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MANIPUR Fact Sheet Immunization Cold Chain and Vaccine Logistics Network

1 State Vaccine 1 Store

District Vaccine The cold chain system 11 Stores in Manipur consists of 210 working cold chain equipment.

96 Cold Ice-Lined Chain Refrigerators 102 Points

102 Deep Freezers

2,189 12 Session Sites Solar Equipment

Sources of data: ॰॰Live data from Electronic Vaccine Intelligence Network (eVIN), as accessed in July 2017. ॰॰eVIN Preparatory Assessment Study, conducted by UNDP in year 2016, with updates provided by the state in 2017. 2 MANIPURMANIPUR The Universal Immunization Programme in Manipur aims to immunize a target population of 48.8 thousand children and 54.3 thousand pregnant women, every year.

The Electronic Vaccine

Intelligence Network (eVIN) Vaccine12 Cold102 Store Chain has been implemented across Keepers Handlers all the vaccine stores and The human resource network cold chain points in Manipur. to manage vaccine logistics in eVIN has facilitated capacity- Manipur consists of 12 vaccine store keepers and 102 cold chain building of all vaccine store handlers. They work under the keepers and cold chain guidance of the State Nodal handlers in the state through Officer-Immunization, State seven batches of training Cold Chain Officer, District Immunization Officers/District programmes on eVIN, during Family Welfare Officers and the last two quarters of 2016. Medical Officers in-Charge. eVIN equipped them with standardised stock registers and smartphones to digitise the vaccine stocks. The entire vaccine logistics data in Manipur is now digitised and real-time data is available for informed decision-making.

3 A Vaccine Supply Network

The state vaccine store, located at West, receives vaccine stocks from GMSD Kolkata and caters to the state, through 11 district vaccine stores. Nine of these DVSs are located at district headquarters and two are located at the sub-district level. These DVSs supply vaccines to 102 cold chain points located at medical colleges, district hospitals, community health centres, primary health centres and a health sub-centre. The CCPs provide vaccines to all 2,189 session sites. Dry Stocks The dry stocks of auto-disabled syringes of 0.1ml, and 0.5ml and disposable reconstitution syringes of 5ml, are supplied by the manufactures. The ’Family Welfare Store’ that shares premises with the SVS supplies dry stocks to 11 DVSs that further supply the same to the CCPs. Cold Chain Points ●● On an average, there are 9 CCPs per district in Manipur. However, there is a wide variation in this number; ranging from district Chandel with only 4 CCPs to district with 19 CCPs. ●● All CCPs cater to a population of less than 1 lakh. Session Sites ●● The state provides vaccination through 2,189 session sites. Highest number of session sites (301) are in district Imphal East. ●● On an average, 21 session sites are catered by one CCP. ●● There is a wide variation in the number of session sites catered by a CCP, ranging from one CCP with only 3 session sites (PHC Punanamei of district Senapati) to another CCP catering to 62 session sites (PHC Machi of district ). ●● There is also wide variation in the distance of session sites from the respective CCPs, ranging from a distance of 1 km for Lamding Lampal Leikai session site under PHC Wangjing Lamding in district Thoubal, to a distance of 120 km distance for Khengjoi session site under PHC Moreh and 130 km for Wajang session site under CHC in district Chandel.

B Vaccine Delivery Mechanism

●● Over 85 per cent of vaccines, from CCPs to session sites, are delivered by ANM or other health staff. The remaining 9 per cent of vaccine stocks are delivered by AVD and 4 per cent by vaccine vans. ●● Functional vaccine vans are available at all nine districts and two sub districts; eight districts have part-time drivers utilised from the offices of the district immunization officer, DFWO or others for vaccine delivery from the DVS to CCPs. Three districts, namely Bishnupur, Moreh and Chandel have functional vaccine vans but no driver is available for vaccine delivery. ●● All DVSs collect vaccines from the SVS; and the process of SVS sending vaccines to DVSs is yet to be initiated. ●● All DVSs distribute vaccines to CCPs through push mechanism except Imphal East, Tamenglong, Imphal West and Kangpokpi where push mechanism of vaccine is yet to be initiated. All DVSs issue vaccines as per the availability of stocks. The frequency of issuing vaccine is not standardised among DVSs and could vary from weekly or monthly to occasionally.

4 C Cold Chain Equipment

The immunization cold chain network of Manipur runs on 210 working cold chain equipment installed across 114 vaccine stores and cold chain points. There are two walk-in coolers in the state. However, one WIC has been non-functional for the last six months and the other one has not been commissioned yet as the building where it is situated was severely affected by earthquake. Manipur has 96 ice-lined refrigerators, 102 deep freezers and 12 solar equipment. Table 1: Working Cold Chain Equipment in Manipur

Type of Equipment Type of Store Solar WIF WIC ILR DF Equipment 210 Total - - 96 102 12 SVS - - 7 3 - DVS - - 13 15 - CCP - - 79 85

Moreover, there are 5 cold chain equipment on stand-by and 62 cold chain equipment under repair. Additionally, around 40 ILRs and 40 DFs are under the process of procurement by the Government of for strengthening the cold chain infrastructure in Manipur.

