Friday, June 21, 2024

Send in the fridges: major infrastructure upgrade to Kenya’s vaccine cold chain rolls out

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Kenya’s immunisation system has received a vital upgrade: 2,061 pieces of new and improved cold chain equipment – valued at US$ 7.09 million (1.1 billion Kenyan shillings) – will shore up preventive health care across the country’s 47 counties.

“Due to its innovative technology, the Ministry is now able to monitor remotely how each of the newly-installed cost-effective CCE is functioning in all the health facilities countrywide and in case of any malfunction, remedial measures [are] promptly undertaken.”

Catherine Silali, biomedical engineer, Ministry of Health

An unbroken cold chain – picture a network of fridges and cold boxes, spread across the entire planet – ensures that vaccines travel from manufacturer to destination, never dipping below or rising above their precariously narrow ideal temperature band. That permits the vaccines to remain potent – in other words, to save lives.

At a March launch event in Nairobi, Kenya’s Cabinet Secretary for Health Susan Nakhumicha Wafula lauded the upgrade, noting that the equipment had been procured with a cold chain equipment optimisation programme (CCEOP) grant from Gavi. “Investing in a high-quality cold chain system ensures that the vaccines that reach our communities and children are effective upon administration and our children continue to be protected from vaccine preventable diseases,” she said.

Following the installation of the new kit in their respective health facilities, a cross-section of health workers sounded an upbeat note.

A nurse in Nairobi, Brigid Adhiambo, said, “The installation of this equipment is a not only a morale booster for us, but also a game-changer in enhancing the timely provision of immunisation services to our local communities… We therefore appeal to parents and caregivers to avail all their eligible children for immunisation.”

Health worker Ann Wanjiru was likewise full of optimism – no child now, or in the future, seeking immunisation services would be turned away from public health facilities for lack of the requisite cold chain equipment, she enthused.

Shaky links

A 2016 national inventory of Kenya’s cold chain had revealed shortcomings, Cabinet Secretary Nakhumicha explained. Approximately one in five health facilities in the country (18%) did not have any cold chain equipment. These relied on vaccine carriers and cold boxes as short-term stopgaps – “often leading to sub-optimal service delivery,” she said.

A 2016 audit showed that about one in five health facilities in Kenya didn’t have any cold chain equipment – “often leading to sub-optimal service delivery,” according to Cabinet Secretary for Health Susan Nakhumicha Wafula

“The audit further revealed that 81% of the facilities with some type of cold chain equipment did not meet performance, quality and safety (PQS) standards set for immunisation supply chain in Kenya (EVMA 2013)”.

This, Nakhumicha noted, was worrying data for a country that aspires to provide efficient, equitable, safe and effective high-quality immunisation services.

“In response to this, the Ministry worked on a joint investment initiative with Gavi to provide cold chain equipment to health facilities and sub-county depots in the 47 counties.”

According to UNICEF representative to Kenya Shaheen Nilofer, the first batch of 200 cold chain equipment (CCE) items in the current upgrade arrived in Kenya in December 2022, rolling out to health facilities in the first portion of 2023. April 2024 marked the finish line for the installation of the new gear.

Reaching more of the unreached

“We are confident that these investments will help increase vaccine equity in this country and help reach the unreached, zero-dose and under-immunised children in our communities,” said Susan Nakhumicha.

Despite efforts to boost vaccination rates, official UNICEF/WHO figures say that Kenya’s rate of coverage with the third dose of the diphtheria, pertussis and tetanus-containing vaccine – a conventional stand-in for vaccine coverage in general – hovers at 90%. Meantime, the Kenya Demographic Health Survey (KDHS 2022) found that only 80% of the children had been vaccinated with all antigens, while 3% had not received any vaccines.

“This translates to approximately 320,000 children younger than one year old in Kenya who are partially vaccinated every year,” said Nilofer. “Most of these children live among the most marginalised communities that face multiple deprivations.”

The Ministry’s acting Director-General, Dr Patrick Amoth, says out of the 1.5 million live births recorded in Kenya annually, between 30,000 to 45,000 children are estimated to qualify as totally unimmunised, so-called ‘unreached’, zero-dose children.

Expanding cold chain infrastructure will materially extend the health system’s reach. Nilofer explained that the new equipment will help expand immunisation services to 2,061 health facilities across the country, enabling more children, adolescent girls and women in the most marginalised, vulnerable and hard-to-reach communities achieve reliable access to immunisation.

“The offering of immunisation services will increase, due to the availability of high-quality, modern CCE up to the highest international standards, and with vaccines being brought closer to the community in a more reliable way.”

Nilofer observed: “Additionally, the CCE project has allowed the procurement as well of modern, upgraded and more efficient cold chain equipment remote automated temperature monitoring technologies in the immunisation supply chain system, and capacity-building of the country’s medical engineering technicians to instal and maintain the cold chain items with new technologies.”

Enter the cold chain technicians

Nilofer noted that Kenya was selected as one of three pilot countries in which the installation and commissioning of the cold chain equipment programme would be done by its own cold chain bio-medical engineers.

A biomedical engineer with the Ministry of Health, Catherine Silali, said some 410 technicians in both the national and the county governments in the 47 counties had so far received specialised training on the installation and maintenance of the cold chain equipment in their respective areas.

“The CCE arrived in three sizes: small vaccine refrigerators (less than 30 litres capacity); medium (between 30 to 60 litres) and large (above 60 to 90 litres). The small, medium and large refrigerators are been availed to dispensaries, level 1 to 3 and level 4 to 5 health facilities respectively, based on their population needs and power supply capacities,” Silali added.

Some of the new cold chain kit comprises solar-powered refrigerators, which will replace the existing, battery-powered ones, as well as obsolete household fridges in some health facilities that are not pre-qualified by the WHO as they lack the requisite temperature stability mechanism required for vaccine storage.

In Nairobi county, for example, Waithaka, Chandaria as well as Kibera community health facilities and Ngong Road dispensary located in informal settlements previously had a “shaky” cold chain system  that was more than ten years old, and kept malfunctioning.

“Following the recent installation of medium-sized refrigerators (through the CCE project), they now boast a functioning, well maintained system enabling health workers to provide seamless immunisation services,” Silali observes.

And, unlike the replaced, obsolete equipment, the CCE comes with innovative technology.

“Due to its innovative technology, the Ministry is now able to monitor remotely how each of the newly-installed cost-effective CCE is functioning in all the health facilities countrywide and in case of any malfunction, remedial measures [are] promptly undertaken,” Silali enthuses.

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