Chain

Management Experience Management Experience

4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 1717--19 February 200919 February 2009

NewNew York York CityCityDrDr Fernando Fernando PerezPerez

PERUPERU

Total estimated population 2008: 28,220,800

Source: National Institute of Statistics

BriefBrief HistoricalHistorical OverviewOverview

1986 EPI launching1986 EPI launching

1990 1990 –– 2000: a decade of major EPI 2000: a decade of major EPI achievements: very high coverage ratesachievements: very high coverage rates

2001 2001 –– 2004:2004:

•• EPI deactivation affecting technical and EPI deactivation affecting technical and managerial submanagerial sub--sectors.sectors.

•• Limited budget for immunization, with Limited budget for immunization, with prioritization on vaccine procurement.prioritization on vaccine procurement.

•• No budget available for maintenance, neither to No budget available for maintenance, neither to equipment renewal.equipment renewal.

•• Serious gap in monitoring and supervision of Serious gap in monitoring and supervision of immunization activities. immunization activities.

•• Human resources gap: no training, no updatingHuman resources gap: no training, no updating

BriefBrief HistoricalHistorical OverviewOverview

�� 2004: It becomes evident the need of 2004: It becomes evident the need of immunization revivalimmunization revival as a programme: as a programme: priority to the introduction of new vaccines priority to the introduction of new vaccines and upgrading of cold chain according to and upgrading of cold chain according to global standards to ensure the global standards to ensure the quality/potency of vaccinesquality/potency of vaccines

�� NATIONAL PLAN review:NATIONAL PLAN review:•• Cold Chain Inventory Cold Chain Inventory –– top prioritytop priority

•• Design of data collection and monitoring tools Design of data collection and monitoring tools

•• Appropriate temperature monitoring of vaccines Appropriate temperature monitoring of vaccines to address the risk of freezing in the cold chainto address the risk of freezing in the cold chain

•• Implementation of a national monitoring systemImplementation of a national monitoring system

Cold Chain Inventory in Cold Chain Inventory in PerPerúú -- 20042004

� History: Previous cold chain inventories • First: 1989

• Second: 1993 -94

� Third national cold chain inventory in Perú is conducted within the context of a renewed policy, budget and managerial MoH framework, which included a new national vaccine law

� Immunization is officially defined as a cost-effective activity of high impact in public health

� A new national immunization strategy is established: EPI recovers its status as a critical public health programme

� Technical and financial support from international cooperation

Results and lessons learnedResults and lessons learned

To procure new complementary cold chain To procure new complementary cold chain equipment equipment

a. 18,761 vaccine carriersa. 18,761 vaccine carriers

b. 449 cold boxesb. 449 cold boxes

c. 200,000 ice packs c. 200,000 ice packs

d, 25,000 thermometersd, 25,000 thermometers

Decentralization and vaccine security: Decentralization and vaccine security: addressing the need of regional cold rooms addressing the need of regional cold rooms

�� NormativeNormative

�� ManagerialManagerial

�� Research and analysisResearch and analysis

�� Monitoring and controlMonitoring and control

Cold Chain Policy Improvements Cold Chain Policy Improvements

•• Ministerial Resolution endorsing new cold chain Ministerial Resolution endorsing new cold chain technical guidelines, including criteria for cold technical guidelines, including criteria for cold chain equipment selectionchain equipment selection

•• Commitment of Ministry of Economy and Commitment of Ministry of Economy and Finance in its implementation within the Finance in its implementation within the framework of decentralizationframework of decentralization

ResultsResults andand AchievementsAchievementsStrengthening of the vaccine storage capacityStrengthening of the vaccine storage capacity

�� Central store Central store

�� Four new macroFour new macro--regional storesregional stores

Central store LIMACentral store LIMA

DISAS Lima y Callao, DISAS Lima y Callao, IcaIca, Ucayali, San Mart, Ucayali, San Martíín, Loreton, Loreto

1.1.-- MacroMacro--regional store AREQUIPAregional store AREQUIPA

Arequipa, Moquegua, Tacna, PunoArequipa, Moquegua, Tacna, Puno

2.2.-- MacroMacro--regional store CUSCOregional store CUSCO

Cusco, Apurimac (Andahuaylas, Abancay), Madre de DiosCusco, Apurimac (Andahuaylas, Abancay), Madre de Dios

3.3.-- MacroMacro--regional store LAMBAYEQUEregional store LAMBAYEQUE

Lambayeque, La Libertad, Piura, Tumbes, Cajamarca, Lambayeque, La Libertad, Piura, Tumbes, Cajamarca, Amazonas.Amazonas.

