Wellington Mkweza is a Cold Chain Technician (CCT) in Mangochi District, Malawi. He is responsible for all the vaccine refrigerators and remote temperature monitoring devices (RTMDs) across his district: over 80 equipment units in total across 39 health facilities. With multiple clinics to cover and limited resources for travel, it has never been easy to perform all the maintenance activities required to keep equipment across the district in working order.
Preventive maintenance for cold chain equipment (CCE) is critically important. Refrigerators designed to last 10 to 15 years can fail in under five years when specific parts (such as condenser coils or door seals/gaskets) are not routinely checked and maintained. So how can countries with only one CCT or Biomedical Engineer per district keep up?
Malawi’s Solution: Increase Preventive Maintenance Coverage through Supportive Supervision & Mentorship
Through the Rapid Response & Repair (R3) initiative, Nexleaf collaborated with the Malawi Ministry of Health and VillageReach to design CCE maintenance solutions built to last. Malawi’s Supportive Supervision & Mentorship approach leverages the skill and experience of seasoned CCTs to train additional health workers in basic troubleshooting and equipment maintenance. When immunization system staff and frontline health facility workers are empowered to care for equipment, preventive maintenance increases.
In Malawi, instituting R3 – particularly supportive supervision combined with WhatsApp peer support for frontline health workers – drove preventive maintenance coverage up from 12% to 85% of facilities.
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- before, during & after: a glimpse inside a vaccine refrigerator reveals the importance of preventive maintenance
Using Real-Time Data to Make Decisions & Protect Vaccines
Mkwenza is now regularly in touch with other health workers via WhatsApp, making sure all CCE in his district is working well and issues are resolved promptly. Furthermore, CCTs like Mkwenza are now using real-time data from RTMDs to monitor and maintain equipment across their districts. Malawi instituted bi-weekly RTM Data Review Meetings for immunization team members, and those check-ins are still going strong across 11 districts beyond the end of the R3 project period. R3 helps health workers get the most out of the data and technology available to them to do their jobs better. More health workers accessing more data ensures countries get the most out of their investments in refrigeration equipment, monitoring technologies, real-time alerts, and equipment data platforms too.
Expanding Preventive Maintenance Improved CCE Performance Across All R3 Countries
When it comes to expanding preventive maintenance, Malawi’s not alone. All three R3 countries decided to invest significant resources in increasing capabilities for frontline health workers. Rwanda trained nurses and health facility managers to troubleshoot and maintain vaccine refrigerators through its hybrid Learning & Enablement initiative. When Tanzania’s health facility staffers – nurses and immunization team staff – learned how to enter equipment data into the new MEIMIS CCE module, they also received training on preventive maintenance for refrigerators and RTMDs. Increased preventive maintenance activity correlated with improvements in CCE performance in every country.
Data doesn’t fix fridges. People do. Malawi saw its cold chain equipment performance improve by connecting health workers to the data, training, support, and resources they need to keep equipment functional and protect vaccines.