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.
And so it was a year in graphs. Each province showed graphs reporting the coverage rates for the different vaccines and trends over the past few years. Interesting enough, but the most interesting part, as always, was the discussion that came out of reviewing those graphs and identifying the challenges that are common across provinces.
At the beginning of the meeting, the National Deputy Director of Public Health encouraged participants to have an “open mind” to find solutions to the challenges faced by the EPI program. She also pointed out that as the program continues to grow, we all must become “true logisticians” to improve the supply chain.
A few of the emerging considerations from the meeting:
- The country will be introducing four new vaccines in the next year. Participants expressed concern about the supply chain once these new vaccines are introduced. Even with the current vaccine schedule, the transport capacity is not sufficient to deliver all vaccines to the provinces on a quarterly basis. Vaccines are currently flown via cargo on the national airline to the Central and Northern provinces, and this already faces huge challenges with capacity and timeliness of deliveries. It was difficult to imagine how this will be resolved when more vaccines are introduced next year.
- Building on the modeling activity we led in two provinces (Gaza and Cabo Delgado), we worked with the HERMES logistics team to run a very preliminary model of national level distribution to the provincial level in order to find the most efficient way to use two new cold trucks the Ministry has recently purchased. Modeling is a tool that can help us each become “true logisticians.” This preliminary model was just enough to show that we still have much work to do before introducing new vaccines! Participants agreed that a full-scale modeling exercise of the entire vaccine supply chain would help in providing relevant information to make better management decisions.
- The preliminary results of a cold chain study also showed some concerning results of the cold chain—not at the health center level but during transportation. This study, led by WHO and CHAI, is still being finalized, but the presentation during the meeting showed the cold chain going out of the ideal range of 2 to 8 degrees Celsius during transportation, putting the vaccines at risk of losing potency. The study raised many more questions than provided answers, and now this is on the radar screen as another area for improvement in 2015.
- Having an open mind is easier said than done. It was interesting to see that many ideas and activities under discussion during the three-day meeting that strayed from the pre-determined government system and “the way it has always been” were the target of a lot of criticism and strong opinions. Despite the criticism, many people exuded the open mind, and it was heartening to see the provinces VillageReach supports were part of this group, vocally appreciative of system optimization activities that have been implemented with each of them.
The graphs shown at the meeting and the conversations in between presentations identified many areas to focus on in 2015. The EPI logistics working group is now taking these recommendations to move them forward to improve the vaccine supply chain.
About the Author: As Program Manager, Wendy Prosser is responsible for the design, implementation, and monitoring and evaluation of health system programs for VillageReach in Mozambique. Efforts in Mozambique seek to streamline vaccine logistics with an improved logistics management information system and transport services. Wendy has over a decade of global health experience in program development and management, research and analysis, capacity building, and behavior change communications. This experience has taken her to Mozambique, Malawi, Angola, Kenya, and South Africa in various public health settings, starting with Peace Corps in Cape Verde. Wendy holds a MPA in International Development and Global Health from the University of Washington.