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No. BASIC DESIGN STUDY REPORT ON THE PROJECT FOR THE IMPROVEMENT OF EXPANDED PROGRAM ON IMMUNIZATION (PHASE II) IN THE REPUBLIC OF ZAMBIA JULY 2006 JAPAN INTERNATIONAL COOPERATION AGENCY GM J R 06-153 1 Preface In response to a request from the Government of the Republic of Zambia, the Government of Japan decided to conduct the Basic Design Study on the Project for the Improvement of Expanded Program on Immunization (Phase II) in the Republic of Zambia and entrusted the study to the Japan International Cooperation Agency (JICA). JICA sent to the Republic of Zambia the Study Team from March 12 to 31, 2006. The Team held discussions with the officials concerned of the Government of the Republic of Zambia, and conducted a field study at the study area. After the team returned to Japan, further studies were made and the present report has been finalized. I hope that this report will contribute to the promotion of the Project and to the enhancement of friendly relations between our two countries. I wish to express my sincere appreciation to the officials concerned of the Government of the Republic of Zambia for their close cooperation extended to the team. July 2006 Masafumi KUROKI Vice-President Japan International Cooperation Agency ① Chiliabombwe ② Chingola ③ Mufulira ④ Kalulushi ⑤ Kitwe ⑥ Ndola ⑦ Luansha Chiengi Kaputa Mpulungu Mbala Nchelenge Nakonde Mporokoso Kawambwa Mungwi Isoka Mwense Luwingu Kasama Chinsali Chilubi Chama LUAPURA NORTHERN Mansa Samfya Mwinilunga Chililabombwe Milenge ① Chingola Mpika Solwezi ② ③ Mufulira Lundazi Lufwanya ④ NORTH-WESTERN ⑤ Kalulushi COPPERBELT⑦ ⑥ EASTERN Chavuma Kitwe Serenje Mambwe Kabompo Makaiti Kasempa Zambezi Mpong Luanshya Mufumbwe Chipata CENTRAL Petauke Mkushi Katete Chadiza Lukulu Kabwe Nyimba Kaoma Mumbwa Chibombo Chongwe Kalabo Mongu Lusaka LUSAKA Luangwa WESTERN Itezi-Tezhi Kafue Namwala Mazabuka Monze Siavonga Senanga 0 50 100 150 ｋｍ Shangombo SOUTHERN Gwembe Sesheke Choma Kazungula Kalomo 0 50 100 150 Sinazongwe Livingstone Map of Zambia Abbreviation AIDS Acquired Immunodeficiency Syndrome ADS Auto-Disable Syringe Syringe for immunization (special specification) BCG Bacille Calmette-Guerin Vaccine Vaccine for prevention of Tuberculosis Old name of Department for EPI in Government of CBoH Central Board of Health Zambia(dissected at March 2006) CFC Chlorofluorocarbon Commonly called: Freon Gas Development Assistance and DAC 23 developed countries( USA, UK, Japan,…) Committee DANIDA Danish International Development Agency DHMT District Health Management Team District Health office is calling DHMT DPT Diphtheria + Pertussis + Tetanus 3 kind mixtures vaccine Expanded Programme on EPI Name of Activities of immunization Immunization Hep. B Hepatitis B Vaccine GAVI Global Alliance for Vaccine A name of Donor GNI Gross National Income Economic incidence Hib Haemophilus influenzae B Name of a vaccine HIV Human Immuno-deficiancy Virus Symptom; AIDS IPV Inactivated polio vaccine For injection LDC Least Developed Country Measles Measles Vaccine MSL Medial Stores Limited Semi-private store company for medical goods NID National Immunization Day Program for National immunization OPV Oral Polio Vaccine Syrup type vaccine PHO Provincial Health Office PIS Product Information Sheets Examined and inspected by WHO, UNICE TT Tetanus Toxicoid Vaccine UCI Universal Childhood Immunization Old program name before EPI UNICEF The United Nations Children's Fund USAID United States Agency for International Development WHO World Health Organization ZAMSIF Zambia Social Investment Fund Preface Location Maps Abbreviations Contents Chapter 1 Background of the Project----------------------------------------------------------1 Chapter 2 Contents of the Project --------------------------------------------------------------2 2-1 Basic Concept of the Project --------------------------------------------------------2 2-2 Basic Design of the Requested Japanese Assistance --------------------------3 2-2-1 Design Policy-------------------------------------------------------------------------3 2-2-2 Basic Plan ----------------------------------------------------------------------------5 2-2-3 Basic Design Drawing -------------------------------------------------------------7 2-2-4 Implementation Policy ------------------------------------------------------------8 2-2-4-1 Implementation Policy -------------------------------------------------------8 2-2-4-2 Implementation Conditions-------------------------------------------------9 2-2-4-3 Scope of the Works ------------------------------------------------------------9 2-2-4-4 Consultant Supervision ------------------------------------------------------9 2-2-4-5 Procurement Plan--------------------------------------------------------------10 2-2-4-6 Quality