Non-electrical cold chain equipment

The state has 75 functional large cold boxes and 98 functional small cold boxes which are currently in use for the transportation of vaccines from stores to CCPs.

Stabiliser ●● Around 78 per cent of the ILRs and DFs are attached with a functional stabiliser and nearly half of these stabilisers are dedicated to the equipment.

●● 90 per cent of the ILRs and DFs are attached with a functional thermometer.

D Human Resource

●● Manipur has 12 vaccine store keepers and 102 CCHs and none of the cold chain points have vacant positions for CCH. ●● There is no dedicated position of cold chain handler in the state and it is an assigned responsibility. In Manipur, around 45 per cent CCHs are male health supervisors and another 50 per cent are ANMs, female health supervisors, GNM or staff nurse.

●● Nearly 25 per cent CCHs are qualified upto 10th standard, 50 per cent are qualified upto 12th standard and the remaining hold diploma or graduation degree.

●● Over 80 per cent CCHs have received the training for cold chain handlers, and majority of them have received it within a year.

●● 100 per cent CCHs have received the eVIN training.

5 Figure 1: Immunization Cold Chain Network in Manipur

Bishnupur DVS 9 CCPs 214 SSs

Chandel DVS 4 CCPs 151 SSs

Chandel (Moreh) 3 CCPs 91 SSs DVS

Churachandpur DVS 8 CCPs 254 SSs

Imphal East DVS 12 CCPs 301 SSs

Imphal 263 SSs West SVS Imphal West DVS 13 CCPs

Senapati DVS 9 CCPs 121 SSs

Senapati (Kangpokpi) 7 CCPs 107 SSs DVS

Tamenglong DVS 8 CCPs 253 SSs

Thoubal DVS 19 CCPs 207 SSs

Ukhrul DVS 10 CCPs 227 SSs

6 Figure 2: Map of Immunization Cold Chain Network in Manipur

0 15 30 60 Kilometers

0# 6

0# 0#

0# 9

7 Imphal W0#0#EST ^5 4 4 0# 0# 8 0#

1

0# 3 0# 2

Code District 1 Bishnupur 2 Chandel 3 Churachandpur 4 Imphal East Legend 5 Imphal West 6 Senapati ^ State Vaccine Store 7 Tamenglong 0# 8 Vaccine Store 9 Cold Chain Points

7 Table 2: District-Wise Availability of Cold Chain Equipment in Manipur 5 4 6 2 1 7 9 1 4 5 58 14 CCE Under Repair 3 0 2 5 By Stand- CCE on 5 8 19 38 17 13 20 38 24 13 19 214 Total 1 1 4 1 1 1 2 1 12 Solar 8 6 5 9 4 1 1 9 85 DF 18 13 11 8 5 6 8 9 4 1 2 7 79 ILR 17 12 176 CCP 0 WIC 0 WIF 0 Solar 1 1 1 1 1 2 2 2 1 2 1 15 DF 1 1 1 1 2 1 1 2 1 1 1 13 28 ILR DVS 0 WIC Working Cold Chain Equipment Working 0 WIF 0 Solar 3 3 DF 7 7 10 ILR SVS 0 WIC 0 WIF Total (Moreh) Thoubal Chandel Chandel Senapati Senapati Bishnupur Imphal East (Kangpokpi) Imphal West Tamenglong Churachandpur

