Thoughts from the Last Mile Welcome to the VillageReach Blog
Jan 27 2015

Versão português

As the world welcomed 2015, Mozambicans were faced with destroyed infrastructure, displaced families and dozens of deaths – the result of catastrophic flooding to the central and northern areas of the country.

The intense  floods caused a power outage on the 12th of January, 2015 in the northern region of the country (Niassa, Cabo Delgado and Nampula) and part of the central Zambézia province. The floods destroyed the electrical towers and power lines that carry electricity from the national grid outside of Maputo  to the northern and central zones of the country, the area’s only source of power. As of the date we closed this blog (23 January 2015) Niassa province was still without electrical power, with no estimate on when it will be  restored.

Flooding-image-2

This wide-spread loss of power has seriously threatened the vaccine cold chain.

Vaccine conservation standards indicate that vaccines must be stored between  2ºC and 8ºC in order for them to remain viable as vaccinations.  Most health facilities use freezers to conserve their supply of vaccines and any long-term loss of power can be detrimental to the supply unless swift action is taken to conserve the vaccines. In order to see the on-the-ground impact the blackout is having on the Expanded Program on Vaccination (EPI) and the cold chain, a VillageReach team visited the Lago and Sanga districts of the Niassa province.  We found that the health centers that are currently without power have taken their vaccines to health units with solar powered freezers. Despite this move, the conservation of vaccines is still a concern for local health authorities as the usual immunization activities are not taking place at the typical locations and times due to the changing location of the vaccines.

A freezer without vaccines. The vaccines from this cooler were transferred from a health center in Metangula to a health center in Mululuca
A freezer without vaccines. The vaccines from this cooler were transferred from a health center in Metangula to a health center in Mululuca

We noted that neither of the two districts had defined alternative strategies for vaccination, while nine of the fixed vaccination stations were dependent on coolers that only could keep vaccines cold for up to seven days. Due to the severity of this particular power outage and no indication of when it will be restored, a seven day cooler is not sufficient to ensure vaccine conservation.

Additionally, overcrowding of freezers is occurring at health facilities that have solar-powered freezers because they are receiving vaccines from multiple facilities. For example, three health centers in the Lago district, including the main health center and the district’s vaccine warehouse, had to transfer their vaccines to the Mululuca Health Center, which is about 40 km from each of the three health centers. The Mululuca Health Center now has to find space to hold all of the vaccines for the entire district.

The natural disaster has unveiled the  concerning reality of current vaccine conservation standards.

Additionally, there is not enough gasoline for vehicles to transport the vaccines from the location where they are being kept to the fixed vaccination spots in the field. This is particularly concerning considering that

the vaccines are now all in one location but cannot be delivered to those who need them.

Furthermore, many facilities without power are depending on coolers powered by batteries to keep vaccines cold. These batteries need to be changed every seven days. Without gasoline and vehicles, getting additional batteries may be impossible and the vaccines are at high risk of spoiling.

Future Implications

  • Elevated percentage of unvaccinated children during the period of the outage
  • Increased demand at vaccine locations once electricity is reestablished
  • Fatigued health technicians who, due to the flood, will need to work to transfer the vaccines back to their original freezers.
  • Poor quality of services and data

A Need for Reflection

Almost every year, floods and severe storms occur in Mozambique and threaten to destroy the country’s infrastructure. Power loss in health facilities is nothing new and almost always occurs during these natural disasters. As of now, the funds that are used to purchase freezers for vaccines only allow for the purchase of electric freezers – solar –powered freezers are not approved for use of funding.  This practice is a topic that needs better reflection and thought, particularly in a location where storms are power losses are so common.


About the Author – Aida Marina Coelho holds a bachelor’s degree in Public Administration and a Masters of Public Health from Curtin University of Technology in Western Australia. Having worked at the Ministry of Education for 10 years in various management capacities, her experience includes coordinating the national program of direct support to schools, implementing the Strategy to Prevent and Combat Alcohol and Drugs, and managing the national expansion of the Geração Biz project focusing on sexual and reproductive health.