Control Plan----------------------------------------------------------12 2-2-4-7 Implementation Schedule ---------------------------------------------------13 2-3 Obligations of Recipient Country -------------------------------------------------13 2-4 Project Operation Plan ---------------------------------------------------------------13 Chapter 3 Project Evaluation and Recommendations------------------------------------15 3-1 Project Effect----------------------------------------------------------------------------15 3-2 Recommendations---------------------------------------------------------------------15 〔Appendices〕 1. Member List of the Study Team 2. Study Schedule 3. List of Parties Concerned in the Recipient Country 4. Minutes of Discussions 5. Cold Chain Delivery List Chapter 1 Background of the Project A majority of cold chain equipment in the Republic of Zambia (hereinafter referred to as “Zambia”) were provided by assistance extended around 1985 by UNICEF and other international organizations. In 1997, DANIDA, WHO and UNICEF conducted surveys and reported that many pieces of the cold chain equipment were now decrepit and it was difficult to store vaccines at an appropriate temperature. Although Zambia drew up a national plan to replace them with new equipment by 2003, they were unable to update the equipment with new one by itself due to budget restraints, requesting the assistance from the Government of Japan. Accordingly in 2002, a number of cold chain equipment were replaced with support from Japan (a total 607 units of refrigerator: 245 units of electrical refrigerator, 266 units of kerosene refrigerator, and 96 units of solar refrigerator; and others), while some refrigerators which were decrepit but still in use were excluded from the priority list of refrigerator to be supplied. Since then, some refrigerators were additionally updated with support from, for example, UNICEF (105 units of kerosene refrigerator in 2002-04) and ZAMSIF (41 units of solar refrigerators for 4 districts of the Eastern Province; 2 districts of the Lusaka Province; 4 districts of the Western Province; 4 districts of the Northern Province; 2 districts of the Luapula Province; and 1 district of the North-Western Province). Even so, due to the financial difficulty of Zambia, the rest of decrepit refrigerators have not been updated, and as of March 2006, about half of the currently used 1,284 units of refrigerators for the storage of vaccines in health facilities across the country (1,335 hospitals, Health Centers and other facilities, other than Provincial Health Office (PHO) and District Health Management Teams; DHMT) are still old and in bad condition. On top of that, there are 51 facilities, where refrigerators for vaccines have been disposed because they were no longer repairable, or which are not equipped with refrigerators after its recent construction. In some cases, decrepit equipment is no longer repairable, and in the other, home-use refrigerators which are inappropriate to store vaccines are substituted, and old refrigerators are still in use through repair. On the other hand, refrigerators currently in use have been used for more than 10 years: some are old models using Chroro-fluorocarbon (CFC) refrigerant or models which are no longer manufactured, so it is difficult to purchase the spare parts. For this reason too, replacement of equipment is urgently needed. At the same time, almost all DHMT is in short of trucks and motorbikes, essential means of transportation for the delivery and distribution of vaccines, and monitoring and various other activities, and need to be provided with such vehicles. Despite such circumstances, the budget (for 2003) per head earmarked for the improvement of health-related infrastructures and equipment in Zambia is 1 US$, of which the budget for the improvement and replacement of cold chain equipment accounts for a mere 4.5 percent: it is impossible to secure necessary funds to replacement cold chain equipment from the Zambian budget for health matters. In line with this, the Government of the Republic of Zambia has requested for a Japan’s Grant Aid (2nd phase) for the improvement of cold chain equipment (including motorbikes, etc.) which is necessary for expanded programme on immunization (EPI) activities. 1 The requested equipment is: 221 electric refrigerators; 126 electric/ kerosene refrigerators; 30 gas/ electric refrigerators; 226 solar refrigerators; 18 electric refrigerators for vaccines and icepacks; 72 voltage regulators; 19,200 icepacks; and 42 motorbikes. Chapter 2 Contents of the Project 2-1 Basic Concept of the Project Drawing up a “Zambia National Cold Chain Five-Year Rehabilitation Plan,” the Republic of Zambia has aimed to replace its decrepit, outdated freezers
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