4.4.-- MacroMacro--regional store JUNINregional store JUNIN

JunJuníín, Pasco, Huancavelica, Ayacucho, Huanucon, Pasco, Huancavelica, Ayacucho, Huanuco

Final decision: expansion to 52 cold rooms according to Final decision: expansion to 52 cold rooms according to

current decentralization management of health systemcurrent decentralization management of health system

1.1. Amazonas Amazonas -- Chachapoyas Chachapoyas 2.2. Amazonas BaguaAmazonas Bagua3.3. Ancash la CaletaAncash la Caleta4.4. Ancash Ancash 5.5. Apurimac Apurimac -- Abancay Abancay 6.6. Apurimac Apurimac -- Andahuaylas Andahuaylas 7.7. Arequipa Arequipa 8.8. Ayacucho Ayacucho 9.9. Cajamarca Cajamarca 10.10. Cajamarca Cajamarca -- Cutervo Cutervo 11.11. Cajamarca Cajamarca -- Chota Chota 12.12. Cajamarca Cajamarca -- JaenJaen13.13. CuscoCusco14.14. Huancavelica Huancavelica 15.15. Huanuco Huanuco 16.16. IcaIca17.17. JunJuníín n 18.18. La Libertad La Libertad 19.19. Lambayeque Lambayeque

20.20. Lima AlmacLima Almacéén Central n Central 21.21. Lima Ciudad Lima Ciudad 22.22. Lima Este Lima Este 23.23. Lima Provincia Lima Provincia 24.24. Lima Sur Lima Sur 25.25. Callao Callao 26.26. Loreto Loreto 27.27. LorLoretoeto -- Yurimaguas Yurimaguas 28.28. Madre de Dios Madre de Dios 29.29. Moquegua Moquegua 30.30. Pasco Pasco 31.31. Pasco Oxapampa Pasco Oxapampa 32.32. Piura Piura 33.33. Piura Piura -- SullanaSullana34.34. PunoPuno35.35. San MartSan Martíín n 36.36. Tacna Tacna 37.37. Tumbes Tumbes 38.38. Ucayali Ucayali

EJ: EJ: VaccineVaccine cold storecold store

GERESA ArequipaGERESA Arequipa

Cold chain improvementsCold chain improvements

�� New data management toolNew data management tool•• Data consolidation and analysis with software Data consolidation and analysis with software which provides detailed information for cold which provides detailed information for cold chain equipment planning and managementchain equipment planning and management

Cold Chain AchievementsCold Chain Achievements

� Procurement of cold chain equipment with national budget (national budget line)

Investment

� 2007 $ 6,600,000

� 2008 $ 4,200,000

2,590 new pieces of equipment procured, ~ new pieces of equipment procured, ~ 46% of total national requirementsof total national requirements

Acquired cold chain equipment: Acquired cold chain equipment:

~ US$ 6,500,000 ~ US$ 6,500,000

153153•• Refrigerators (Solar)Refrigerators (Solar)

372372•• Refrigerators (Gas)Refrigerators (Gas)

1,1631,163•• FreezersFreezers

1,1121,112•• Refrigerators (electric)Refrigerators (electric)

5252•• Cold roomsCold rooms

QuantityQuantityProcuredProcured

19,10419,104•• Cold packsCold packs

7,1597,159•• ThermometersThermometers

4,0964,096•• Vaccine CarriersVaccine Carriers

1,5051,505•• Cold BoxesCold Boxes

Detected weaknessesDetected weaknesses

Temperature monitoring to assess Temperature monitoring to assess freezing in the cold chain freezing in the cold chain conducted in Mayconducted in May--August 2008:August 2008:

•• Inadequate preparation of cold Inadequate preparation of cold packs.packs.

•• Lack of training for existing human Lack of training for existing human resourcesresources

•• Lack of human resourcesLack of human resources•• Lack of local supervisionLack of local supervision

Major achievementsMajor achievements

National Implementation of Cold National Implementation of Cold

Chain Failure ManagementChain Failure Management

National Implementation of National Implementation of

recommendations to prevent recommendations to prevent

freezing in the cold chainfreezing in the cold chain

Vaccine distribution monitoring Vaccine distribution monitoring -- 20092009

40Tinitag explorer Software (Win98 2nd Ed, W2000 or

XP)SWCD-0040

80Tinytag Transit/Tinytalk PC download cable (USB)

CAB_0005-

USB

80

5,000

Tinytag Shuttle sofwareSWCD_00600

Tinitag Talg 2 Medical, temp (-40°to 85°C)TK-4014

••Monitoring of vaccine distribution using temperature data loggerMonitoring of vaccine distribution using temperature data loggers.s.

Introduction of new vaccines in PeruIntroduction of new vaccines in Peru

•• PneumococcalPneumococcal

•• InfluenzaInfluenza

•• RotavirusRotavirus

IPV Población en riesgo

dT

DPT o (DaPT)

DPT o (DaPT+Hib)

AMA

SRP

ROTAVIRUS

INFLUENZA

NEUMOCOCO

PENTAVALENTE

APO

HvB

BCG

Población en riesgo

Personal de

Salud

Mayores de 60 años

MEF Gestant

es

4 año

s

18 mese

s

15 mese

s

1 año

8 meses

7 mese

s

6 meses

5 meses

4 mese

s

3 mese

s

2 meses

Reciennacido

VACUNA

National Immunization Schedule - ESNI MINSA - PERU 2009

GRACIASGRACIAS

cadenadefrio@minsa.gob.pecadenadefrio@minsa.gob.pe