8 Table 3: List of Vaccine Storage Points in Manipur

Name of Vaccine Name of Vaccine Sr. No. District Sr. No. District Storage Point Storage Point 1 Imphal West Manipur SVS 46 Imphal East Sawombung PHC 2 Bishnupur Bishnupur DVS 47 Imphal East Yaingangpokpi PHC 3 Chandel Chandel DVS 48 Imphal East Yambem PHC 4 Chandel Moreh DVS 49 Imphal West Immunization cell DFW 5 Churachandpur Churachandpur DVS 50 Imphal West Kakwa PHC 6 Imphal East Imphal East DVS 51 Imphal West Khumbong PHC 7 Imphal West Imphal West DVS 52 Imphal West Khurkhul PHC Senapati 53 Imphal West PHC 8 Kangpokpi DVS (Kangpokpi) 54 Imphal West Mekola PHC 9 Senapati Senapati DVS 55 Imphal West Phayeng PHC 10 Tamenglong Tamenglong DVS 56 Imphal West RIMS Medical college 11 Thoubal Thoubal DVS 57 Imphal West Samurou PHC 12 Ukhrul Ukhrul DVS 58 Imphal West Sekmai CHC 13 Bishnupur Bishnupur DH 59 Imphal West Sekmaijing PHC 14 Bishnupur Kumbi PHC 60 Imphal West Singjamei UHC 15 Bishnupur Laimapokpam PHC 61 Imphal West Wangoi CHC 16 Bishnupur CHC 62 Senapati Laii PHC 17 Bishnupur Moirang RFWC 63 Senapati Mao CHC 18 Bishnupur CHC 64 Senapati Maram PHC 19 Bishnupur PHC 65 Senapati Oinam PHC 20 Bishnupur Oinam PHC 66 Senapati Paomata PHC 21 Bishnupur Thanga PHC 67 Senapati Phaibung PHC 22 Chandel Chakpikarong CHC 68 Senapati Punanamei PHSC 23 Chandel Chandel DH 69 Senapati Senapati DH 24 Chandel Komlathabi PHC 70 Senapati Tadubi PHC 25 Chandel Machi PHC 71 Senapati (Kangpokpi) Gamphazol PHC 26 Chandel (Moreh) Moreh PHC 72 Senapati (Kangpokpi) KalapaharPHC 27 Chandel (Moreh) Moreh SDH 73 Senapati (Kangpokpi) Kangpokpi CHC 28 Chandel (Moreh) Tengnoupal PHC 74 Senapati (Kangpokpi) Maphaou PHC 29 Churachandpur PHC 75 Senapati (Kangpokpi) Motbung PHC 30 Churachandpur Churachandpur DH 76 Senapati (Kangpokpi) Saikul PHC 31 Churachandpur Parbung CHC 77 Senapati (Kangpokpi) Twaichong PHC 32 Churachandpur Sagang PHC 78 Tamenglong Haochong PHC 33 Churachandpur Saikot PHC 79 Tamenglong Khoupum PHC 34 Churachandpur PHC 80 Tamenglong Noney PHC 35 Churachandpur Sinzawal PHC 81 Tamenglong Nungba CHC 36 Churachandpur Thanlon PHC 82 Tamenglong Oinamlong PHC 37 Imphal East Akampat PHC 83 Tamenglong Tamei PHC 38 Imphal East Andro PHC 84 Tamenglong Tamenglong DH 39 Imphal East Bashikhong PHC 85 Tamenglong Tousem PHC 40 Imphal East Heingang PHC 86 Thoubal Charangpat PHC 41 Imphal East CHC 87 Thoubal Haoreibi CHC 42 Imphal East Jnims hospital MC 88 Thoubal Heirok CHC 43 Imphal East Keirao Makting PHC 89 Thoubal Hiyanglam PHC 44 Imphal East Lamlai PHC 90 Thoubal CHC 45 Imphal East Sagolmang CHC

9 Name of Vaccine Name of Vaccine Sr. No. District Storage Point Sr. No. District Storage Point 91 Thoubal Kakching Khunou PHC 103 Thoubal Wangoo Laipham PHC 92 Thoubal Khoirom PHC 104 Thoubal Yairipok CHC 93 Thoubal Khongjom PHC 105 Ukhrul PHC 94 Thoubal Leishangthem PHC 106 Ukhrul PHC 95 Thoubal Lilong PHC 107 Ukhrul Kamjong CHC 96 Thoubal Nongpok Sekmai PHC 108 Ukhrul Kasom khullen PHC 97 Thoubal Pallel PHC 109 Ukhrul Khullen PHC 98 Thoubal Serou PHC 110 Ukhrul Lambui PHC 99 Thoubal Sugnu CHC 111 Ukhrul PHC 100 Thoubal Thoubal DH 112 Ukhrul PHC 101 Thoubal Thoubal RFWC 113 Ukhrul Tolloi PHC 102 Thoubal Wangjing Lamding PHC 114 Ukhrul Ukhrul DH

List of Abbreviations AVD Alternate Vaccine Delivery MCH Medical College Hospital ANM Auxiliary Nurse and Midwife PHC Primary Health Centre CCE Cold Chain Equipment RFWC Rural Family Welfare Centre CCH Cold Chain Handler SE Solar Equipment CCP Cold Chain Point SS Session Sites CHC Community Health Centre SVS State Vaccine Store DF Deep Freezer UHC Urban Health Centre DH District Hospital UNDP United Nations Development Programme DVS District Vaccine Store WIC Walk-in Cooler eVIN Electronic Vaccine Intelligence Network WIF Walk-in Freezer ILR Ice-Lined Refrigerator

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Manipur - Factsheet, Immunization Cold Chain and Vaccine Logistics Network, 2017. Prepared and printed by the United Nations Development Programme for the Ministry of Health and Family Welfare, Government of India. 12