Peru:Peru: ColdCold ChainChain ManagementManagement ExperienceExperience 4th Annual Global Immunization Meeting 17 -19 February 2009 New York City Dr Fernando Perez PERUPERU Total estimated population 2008: 28,220,800 Source: National Institute of Statistics BriefBrief HistoricalHistorical OverviewOverview 1986 EPI launching 1990 – 2000: a decade of major EPI achievements: very high coverage rates 2001 – 2004: • EPI deactivation affecting technical and managerial sub -sectors. • Limited budget for immunization, with prioritization on vaccine procurement. • No budget available for maintenance, neither to equipment renewal. • Serious gap in monitoring and supervision of immunization activities. • Human resources gap: no training, no updating BriefBrief HistoricalHistorical OverviewOverview 2004:2004: ItIt becomesbecomes evidentevident thethe needneed ofof immunizationimmunization revivalrevival asas aa programme:programme: prioritypriority toto thethe introductionintroduction ofof newnew vaccinesvaccines andand upgradingupgrading ofof coldcold chainchain accordingaccording toto globalglobal standardsstandards toto ensureensure thethe quality/potencyquality/potency ofof vaccinesvaccines NATIONALNATIONAL PLANPLAN review:review: • Cold Chain Inventory – top priority • Design of data collection and monitoring tools • Appropriate temperature monitoring of vaccines to address the risk of freezing in the cold chain • Implementation of a national monitoring system ColdCold ChainChain InventoryInventory inin PerPer úú -- 20042004 History: Previous cold chain inventories • First: 1989 • Second: 1993 -94 Third national cold chain inventory in Perú is conducted within the context of a renewed policy, budget and managerial MoH framework, which included a new national vaccine law Immunization is officially defined as a cost-effective activity of high impact in public health A new national immunization strategy is established: EPI recovers its status as a critical public health programme Technical and financial support from international cooperation ResultsResults andand lessonslessons learnedlearned To procure new complementary cold chain equipment a. 18,761 vaccine carriers b. 449 cold boxes c. 200,000 ice packs d, 25,000 thermometers Decentralization and vaccine security: addressing the need of regional cold rooms Normative Managerial Research and analysis Monitoring and control ColdCold ChainChain PolicyPolicy ImprovementsImprovements • Ministerial Resolution endorsing new cold chain technical guidelines, including criteria for cold chain equipment selection • Commitment of Ministry of Economy and Finance in its implementation within the framework of decentralization ResultsResults andand AchievementsAchievements StrengtheningStrengthening ofof thethe vaccinevaccine storagestorage capacitycapacity Central store Four new macro -regional stores Central store LIMA DISAS Lima y Callao, Ica , Ucayali, San Mart ín, Loreto 1. - Macro -regional store AREQUIPA Arequipa, Moquegua, Tacna, Puno 2. - Macro -regional store CUSCO Cusco, Apurimac (Andahuaylas, Abancay), Madre de Dios 3. - Macro -regional store LAMBAYEQUE Lambayeque, La Libertad, Piura, Tumbes, Cajamarca, Amazonas. 4. - Macro -regional store JUNIN Jun ín, Pasco, Huancavelica, Ayacucho, Huanuco Final decision: expansion to 52 cold rooms according to current decentralization management of health system 1. Amazonas - Chachapoyas 20. Lima Almac én Central 2. Amazonas Bagua 21. Lima Ciudad 3. Ancash la Caleta 22. Lima Este 4. Ancash 23. Lima Provincia 5. Apurimac - Abancay 24. Lima Sur 6. Apurimac - Andahuaylas 25. Callao 7. Arequipa 26. Loreto 8. Ayacucho 27. Lor eto - Yurimaguas 9. Cajamarca 28. Madre de Dios 10. Cajamarca - Cutervo 29. Moquegua 11. Cajamarca - Chota 30. Pasco 12. Cajamarca - Jaen 31. Pasco Oxapampa 13. Cusco 32. Piura 14. Huancavelica 33. Piura - Sullana 15. Huanuco 34. Puno 16. Ica 35. San Mart ín 17. Jun ín 36. Tacna 18. La Libertad 37. Tumbes 19. Lambayeque 38. Ucayali EJ: Vaccine cold store GERESA Arequipa ColdCold chainchain improvementsimprovements NewNew datadata managementmanagement tooltool • Data consolidation and analysis with software which provides detailed information for cold chain equipment planning and management ColdCold ChainChain AchievementsAchievements Procurement of cold chain equipment with national budget (national budget line) Investment 2007 $ 6,600,000 2008 $ 4,200,000 2,590 newnew piecespieces ofof equipmentequipment procured,procured, ~~ 46% ofof totaltotal nationalnational requirementsrequirements AcquiredAcquired coldcold chainchain equipment:equipment: ~~ US$US$ 6,500,0006,500,000 Procured Quantity • Cold rooms 52 • Refrigerators (electric) 1,112 • Freezers 1,163 • Refrigerators (Gas) 372 • Refrigerators (Solar) 153 • Cold Boxes 1,505 • Vaccine Carriers 4,096 • Thermometers 7,159 • Cold packs 19,104 DetectedDetected weaknessesweaknesses TemperatureTemperature monitoringmonitoring toto assessassess freezingfreezing inin thethe coldcold chainchain conductedconducted inin MayMay --AugustAugust 2008:2008: • Inadequate preparation of cold packs. • Lack of training for existing human resources • Lack of human resources • Lack of local supervision National Implementation of MajorMajor achievementsachievements recommendations to prevent freezing in the cold chain National Implementation of Cold Chain Failure Management VaccineVaccine distributiondistribution monitoringmonitoring -- 20092009 • Monitoring of vaccine distribution using temperature data logger s. TK-4014 Tinitag Talg 2 Medical, temp (-40°to 85°C) 5,000 CAB_0005- USB Tinytag Transit/Tinytalk PC download cable (USB) 80 SWCD_00600 Tinytag Shuttle sofware 80 Tinitag explorer Software (Win98 2nd Ed, W2000 or SWCD-0040 XP) 40 IntroductionIntroduction ofof newnew vaccinesvaccines inin PeruPeru • Pneumococcal • Influenza • Rotavirus National Immunization Schedule - ESNI MINSA - PERU 2009 2 3 4 5 6 7 8 15 18 4 MEF Mayores Persona Recien 1 VACUNA mes mese mese mes mes mese mes mese mese año Gestant de 60 l de Población nacido año es s s es es s es s s s es años Salud en riesgo BCG HvB APO PENTAVALENTE NEUMOCOCO INFLUENZA ROTAVIRUS SRP AMA DPT o (DaPT+Hib) DPT o (DaPT) dT IPV Población en riesgo [email protected]@minsa.gob.pe GRACIASGRACIAS.