After the decision to deploy/upgrade systematic temperature monitoring and integrate it into the programme policies and objectives, experience from early deployments shows that the following points should be addressed as early as possible in order to avoid bottlenecks.
Budget
- Make sure budget is not under-estimated and addresses both one-off and recurrent costs.
- Seek alternative funding sources that could be available for innovative temperature monitoring projects by involving partners not only at local level but also at international level as it can help identify supplementary funds that the country might not be aware of (for example the new Unicef Innovation Fund at www.unicefinnovationfund.org).
- It should be flexible with built-in contingency. Release and disbursement of funds should not be based on too many conditions and ideally should be automated when a budget line is created.
Definition of Human Resources needs and clear role mapping
- An objective assessment of current HR capacities could lead to changes in the staffing as different skills could be necessary to carry out the deployment of an effective temperature monitoring system.
- All involved should be well aware of their responsibilities in the process (backup persons and escalation tree defined and documented) and job descriptions should be reviewed.
High-level roadmap, resource & time-planning: (Gantt)
- Build in contingency
- Review frequently (delays in the delivery process, printing of material are almost the norm).
- Unpredictable costs may need to be added and if the funds release process is too cumbersome, this can delay the whole project, even for small budget deviations.
Documentation and communication plan
- Training material and forms should be ready and dispatched on time, and in sufficient quantity.
- They should be standardized. Lack of standardized forms can confuse staff unnecessarily. For example, if they are trained on one type of temperature monitoring chart and another type is still circulating.
- Archiving/backing-up conventions should be discussed, decided upon and shared. They should be realistic, based on the local context and resources.
Up-front training on how to manage the system
- Training should not be pressed into a 2-hour multiple-training session.
- It requires time and resources and should be organized, repeated and should include verification that skills are acquired.
- It should not only deal with technical issues but also with structural issues.
Procurement, deployment & installation plan
- Procurement can be delayed so contingency should be built in.
- For 30DTR, select the best deployment strategy for the country, nationwide versus pilot. Smaller pilot would probably be easier to manage and learn lessons from, before starting nation-wide deployment. Phasing allows for some reuse of resources, in particular for training and management of the deployment project. On the other end, economies of scale for bulk procurement and/or installation can reduce the price for each single device.
- For installation of RTM products, certified technicians who speak the local language might need to be booked a long time in advance.
SOP Breakdown
The devil is in the detail but Standard Operating Procedures (SOP) as policy documents for the programme should be differentiated from the reference documents for instructions at site level. For site level it should not be long complicated documents (nobody is going to read them or use them).
- Splitting them into many one-pagers and user-friendly pictograms will improve their usefulness.
- They should be live documents. SOPs should be reviewed, verified and if necessary adjusted during the implementation period.
Not only SOPs directly related to temperature monitoring need to be reviewed and revised but all workflows and SOPs related to the vaccine supply chain, including the following processes:
- Vaccine stock replenishment (over-stocking is a threat to proper management of the cold chain)
- Outreach/campaigns (unmanaged return of vaccine stock can "mess up" stock levels)
- Discarding of vaccines and equipment (broken equipment can fill up the space)
- Inventory update process and repairs system
- Staff leave system (informing of up-coming leave and designating a back-up person)
More information and material can be found in the related resources below.
Related resources
| Title | Author | Year | Type | Language |
|---|---|---|---|---|
| 30DTR guide | Guidance | English | ||
| Flow chart RTM and equipment management | UNICEF | Poster/infographic | English | |
| Lao roles mapped against activities | Tool | English | ||
| Programmatic and financial benefits of establishing an effective temperature monitoring system in the vaccines supply chain - case study in Cameroon | UNICEF | 2020 | Guidance | English |
| SOP nurses Mozambique | Presentation | English | ||
| The cost-effectiveness of implementing an effective continuous temperature monitoring system in the vaccine supply chain - Executive summary | UNICEF | 2020 | Guidance | English |
This document shows in a flow chart an example of the processes and communications in a Temperature monitoring system.
This document is an example from the CCIS project in Laos of a table to define and map roles and responsibilities within Temperature Monitoring.
Link: http://www.technet-21.org/library/2469-lao-roles-mapped-against-activities
This document is a guidance issued by UNICEF for the implementation of systematic temperature monitoring systems using 30DTR at Static Delivery Points (Health facilities)
Guidance issued by UNICEF presenting a few step-by-step guidelines for partners intending to implement RTM solutions.
This document issued by WHO/EVM provides models of Standard Operating Procedures to cover all aspects of Effective Vaccine Management
This sample Jobaid from from the ColdTrace pilot in Mozambique is a one-page poster on the routine maintenance of refrigerators and corrective measures in case of temperature excursions.
Link: http://www.technet-21.org/library/2489-sop-nurses-mozambique
Those one-pagers have been specially developed by PATH to allow in-country cold chain technicians to get at a glance a summary of key maintenance tasks across the various types of cold chain equipment they are handling.
Link: http://www.technet-21.org/library/2241-how-to-care-for-your-vaccine-refrigerator