Her experience in planning, implementation, monitoring, and supervision for programs focusing on promoting good health and strong coordination with government, NGO, international organization, and donor partners is valuable in her role as VillageReach Mozambique’s Program Officer where she joined in 2011. As Program Officer, she is responsible for monitoring and supervising the Dedicated Logistics System in the various provinces with a focus on implementation planning and technical management.
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Jan 26 2015
flooding in Mozambique, river bridge
Transbordo do rio Licungo no distrito de Mocuba, a norte da província da Zambézia que atingiu 12m de altura, seis metros acima do nível de alerta máximo. (imagem jornal @Verdade).

ENGLISH VERSION

O clima em Moçambique é caracterizado por ser húmido e tropical, estando na lista dos países do mundo mais vulneráveis a catástrofes naturais, segundo as Nações Unidas. A época chuvosa 2013-2014 foi caracterizada pela ocorrência de chuvas extremas em particular na região sul do país nomeadamante, a província de Gaza, que resultaram em inundações e destruição de infra-estrutura. Centenas de moçambicanos morreram e outros milhares tiveram de abandonar as suas casas. Na presente época chuvosa, 2014-2015, as chuvas caem com alguma regularidade em todo o país, no entanto, diferente cenário vive-se nas zonas centro e norte tendo obrigado o Conselho de Ministros de Moçambique a decretar “alerta vermelho institucional” logo nos primeiros dias de 2015. Infra-estruturas destruídas, familias desalojas e dezenas de mortes foram o destaque da imprensa Moçambicana e não só, logo no inicio do ano novo.

As chuvas intensas resultaram num apagão desde o dia 12 de Janeiro de 2015 em toda a região norte do país (Niassa, Cabo Delgado e Nampula) e uma parte da provincia central da Zambézia. A falta de corrente elétrica deu-se devido ao desabamento de algumas torres que transportam a corrente eléctrica da rede nacional. Esta situação comprometeu a cadeia de frio nas unidades sanitárias que utilizam geleiras eléctricas para a conservação de vacinas. A província de Niassa é o nosso foco neste blog.Flooding-image-2

Para perceber no terreno qual o impacto deste apagão no programa Alargado de Vacinação, uma equipa da VillageReach visitou os distritos de Lago e Sanga, na provivíncia de Niassa. Constatamos que as unidades sanitárias que usam o sistema de rede eléctrica nacional haviam retirado as vacinas para Unidades Sanitárias com geleira de sistema solar. Contundo, a conservação das vacinas ainda constitui uma preocupação para as autoridades sanitárias locais, uma vez que as actividades de vacinação não estão a decorrer nos habituais postos fixos por falta de recursos para o manuseamento das vacinas dos locais onde estão a ser conservados.

As autoridades Sanitárias locais agiram com rapidez uma vez que as geleiras já marcavam temperaturas altas, muito acima do padrão recomendado pelas normas de conservação de vacinas (+2ºC a 8ºC).

A freezer without vaccines. The vaccines from this cooler were transferred from a health center in Metangula to a health center in Mululuca
Geleira sem Vacinas. Vacinas transferidas do CS de Metangula para CS de Meluluca

Constrangimentos foram constatados nomeadamente, nenhum dos dois distritos tinha definido estratégias para vacinação, nove (9) Postos fixos de vacinação  usando o caixa isotérmica de 7 dias. O congestionamento de vacinas nas unidades sanitárias com geleiras solares, visto estarem a receber vacinas de diferentes unidades, por exemplo, no distrito de Lago, três centros de saúde, incluíndo o centro de saúde sede e as vacinas do depósito distrital, tiveram de ser transferidas para o CS de Miluluca (com geleira RCW 50) que dista a cerca de 40Km de cada um dos três centros de saúde. Colmans com acumuladores estão a ser usados nos centros de saúde com falta de corrente eléctrica, reabastecidos, em média, em cada 7 dias. A sobrelotação das geleiras “receptoras”, como o CS de Meluluco, é uma realidade preocupante no que diz respeito as normas de conservação de vacinas. A estes constrangimentos, adiciona-se a falta de combustível para abastecer viatura/morizadas que devem efectuar o transporte das vacinas dos locais onde estão conservados para os postos fixos paralisados.

Futuras Implicações

    • Elevada percentagem de crianças não vacinadas durante o périodo do apagão;
    • Maior demanda nos postos fixos após o restabelecimento da corrente eléctrica;
    • Fádiga dos técnicos de saúde devido o enchente que irá se verificar nos postos fixos ;
    • Fraca qualidade dos serviços e de dados.

