4.5 RTM "soft start"

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After installation, a “soft start period” is recommended. It is a period where the system is in place but not fully activated, a period where ownership is progressively transferred to the local staff while the manufacturer and implementing partner/s still are fully available for support. It facilitates observation and fine-tuning before all the features of the system are introduced to the users. All early roll-outs highlighted this as a good practice.

This strategy has sometimes been pushed back due to the extra time it takes, i.e. increased cost, but it enables the users to have a much better understanding and ownership of the system and drastically improves sustainability. The extra cost should be considered in the perspective of the lifespan of the system. Furthermore a soft transitional start can greatly help with the review and eventually revision of the SOPs, thereby rendering them more effective. 



A thorough iterative review with stakeholders of the reporting and notifications system facilitates the fine-tuning of the system parameters.

RTM will bring visibility into the system, uncovering previously hidden issues that will need to be dealt with before moving forward and handing over. If these issues are not resolved before full activation of the alarms and hand-over, the health workers and EPI staff might be overwhelmed with the number of alarms. It is recommended to engage only a small group of users together with the implementation team for the resolution of these newly identified issues. 

The box below calls out for the need to consider the whole organisation of a system of responsibilities for the protection of the vaccines.


Focus should be on the system and not only on the devices, as it is important for the users to understand that RTM per se is not sufficient to protect the vaccines if alarms are not followed by corrective action. Even though the data gathering and reporting is automatized, RTM should not give users a false sense of security. Vaccines are not protected if alarms do not trigger appropriate corrective actions and these actions cannot be automatized. This factor cannot be highlighted enough.


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