Necessidade de reflexão!!!

Em quase todos os anos, Moçambique é fustigado por cheias e tempestades fortes que destroem infra-estruturas, a falta de corrente elétrica nas unidades sanitárias repete-se a cada ano quando estes fenómenos ocorrem. A compra de geleiras somente elétricas para o país, como está a acontecer neste momento com os fundos do HSS, é um assunto para melhor reflexão.

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Jan 22 2015

VillageReach operates several programs in the areas affected by the recent flooding in Malawi including the Kwitanda Community Health Project, located in Balaka District. VillageReach’s ongoing work in Kwitanda highlights the critical role of infrastructure and how systemic improvements are critical to community health outcomes, especially when disaster hits.

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Jan 20 2015

 

This week, our blog, Thoughts from the Last Mile is dedicated to our staff who live and work in Malawi and Mozambique where devastating flooding this past week has greatly intensified the existing barriers to healthcare delivery brought on by a lack of infrastructure-energy, roads, communications, etc.  While aid is available, the inability to get aid to those in need remains a significant challenge. This critical lack of access is the basis on which VillageReach was created.

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Jan 08 2015

Why Peer-to-Peer Learning is a Critical Part of Health System Improvement

As the Country Director for VillageReach in Mozambique, I am very encouraged by the progress we have made in the last 12 months. Great strides were made at the national level to bring attention to the need for supply chain system optimization based on the achievements of the Dedicated Logistics System (DLS). Peer-to-peer learning played a key role in that progress.

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Dec 17 2014

Last week, the Ministry of Health in Mozambique hosted the yearly national level meeting for the Expanded Program on Immunizations (EPI). Several people from each of the ten provinces in the country as well as the national level participated, including the provincial level medical chief and the EPI managers. It was a time to reflect back on recommendations made at last year’s meeting, review the data coming from the provincial EPI programs, and identify ways to improve activities.

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Dec 04 2014

The Role of Data Collection and One Community’s Path Toward Change

While working on the Kwitanda Community Health Project (KCHP), based in the Kwitanda catchment area, Balaka District, in southern Malawi, I have seen firsthand how critical the role of data collection is to improving health outcomes. In this rural and remote setting, the news of a maternal death spreads quickly, but quietly, almost like a rumor or story. “Did you hear? Another mother died in childbirth in that village. Another neonatal death occurred last week.” It is difficult to understand the causes of the death, or how often they occur because little information is collected and reported on these events.

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Nov 21 2014

Last week marked the seventh annual Global Health Supply Chain Summit, which brings together academics, supply chain specialists, ministry of health representatives, bi-laterals, and even private sector logisticians each year to check in, explore new ideas, report on studies, and essentially challenge each other to keep improving supply chain management in the countries where we work.

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Oct 10 2014

I am a clinician by profession, serving a population of over 30, 000 in the 25 villages that my health center serves. I am the only clinician at the health facility with a single nurse to assist covering when possible.  We recently lost the only health surveillance assistant that was trained as a drug clerk as she has left to pursue a one and a half year course in midwifery. This leaves me as the only clinician and also the only person to manage stocks in the medicine store (pharmacy).  I undertake the majority of dispensing responsibilities as the hospital attendants that sometimes need to fill this role are not knowledgeable about medicines. When it’s month end, I am also responsible for doing the physical inventory and producing a monthly report.  Each of these tasks requires time away from my primary responsibility of treating patients. This results in less time with patients, and inadequate reporting of essential information required to manage inventory. For example, I am not sure the reports that I send are even a true representation of the situation on the ground due to the limited time I have to devote to this task.

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Oct 07 2014
It seems like a stretch—using Legos to find efficiencies in a vaccine supply chain. But that was the concept we worked with last week in Mozambique with representatives from both national and provincial level Ministry of Health, UNICEF, WHO, and VillageReach, led by the HERMES logistics team taking us through the use of the HERMES modeling tool. The HERMES model, which stands for Highly Extensible Resource for Modeling Supply Chains, allows a ministry of health to simulate different scenarios in a vaccine supply chain by changing the different components to find efficiencies.
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